NSSO REPORT

MORBIDITY, HEALTH CARE AND THE CONDITION OF THE AGED
(JANUARY – JUNE 2004)

Report No. 507 on “Morbidity, Health Care and the Condition of the Aged” based on the 60th round of National Sample Survey (NSS) carried out during January to June 2004 by the National Sample Survey Organisation (NSSO), in the Ministry of Statistics and Programme Implementation, Government of India, has been released. At the request of Ministry of Health and Family Welfare, these subjects were taken up during the NSS 60th round along with the regular subjects of household consumer expenditure and employment-unemployment.
2. The NSS made its first attempt to collect information on morbidity during October 1953 - March 1954 (NSS 7th round). This maiden attempt and the subsequent three surveys (NSS 11th to 13th rounds) on the subject carried out during the years 1956 and 1958 were exploratory in nature and aimed to evolve an appropriate data collection method for studying morbidity profile in India. However, a full-scale survey on morbidity was conducted for the first time during October 1973 - June 1974 in the 28th round of NSS. Since then, collection of data on morbidity became a part of the decennial surveys on social consumption carried out in NSS 35th (July 1980 - June 1981), 42nd (July 1986 - June 1987) and 52nd rounds (July 1995 - June 1996).
3. The present report for the NSS 60th round is based on the ‘Central sample’ data collected by the NSSO. The enquiry covered the curative aspects of the general health care system in India, utilization of health care services provided by the public and private sector and the expenditure incurred by the households for availing these services. In addition, information on the condition and problems of the aged persons was also collected.
4. The survey was spread over 4,755 villages and 2,668 urban blocks covering 73,868 households across the country. Some important findings from the survey are presented in this note.
Morbidity and Health Care

· Number of persons reporting ailment during a period of 15 days prior to the date of survey per 1000 persons was 88 in the rural areas and 99 in the urban areas. The proportions were marginally higher among the women as compared to men both in the rural and urban areas.

· The proportion of ailing persons (PAP) per 1000 increased with the age of the person, it being 72 for rural and 79 for urban for the children in the age group 0-14 years and 283 for rural and 368 for urban for the persons aged 60 years or more.
· The proportion of persons reporting commencement (PPC) of any ailment during last 15 days per 1000 persons was about 45 for both rural and urban. The PPC is higher for both the children (54 for rural and 59 for urban) and for aged persons (68 for rural and 55 for urban) as compared to other age-groups.

· Percentage of the spells of ailments that got medically treated was 82 and 89 per cent for rural and urban respectively.

· Among the reasons for not getting the ailment treated, the reason ‘ailment not considered serious’ was the most common single reason both among the rural (32 per cent) and urban (50 per cent) persons.

· About 23 persons in rural and 31 persons in urban per 1000 persons in the country reported being hospitalized during the last 365 days prior to the date of survey and the incidence rates were almost the same for both sex.

· About 58 per cent of the hospitalised cases in the rural areas and 62 per cent in the urban areas were treated in the private hospitals and the rest in the government hospitals. A similar trend but a predominant use of private health facilities was observed for treatment of ailments not amounting to hospitalisation (rural - 78 per cent, urban - 81 per cent).

· The average duration of hospitalized treatment was higher in the case of government hospital (rural – 10.9 days; urban – 10.8 days) than that in the case of private hospital (rural – 8.3 days; urban – 7.3 days).

· The average medical expenditure in the case of non-hospitalised treatment during a period of last 15 days had been Rs. 257 in the rural and Rs. 306 in the urban areas. This expenditure was higher in the case of males (rural - Rs. 275; urban - Rs. 322) than that in the case of females (rural - Rs. 240; urban - Rs. 291).

· The average medical expenditure per hospitalisation during a period of last 365 days was estimated as Rs. 5,695 in the rural and Rs. 8,851 in the urban areas. The average expenditure in the case of hospitalisation of male member was a little more (rural - Rs. 5,946; urban - Rs. 9,535) than those on females (rural - Rs. 5,406; urban - Rs. 8,112).

· The average total expenditure per hospitalised treatment that included the medical expenditure as well as other incidental expenditure such as traveling cost, lodging charges, etc., of other members of the household accompanying the ailing person, was estimated from the survey as Rs. 6,225 in the rural areas and Rs. 9,367 in the urban areas. The average amount of this expenditure in government hospitals was Rs. 3,238 in the rural and Rs. 3,877 in the urban areas which was much lower than that in private hospitals (rural - Rs. 7,408; urban – Rs.11,553).

Immunisation of Children Aged 0 –4 Years

· Among the children of age 0-4 years, around 89 per cent in the rural and 94 in the urban areas received any immunisation during a period of 365 days.

· The average expenditure incurred on receiving immunisation during a period of last 365 days was estimated at Rs. 19.90 in the rural (boys– Rs. 22.30; girls– Rs. 17.40) and Rs. 113.40 in the urban areas (boys– Rs. 109.20; girls– Rs. 118.30).

Pregnancy, Childbirth & Maternity Care

· About 13 per cent of the women of child-bearing age 15-49 years were pregnant any time during a period of last 365 days prior to the date of survey in the rural areas as compared to 11 per cent in the urban areas.

· About 72 per cent of the rural and 69 per cent of the urban pregnant women in the child-bearing age-group delivered a child.

· As high as 65 per cent of the deliveries were non-institutional in the rural as compared to 26 per cent in the urban areas.

· About 18 per cent of the total childbirths in the rural areas and 31 per cent in the urban areas took place in the Government hospitals.

· The average expenditure per rural childbirth was estimated at Rs. 1,169, which was considerably lower than the expenditure of Rs. 2,806 in the urban areas. Moreover, average expenditure on childbirth in government hospital (Rs. 1165 in the rural and Rs. 994 in the urban) was much lower than in the private hospitals (rural – Rs. 4,137; urban – Rs. 5,480).

· About 70 per cent of the rural and 84 per cent of the urban pregnant women in the child-bearing age-group availed of any antenatal care services.

· In the case of post-natal care services, 63 per cent of the rural mothers in the rural areas and 73 per cent of the urban mothers availed of these services.

· The average expenditure for the antenatal care and post-natal care services in the rural areas was Rs. 499 and Rs. 402, respectively. The corresponding average expenditure in the urban areas was Rs. 905 and Rs. 595, respectively.

Condition of the Aged (60 yrs. or more)

· Around 7 per cent of the Indian population was aged, i.e., persons of age 60 years and above.

· The old-age dependency ratio (proportion of aged persons per 1000 persons in the age-group 15-59 years) was much higher in the rural areas (125) than in the urban areas (103).

· The sex-ratio among the aged was much higher in the urban (1046) than in the rural (985) areas.

· About 58 per cent of the aged persons, in both rural and urban, lived with their spouse and 32 per cent lived with their children only. About 5 per cent of the aged in rural and 4 per cent in urban lived alone.

· About 67 per cent of the aged in rural and 64 per cent in urban depended on others for their day-to-day maintenance.

· Among the economically dependent aged, about 78 per cent in rural and 76 per cent in urban were dependent on their children and 13 per cent in rural and 15 per cent in urban on their spouse.

· The proportions of the aged persons who could not move or were confined to bed were 7.7 per cent in the rural and 8.4 per cent in the urban areas.