Economics of Health with Reference to Health Facilities Available

in Vidarbha
Dr. R. Y. Mahore
Former Professor and Head,
Department of Economics,
Rashtrasant Tukadoji Maharaj Nagpur
University, Nagpur - 440033
Dr. Samit L. Mahore
Assistant Professor,
Department of Economics,
Rashtrasant Tukadoji Maharaj Nagpur
University, Nagpur - 440033

There are two words in health economics i.e. Health and Economics. World health organisation
has defined health as under, Health as a state of complete physical, mental and social wellbeing
and not merely absence of disease or infirmity.

Health is defined in two ways positive and negative. Positive definition of health focuses on
the aspect of life that produces health, fitness and well-being. According to WHO (Callahan,
1973) ‘health is a State of complete physical, mental and social well-being and not merely the
absence of disease or infirmity. Negative model define health is absence of an illness and
disease. An individual believes they have a good state of health when there is nothing wrong
with them it means no physical illness, disease, injury, mental stress, free from pain and
discomfort (Tampere, 2015). Now a day health has become more significant. It is one of the
important determinants of human development index. There is a disparity in health facility
between various states of the country.

In recent years health is becoming more valuable and diseases becoming more expensive. It
means that the expenditure on medicine and treatment is increasing. By the combination of
health and economics we can define health economics.

“Health economics is an application of economic theory, models and empirical technique to

the analysis of decision making by individuals, health care providers, and governments with
respect to health and healthcare” Morris, Devlin Parkin and Spencer (Morris, 2012).

When we spend on health care, we have to consider some important points.

1. To what extent life and health is useful for economic analysis?

2. The objective of social policy is to improve the general health of public.
3. Whether efficiency is more important than equity principle?
4. Health economics on one side studies the objectives of health and on the other side it
studies the achievement on the basis of financial provision.

The determinants of health are diet, environment, exercise, nature of work, place of work,
methods or treatment of diseases, education, economic condition, social systems etc. it is
said that unhealthy persons cannot enjoy the benefits of healthy and happy life.

1
Demand for health

The patients demand various types of health services. The demand for health is similar to the
demand for other goods. The consumers spend for the consumption of health services. Health
is a stock concept. Health is also one of the types of capital. We get direct satisfaction from it.
When we treat health as a capital we get various types of indirect benefits. The investment on
health is more expensive. When marginal expenditure on health is equal to marginal revenue
is a condition of optimum investment. There are various methods in treatment of diseases.

Supply of Health

The supply of health care depends upon scale of production. In multi- speciality hospital
various facilities are available. On the other hand some hospitals provide limited health
services. If health services are provided by more institutions the profit of the institution fall.
In the market there are two types of institutions providing health services i.e. private and public.
The private institutions charge more fees for their services. The public or government hospitals
provide fee medical services to poor people and for others they charge nominal fees.

Market Equilibrium

Market equilibrium depend upon demand for and supply of health services. The consumers
demand health services and health services are supplied by the institutions, doctors and nurses.
They are service providers. The consumers expects that they must get services at a lower cost.
The suppliers expect that they must get more price for their services. The law of demand is not
applicable to health services. The patients always demand health services taking into
consideration their economic condition. We demand health services to cure disease the health
care affect the health of patients. Health is non-transferable or it cannot be sold in the market
like other commodities.

Type of Health Care Markets

The following are the various types of health care markets-

1. Financial market deals with the demand for and supply of health finances.
2. Human Resource Market is related to the demand for and supply of doctors, nurses,
technicians etc.
3. Institutional Market is related to the demand for and supply of health providing
institutions important.
4. Market for Machines and equipment’s for health services deals with demand and
supply.
5. Market for Medical Education is related to the demand for and supply of medical
education.

Health is a fundamental right but it has become a private market oriented commodity. The poor
people are not getting adequate health facility. If we consider efficiency and equality then there
is no substitute to public expenditure. In 2000, 20% population was residing in developed
countries and their share in total health expenditure was 90% (WHO, 2003). The quality of

2
health depends upon the numbers of doctors and nurses per lakh population. One doctor per
thousand population is ideal proportion. In 2006, the proportion was 60 doctors per lakh
population. It means that 40 % more doctors were needed. In 2006 the deficiency of nurses was
50 percent. In the same year 60 % more dentists were required. WHO’s target was health for
all by 2000. But in 2018 this has not been achieved. Primary health centres and sub centres are
working at primary level. At the middle level district hospitals are providing health services.
At the higher level in urban areas medical colleges and hospitals, super speciality hospitals and
others specified hospitals provide health services.

Planning, budgeting and monitoring mechanism is one of the important parts of health. We
have completed 12 five year plans. In every 5 year plan health expenditure has increased
continuously. The government has implemented various schemes to eradicate fatal diseases.
Health security is a combined responsibility of central and state governments. During 2017-18,
the budgetary provision of health and family welfare ministry was Rs. 47352.5 crore increase
to Rs.52800 crore for 2018-19. To achieve the objectives of “Ayushyaman Bharat” Finance
Minister has declared to start 24 new government medical colleges in the 2018-19 budget
(Budget Speech 2018-19). From 2018-19, every year 10 crore family would be brought under
life insurance. Every family would be covered under health insurance scheme up to 5 lakh
rupees. The proportion of health expenditure to GDP was 0.96% in 2004-05 increased to 1.1%
in 2008-09. In 2017-18 it was 1.4%. The share of insurance companies in total health
expenditures is 3% in India (GOI, 2017-18).

District wise disparities in Health Facilities in Vidarbha Region of Maharashtra

The present study is based on latest available district level household and facility survey 2012-
13.

No. of Health Institutions in Vidarbha

The number of sub health centres is highest in Buldana district and lowest in Bhandara,
Gadchiroli and Washim districts. The number of Primary Health Centres is highest in
Chandrapur district and lowest in Washim district. The number of community Health Centres
is highest in Chandrapur and Buldana district and lowest in Wardha district. The number of
Sub Divisional hospitals is highest in Amravati district and there is not a single sub-divisional
hospital in Washim district. In some districts there are two district hospitals and in some
districts there is only one district hospital. (See table no. 1)

Availability of Health Infrastructure, Staff and Services: Sub-Health centres

The maximum sub-health centres are located in Government buildings. In Washim district all
sub-health centres are located in government buildings. In Yavatmal district only 41.6 percent
sub-centres are located in Government buildings. ANM staff is sufficient in all the districts of
Vidarbha. There is a deficiency of Male Health Workers in Sub-Health centres in some
districts. The percentage of MHW was 47.8 in Bhandara district and 92.1 in Buldana district.
(See table no. 2)

3
Primary Health Centres

It is mentioned that the Primary Health Centres are functioning 24x7 hours. The percentage of
this in Vidarbha ranges from 53.6 in Buldana district to 95.2 in Gadchiroli district. The
percentage of Lady Medical Officers ranges from 20 in Washim district to 52.4 in Gadchiroli
district. The percentage of at least 4 Beds in PHC ranges from 85 in Gondiya district to 95.4 in
Akola district. The progress of PHCs regarding AYUSH doctor is not satisfactory in all districts
of Vidarbha. In Bhandara, Chandrapur and Yavatmal district thee is not a single AYUSH
doctor. The availability of residential quarters for Medical Officers is satisfactory in all
districts. But it is observed that most of the Medical Officers are not staying at Head Quarters.
The facility regarding new born care services is satisfactory in all the districts. There is a wide
disparity regarding referral services in the districts of Vidarbha. The progress regarding the
deliveries in PHCs in all the districts is not satisfactory. (See Table No. 3)

Facilities in Community Health Centres

It is observed that in all the Community Health Centres normal delivery services were
available. In most of the community health centres in all the districts very few Obstetricians /
Gynaecologists are available. The Anaesthetists are not available in most of the CHCs. The
functional operation Theatres are available but manpower is not available in most of the CHCs,
The working of first Referral units is not satisfactory. It is observed that new born care services
are available in CHCs in all districts. It is very difficult to provide all the services in CHCs
without required personnel. (See Table no.4)

Facilities in Sub-Divisional Hospitals in Vidarbha

No Paediatrician is appointed at Wardha, Gondiya and Gadchiroli districts. There is one

Radiographer in Wardha, Chandrapur and Gadchiroli district, two in Amravati District and no
Radiographer in other district. It is observed that 2D Echo facility is not available in all the
SDHs. It is mentioned that critical care Area and Suggestions Box is available in most of the
SDHs. There is a need to appoint the staff as per requirement.

Health Facilities in District Hospitals

In some district hospitals there is only one Paediatrician and in some districts there are two
paediatricians. There is no Radiographer in Bhandara, Gondiya, Amravati, Washim and
Yavatmal district hospitals. In Nagpur and Wardha district hospitals there are two each
Radiographers and only one radiographer in the remaining districts. In Wardha district hospital
there are two units of 2 D Echo facility. In 5 districts there is only one 2D echo units and in 4
districts this facility is not available. In some districts 2 units of ultra sound facility is available
and in some districts only one unit is available. The condition is same regarding three phase
connection, Critical Care Area Suggestion and Complaint Box (See table no.5)

4
Accessibility of Health Facilities

The sub-centres must be available within 3 kms. from the villages. In most of the villages this
facility is not available. The percentage of availability of sub-centre within of 3 kms. ranges
from 47.7 in Bhandara district to 86.4 percent Wardha district. The Primary Health Centre
should be available within 10 kms. from the village. This facility ranges from 64.7 percent in
Chandrapur district to 93.2 percent in Wardha district. (See Table No.6)

Health Programmes at Village Level

The percentages of villages having ASHA ranges from 48 in Bhandara district to 94.1 in
Chandrapur district. The percentage of villages having Village Health Nutrition and Sanitation
committee (VANSC) ranges from 56 in Washim district to 100 in Bhandara district. (See Table
No.6)

Population Covered by SHC, PHC and CHC during 2012-13

The population covered by each sub-health centre was 6460 in Maharashtra. As compared to
Maharashtra the average is less in Nagpur, Wardha, Bhandara, Gondiya, Chandrapur,
Gadchiroli, Washim and Yavatmal districts. In the remaining districts the average is greater
than the state.

The population covered by each Primary Health Centre was 37709 in Maharashtra. As
compared to Maharashtra the average is more in Nagpur, Amravati, Buldana and Yavatmal
districts. In the remaining districts the coverage is lower than the State.

The population covered by each Community Health Centre was 47977 in Maharashtra. As
compared to Maharashtra the average is lower in Amravati, Akola, Washim, and Buldana
districts. In the remaining districts the average is higher than the state. (See Table No 7.)

Conclusion

Health is one of the determinants of HDI. It is necessary to increase Government expenditure

on additional staff. The number of doctors is not as per the requirement. The supporting staff
needs to be appointed on priority basis. The health of the people is the real wealth of the
country. It is necessary to provide health facilities in all district of Vidarbha region. In this
regard the views of Harbison and Amartya Sen are important. Harbison has mentioned in 1973
that the important determinants of health are economic development and stability. According
to Amartya Sen, ‘Economic development is not the ultimate aim. Human life is more valuable.
Government has to spend for the physical, mental, educational and emotional development of
the children. Children are the future human capital of the country.’

5
References
Budget Speech 2018-19. (2018). Budget Speech 2018-19. Retrieved from www.indiagudget.gov.in:
https://www.indiabudget.gov.in/ub2018-19/bs/bs.pdf

Callahan, D. (1973). The WHO Definition of Health. The Hastings Center, 1(3), 77-78.

GOI. (2011). Investing in Health. New Delhi: Government of India.

GOI. (2017-18). Economic Survey, Government of India . New Delhi: Ministry of Finance, Department
of Economic Affairs, Economic Division.

GOI. (2018). Annual Budget 2018-19. New Delhi: Ministry of finance, Governemnt of India.

Harbison, F. H. (1973). Human Resource as the Wealth of Nation. New York: Oxford University Press.

Morris, D. P. (2012). Economic Analysis in Healthcare. Noida, UP India: Wiley.

Sen A.S. and Basu R. N. (1968). Economics of Health. New Delhi: Health Division, Planning
Commission, Government of India.

Tampere, U. o. (2015). University of Tampere. Retrieved from www.uta.fi:

http://www.uta.fi/med/tacc-gh/sdh/aims/key_value/positive_model.html

WHO. (2003). World Health Organisation. Geneva: WHO.

WHO. (2011). Trends of Health Expenditure. Geneva, Switzerland: World Healh Organization .

WHO. (2012). Health Status Report. Geneva, Switzerland: World Health Organisation .

World Bank. (1993). World Development Report : Investing in Health. New York: World Bank and
University Press,.

World Health Organisation. (2003). World Health Report. Geneva, Switzerland: World Health
Organisation.

6
 Table No. 1
No. of Health Institutions in Vidarbha

Health Facilities Nagpur Wardha Bhandara Gondiya Chandrapur Gadchiroli Amravati Akola Washim Buldana Yavatmal Vidarbha Maharashtra
No. of Sub Health
Centres 25 37 23 25 34 23 29 32 23 38 24 313 1019
No. of Primary Health
Centres (PHCs) 21 22 16 20 29 21 20 22 15 28 20 234 778
No. of Community
Health Centres (CHCs) 7 3 4 6 10 9 7 5 6 10 9 76 249
No. of Sub Divisional
Hospitals 2 1 2 1 2 3 4 1 0 3 3 22 80
No. of District
Hospitals 2 2 1 2 1 1 2 1 1 1 1 15 39
Source: District Level Household and Facility Survey (2012-13) Maharashtra, Ministry of Health and Family Welfare, GOI

Table No. 2
Availability of Health Infrastructure, Staff and Services in Sub-Health Centres in Vidarbha

Nagpur Wardha Bhandara Gondiya Chandrapur Gadchiroli Amravati Akola Washim Buldana Yavatmal
SHCs Located in Government
Building 84.00 97.30 86.90 96.00 94.10 95.60 96.50 68.70 100.00 78.90 41.60
SHCs with ANM 100.00 94.50 95.60 100.00 100.00 100.00 100.00 93.70 95.60 92.10 100.00
SHCs with Male Health worker 76.00 56.70 47.80 88.00 73.50 82.60 89.60 68.70 82.60 92.10 62.50
SHCs with ANM residing in SHC
quarter where facility is available 95.60 100.00 90.90 95.60 100.00 90.90 96.30 86.40 95.40 96.90 92.80
SHCs with additional ANM 56.00 82.60 59.10 76.00 52.90 73.90 55.20 36.60 36.30 57.10 41.60
Source: District Level Household and Facility Survey (2012-13) Maharashtra, Ministry of Health and Family Welfare, GOI

7
 Table No. 3
Availability of Health Infrastructure, Staff and Services at in Primary Health Centres in Vidarbha

Primary Health Centre

(PHCs) Nagpur Wardha Bhandara Gondiya Chandrapur Gadchiroli Amravati Akola Washim Buldana Yavatmal
PHCs functioning on 24X7
hours basis 71.40 86.40 81.20 80.00 79.30 95.20 85.00 72.70 86.60 53.60 55.00
PHCs having Lady Medical
Officer 42.80 50.00 26.60 20.00 44.80 52.40 38.80 36.40 20.00 28.50 42.10
PHCs with at least 4 beds 95.20 95.20 93.70 85.00 93.10 95.20 89.50 95.40 93.30 100.00 95.00
PHCs with AYUSH doctor 14.30 13.60 0.00 5.00 0.00 4.70 5.50 13.60 6.70 14.30 0.00
PHCs having residential
quarter for Medical Officer 90.50 81.80 75.00 95.00 86.20 100.00 85.00 81.80 86.60 78.60 95.00
PHCs having new born care
services on 24X7 hours basis 100.00 83.30 100.00 89.50 92.80 95.00 94.40 89.50 100.00 90.50 100.00
PHCs conducted at least 10
deliveries during last one
month on 24X7 hours basis 47.60 10.50 38.50 27.70 26.90 47.60 55.60 40.00 30.70 54.50 33.30
Source: District Level Household and Facility Survey (2012-13) Maharashtra, Ministry of Health and Family Welfare, GOI

8
 Table No. 4
Availability of Health Infrastructure, Staff and Services at in Community Health Centres (CHCs) in Vidarbha
Community Health Centre
Nagpur Wardha Bhandara Gondiya Chandrapur Gadchiroli Amravati Akola Washim Buldana Yavatmal
(CHC)
CHCs having 24X7 hours
normal delivery services 7 3 4 6 10 9 7 5 6 10 9
CHCs having
Obstetrician/Gynaecologist 2 1 0 2 2 1 3 1 1 1 3
CHCs having Anaesthetist 2 0 0 0 2 1 4 1 0 0 5
CHCs having functional
Operation Theatre 7 3 4 5 10 8 7 5 6 7 8
CHCs designated as FRUs 1 0 0 0 1 0 2 0 2 2 1
CHCs designated as FRUs
offering caesarean section 4 1 4 1 2 7 2 2 1 1 6
CHCs having new born care
services on 24X7 hours basis 7 3 4 6 8 8 3 4 3 8 9
Source: District Level Household and Facility Survey (2012-13) Maharashtra, Ministry of Health and Family Welfare, GOI

Table No. 5
Availability of Health Infrastructure, Staff and Services at in District Hospitals (DH) in Vidarbha
District Hospital (DH) Nagpur Wardha Bhandara Gondiya Chandrapur Gadchiroli Amravati Akola Washim Buldana Yavatmal
DHs having Paediatrician 2 2 1 1 1 1 2 1 1 1 1
DHs having regular
radiographer 2 2 0 0 1 1 0 1 0 1 0
DHs having 2D Echo
Facility 1 2 0 0 1 1 1 0 0 1 0
DHs Ultrasound facility 2 2 1 2 1 1 2 1 1 1 1
DHs having three phase
connection 2 2 1 2 1 1 2 1 1 1 1
DHs having critical care
area 2 2 1 1 1 1 1 1 1 1 1
DHs having suggestion and
complaint box 2 2 1 2 1 1 1 1 1 1 1
Source: District Level Household and Facility Survey (2012-13) Maharashtra, Ministry of Health and Family Welfare, GOI

9
 Table No. 6
Accessibility of Health Facility and Health Programmes at Village Level in Vidarbha

Accessibility of Health Nagpu Wardh Bhandar Gondiy Chandrapu Gadchirol Amravat Washi Buldan Yavatma
Akola
Facility r a a a r i i m a l
Villages with sub-Health
Centre within 3 km 60.00 86.40 64.00 68.00 79.40 76.00 67.60 61.70 48.00 47.70 72.00
Villages with PHC within
10 km 92.00 93.20 92.00 92.00 64.70 76.00 82.40 82.40 72.00 70.40 72.00
Percentage of villages
having ASHA 92.000 88.600 48.000 52.000 94.100 64.000 79.400 76.500 84.000 70.400 76.000
Percentage of Villages
having Village Health
Nutrition and Sanitation
Committee (VHNSC) 84.000 95.400 100.000 88.000 79.400 80.000 85.300 58.800 56.000 95.400 92.000
Source: District Level Household and Facility Survey (2012-13) Maharashtra, Ministry of Health and Family Welfare, GOI
Table No. 7

Average Population Covered by SHCs, PHCs and CHCs in Vidarbha

Average
Vidarbha Maharashtra
Population Nagpur Wardha Bhandara Gondiya Chandrapur Gadchiroli Amravati Akola Washim Buldana Yavatmal
covered by
Sub-Health 5901 6460
Centre 6304 5305 5455 5473 5372 4205 7343 6476 6090 8262 4624
40307 37709
PHCs 38309 35603 28479 29642 30717 30836 78666 36526 31812 51687 51100
57605 47977
CHCs 81751 100180 83653 63165 56281 51207 47142 40966 30889 23016 55407
Source: District Level Household and Facility Survey (2012-13) Maharashtra, Ministry of Health and Family Welfare, GOI

10
Abstract

Economics of Health with reference to Health Facilities Available

in Vidarbha
Dr. R. Y. Mahore
Former Professor and Head,
Department of Economics,
Rashtrasant Tukadoji Maharaj Nagpur
University, Nagpur - 440033
Dr. Samit L. Mahore
Assistant Professor,
Department of Economics,
Rashtrasant Tukadoji Maharaj Nagpur
University, Nagpur - 440033

World health organisation has defined health as under, Health as a state of complete physical,
mental and social wellbeing and not merely absence of disease or infirmity. In recent years
health is becoming more valuable and diseases becoming more expensive. It means that the
expenditure on medicine and treatment is increasing. The determinants of health are diet,
environment, exercise, nature of work place of work, methods or treatment of diseases,
education, economic condition, social systems etc. The demand for health is similar to the
demand for other goods. The supply of health care depends upon scale of production. In multi-
speciality hospital more facilities are available. A patients needs the services of an expert doctor
to cure his disease.

Market equilibrium depend upon demand for and supply of health services. The health services
are supplied by the institutions, doctors and nurses. The consumers expects that they must get
services at a lower cost and suppliers expect more price for their services. But law of demand
is not applicable to health services. The patients always demand health services taking into
consideration their economic condition. We demand health services to cure disease the health
care affect the health of patients.

The poor people are not getting adequate health facility. Primary health centres and sub centres
are working at primary level. At the middle level district hospitals are providing health services.
At the higher level in urban areas medical colleges and hospitals, super speciality hospitals and
others specified hospitals provide health services.

There is a need to increase expenditure on health in India. Health is one of the determinants of
HDI. It is necessary to increase Government expenditure on additional staff. The number of
doctors is not available as per the requirement. The supporting staff needs to be appointed on
priority basis. The health of the people is the real wealth of the country.

11