Pattern of private expenditure on health and education across social groups in Uttar Pradesh and Madhya Pradesh

Transcription

1 Pattern of private expenditure on heath and education across socia groups in Uttar Pradesh and Madhya Pradesh Ram Singh, Research Schoar, Centre for the Study of Regiona Deveopment (CSRD), Jawahara Nehru University, New Dehi, , Dehi, dia ABSTRACT This paper anayses the pattern and financia burden of expenditure on heath and education services across socia groups in two sociay and economicay most backward states of dia. recent years, the cost of education and heath services have been rising sharpy which is compeing househods to expend arger part of their househod budget on these services. This rising cost of these services severey affects the socia and economic conditions of the most deprived socia groups which further hamper the overa deveopment of the economy and society. The efficient poicy actions from government side is much needed to enarge the effective and efficient socia infrastructure in order to empower the most deprived and to enhance socia deveopment of the individua and nation as whoe which further promotes incusive economic deveopment of the country. Keywords: Heath, Education, catastrophic, out-of pocket expenditure troduction Education and heath are important merit goods. The concept of merit goods was deveoped by Musgrave in 1959 to describe commodities that ought to be provided by state even if the members of society do not demand them. Thus, in broad sense, the merit goods are those goods whose consumption not ony benefits their consumers but aso non-consumers. The state shoud directy suppy merit goods in the economy or aternativey it shoud subsidize their production and consumption. The market mechanism cannot provide merit goods efficienty to a the section of society because price determined by the market forces may excude that section of society in the economy who has not sufficient purchasing power in hand. Thus, the arge positive externaities created by merit goods on the society or economy make it necessary for the state to take the responsibiity of suppying of merit goods in its jurisdiction. According to Schutz (1961), Expenditure on heath and education is aso a form of investment in human capita and this kind of investment increases the better job opportunities and productivity of workforce in the economy. The expenditure on heath and education pays an important roe in the process of economic, socia and human deveopment of any economy because it creates efficient and productive workforce, responsibe citizens and aso heps in making poitica and socia stabiity in the economy. Househods in dian economy have been expending a arge share of their Monthy Per Capita Consumption Expenditure (MPCE) on heath and education services. The Right of Chidren to Free and Vo (3), Issue-4, Apri IJSIRS 85

2 Compusory Education (RTE) Act, 2009, which came into effect on 1 Apri 2010, makes it necessary for state to provide free and compusory education to a chidren under age 6-14 years, broady it is known as Right to Education. But in case of providing better heath care services to every individua in the economy, ony a itte progress so far has been achieved. After the introduction of economic reform on Juy 1991, the heath and education services are argey being provided by private payers at market determined high price and sti the pace of privatization of heath care and education services are high in the dian economy. recent years, the cost of heath care services has grown sharpy and it has ed high out of pocket (OOP) expenditure on heath services. The nationa heath poicy (draft) 2015 aims to significanty reduce out-of-pocket heath expenditure due to high cost of heath services and reduced the proportion of househods experiencing catastrophic heath expenditures and consequent impoverishment. The high out-of-pocket expenditure on heath services are affecting more to the vunerabe sections of the economy, because high cost of heath care services pushes a arge number of persons into poverty and debt trap in dia. The high cost of heath services is financed by househods past saving, seing productive assets and borrowing money from reatives and moneyenders (at a very high rate of interest). Out-of-pocket expenditure on heath serves basicay indicates the money amount paid by househods at the point they receive heath care services. Many research works have shown that the rising OOP expenditure on heath is taking a form of catastrophic out-of-pocket heath expenditure. Catastrophic expenditure refers to any expenditure that threatens househod s basic needs. According to Berki (1986), the catastrophic out-of-pocket heath expenditure is that expenditure which consumes a arge share of the househod s budget and affects househod s abiity to maintain a decent iving standard. According to nationa heath poicy (draft) 2015, heath care costs of a househod exceeding 10% of its tota monthy consumption expenditures or 40% of its non-food consumption expenditure is designated catastrophic heath expenditure. The high cost of heath services aso affects the overa wefare of househods because it cuts the expenditure on other basic human capabiity buiding inputs. Thus, in an economy where financia protection against the disease and i heath is not proved by state, any heath shocks affects househods (especiay marginaized househods) deepy by two way; first, it consumes a arge part of their budget and second, it push them into poverty and debt trap with jeopardizing future economic wefare. dia, NSSO provides data on the heath expenditure in two component- stitutiona and non-institutiona heath expenditure. The reca period for institutiona heath expenditure is 365- days and 30-days for non-institutiona heath expenditure. stitutiona heath expense refers to a expenses which are incurred for medica treatment undergone as an in-patient of a medica institution (such as a hospita or nursing home) or otherwise it is non-institutiona heath expenditure. stitutiona heath expenses incude Medicine, X- ray, ECG, pathoogica test, etc, doctor s/surgeon s fee, hospita & nursing home charges and other medica expenses, and non-institutiona heath expenses incude Medicine, X-ray, ECG, pathoogica test, etc., doctor s/ surgeon s fee, famiy panning devices and other medica expenses. ternationay, education (particuary eementary education) has been approved as a basic human needs and it must be provided free by state to its entire citizen. The Artice 41 of directive principes of dian constitution ceary said that education shoud be a right (right to education) and must be provided free to a by the state. The State sha, within the imits of its economic capacity and deveopment make effective provision for securing the right to work, to education and to pubic assistance in cases of unempoyment, od age, sickness and disabement, and in other cases of undeserved want. (Artice 41). According to human deveopment and human rights perspectives, education forms an essentia component of human iving and this shoud be provided universay to everyone without any 86 Vo (3), Issue-4, Apri IJSIRS

3 discrimination as an entitement, and as a fundamenta right. 1 The Right of Chidren to Free and Compusory Education (RTE) Act, 2009, which came into effect in 1 Apri 2010, inserts artice 21a in the constitution which makes it necessary for state to provide free and compusory education to a chidren under age 6-14 years, and broady it is known as Right to Education. Education pays an important roe in process of deveopment via promoting higher abour efficiency and productivity, reducing poverty and fertiity eve, making peope more aware about their rights and duties and finay heping overa (socia, economic, poitica and environmenta) deveopment of the economy. Education, in dia, is free ony for chidren up to age 6-14 years. Much evidence shows that in recent year, househods are spending a arge proportion of their budget on educationa service. The cost of education, with commerciaization of education, is rising rapidy in economy and marginaized socia groups of the economy are not in the position to afford the high cost of education beyond eementary eve (up to eementary eve education is free). Househods are spending a arge proportion of their budget on tuitions and other fees, other payment to schoo, other necessary expenditure on textbooks, stationary, uniform and transport etc. (Tiak, 1996). The high cost of education has two dimensions; first, it consumes arger part of househods budget and eaves ess amount of budget to spend on other human capabiity buiding inputs and second, it makes marginaized (purchasing poweress) sections unabe to attain quaitative education beyond eementary eve (aso better quaity eementary education). dia, NSSO provides data on educationa expenditure by househods. this study, for both time periods and , educationa expenditure incudes- expenses on books, journas, newspapers, periodicas, ibrary charges, stationery, tuition and other fees (schoo, coege etc.), private tutor/coaching centre, other educationa expenses, 1 Tiak, J. B G (2009): Househod expenditure on education and impications for Redefining the Poverty Line in dia. and the reca period on education expenditure is 365-days in both rounds (55 th and 68 th ) of NSSO. About Study Area The study area of the paper is Uttar Pradesh (UP) and Madhya Pradesh (MP) and according to IHDR 2011, in terms of ranking in HDI vaue, these two states had occupied the same rank in 2001 and 2011.According to IHDR 2011, Uttar Pradesh ranked 18 th in the and it aso occupied same rank in the , the performance of Madhya Pradesh in progress of human deveopment was aso amost simiar, in the , M.P. occupied 20 th rank and rank was same in the These two states are the economicay most backward states in the dia. Their performance in the progress of socia indicators is worst in comparison of other states. These two states were the part of BIMARU states, a term coined by Ashish Bose. Is private higher expenditure on education and heath bad or good? The education and heath services are important merit goods which create arger positive externaities in society and many deveopment economists have argued that these merit goods shoud be provided free by state to its a citizens. The deveopment experience of deveoped countries shows that the a deveoped countries had made provision for free education and heath services to its citizens in the form of universaizing education and heath across country. dia, the provision of free education is imited up to eementary eve (cass I-VIII) and beyond the eementary eve the education it is not free and existing pubic heath sector is performing worst and it is highy underdeveoped. dia, since 1991 when economic reform was done, the cost of private educationa and heath services has been rising rapidy which creates high financia burden on the society especiay the deprived section. The cost of these merit goods are rising rapidy since 1991 because government has reduced Vo (3), Issue-4, Apri IJSIRS 87

4 its roe in providing these merit goods and private sectors (market forces) are taking eading roe in providing heath and education service at higher price which basicay excudes resource poor or purchasing poweress section of society in the process of avaiing these services. The high cost of education and heath services eats arger part of househod s budget and eaves esser amount to expend on other human capabiity buiding inputs. The high cost of these merit goods act as doube edged sword because the high cost of these merit goods discouraged ow income groups to pursue quaitative educationa services and use better heath services and it aso push them into the vicious circe of poverty and debt. Thus, the high private expenditure on heath and education by deprived and resource poor persons are economicay and sociay bad and it pushes them into poverty and debt trap. Private expenditure on education across socia groups in UP and MP Education is an important dimension of human deveopment and it has arge capacity to produce positive externaities on the society. The deveopment experience of deveoped countries has shown that at the initia stage of economic deveopment of the economy, deveoped countries had made education free with universa coverage not ony up to eementary eve but aso beyond the eementary eve. Educationa deveopment is the pre-requisite of the economic deveopment for any country and in dia; educationa deveopment is not much satisfactory. Tabe 1.1 shows the per capita education expenditure in rea terms at base year across the socia groups in UP and MP in and From the tabe 1.1 it is cear that education expenditure in both states has increased across the socia groups in a sectors (rura, urban and overa) during and rura sector, the monthy per capita expenditure on education was highest in Other caste in both years in UP and MP. UP, the expenditure on education by SCs socia group was owest 7.4 in and 21.6 in and in MP, expenditure on education by STs was owest in both years ( 1.97 in and 6.22 in ). urban sector the cost of education services are higher than rura sector , the education expenditure of SCs ( 23.74) and OBCs ( 25.79) was esser than rest of socia groups and in , again the expenditure of these socia groups was esser than rest of socia groups. The main reason behind this is that, the eve of income and education of these socia groups has been ow in UP in both years and aso high cost of education services has prevented them to not expend much on and pursue education (at botheementary and beyond eementary eve). MP, the education expenditure of STs (16.54) in was owest, whereas in , the education expenditure of SCs (43.91) was owest in Thus, the overa (R+U) pattern of education expenditure across the socia groups aso indicates that the deprived casses of economy are expending much ess on education services in both states in both years. Though, the amount of expenditure on education has increased across the socia groups in both states during and During this time period, the compound annua growth rate of per capita education expenditure on average was 4.34% in UP and by 8.66% in MP. UP, it was highest of Others (6.26%) and owest of SCs (4.44%). MP, the compound annua growth rate of education expenditure was highest of STs (11.67%) and owest of SCs (5.48%). The pattern of percentage of rea MPCE (Monthy Per Capita Consumption Expenditure) aso ceary shows that S Cs and OBCs socia groups in UP were spent east percentage of their rea MPCE on education services. The percentage of rea MPCE on education was 1.77% in and 3.14% in of SCs and it was 2.30% in and 4.25% in of OBCs in UP. The percentage of rea MPCE on education services of Other has been high in both years (5.14% in and 11.28% in ). MP, the simiar situation aso exist, the derived section (STs and SCs) of economy has been spending esser amount on education services in comparison to their advanced counterpart in economy. The STs and SCs are the most deprived sections of the economy in 88 Vo (3), Issue-4, Apri IJSIRS

5 MP and they are sti economicay and educationay most backward. And, due to ow eve of education and income, they are unabe to spend more on educationa services , STs and SCs had spent 0.72% and 2.17% of their rea MPCE on educationa services respectivey and in ; it was 2.51% of STs and 3.09% of SCs, respectivey. both years, the percentage of rea MPCE and aso absoute amount of expenditure on education was higher of the Other socia group in MP. Thus, it is cear from above anaysis that the deprived section of economy in both states are spending esser amount on educationa services due to ow eve of income, ignorance about the importance of education (Iiteracy) and high cost of educationa services. Though, the per capita monthy expenditure on education has increased across socia groups in both states, but the compound annua growth rate of the per capita monthy expenditure on education has been high across socia groups in MP than UP. There is nothing ike "free" education in dia, because househods are spending a sizeabe amount on educationa services. The a section-rich and poor (marginaized SCs, STs and OBCs) are spending a arger part of their househod budget on the educationa services (Tiak, 2002).The high costs of education discourage derived socia groups (ow income group) to pursue high education and it aso make househods poor because it consumes a arge part of their income. Due to these reasons, the Suresh Tendukar committee on poverty ine had incuded education expenditure in poverty ine. Tabe 1.1: Pattern of monthy per capita private expenditure on Education across the socia groups in and (figures of and are adjusted from CPI defator with base year ) RURAL SECTOR URBAN SECTOR OVERALL (R+U) UP MP UP MP UP MP Socia groups/year ST SC OBC OTHER ALL Source: Computed from NSSO 55 th and 68 th round, unit eve data Vo (3), Issue-4, Apri IJSIRS 89

6 ternationa Journa of Scientific & novative Research Studies Tabe 1.2 Percentage of rea MPCE* on educationa services Uttar Pradesh Madhya Pradesh Uttar Pradesh Madhya Pradesh Rura n Tota Rura n Tota Rura n Tota Rura n Tota ST SC OBC OTHER ALL Source: Computed from NSSO 55 th and 68 th round Note: * MPCE refers to Monthy Per capita Consumption Expenditure Figure 1.1: Annua growth rate in monthy per capita educationa expenditure ( and ) ST 8.00 SC 6.00 OBC OTHER ALL 0.00 UP MP UP MP UP MP RURAL URBAN OVERALL Source: Cacuated from NSSO 55 th and 68 th round, unit eve data Pattern of private expenditure on heath across socia groups in UP and MP Heath is an important factor that affects both economic and human deveopment of economy. dia, the share of out-of-pocket expenditure in tota expenditure by househods on heath services is 70% (GOI, 2005). The Word Heath Report (2000) identified that the fundamenta objective of heath care system is to provide financia protection against the cost of i heath. I heath affects househods in two ways; first, it aggravates out-of-pocket expenditure on heath and second, it undermines income generation which further jeopardizes the economic wefare of househods. Househods are facing high monetary burden of heath services in deveoping country ike dia, where heath system is not we functioning and we deveoped. recent years, the costs of heath services have been rising 90 Vo (3), Issue-4, Apri IJSIRS

7 rapidy in dia, and high cost of heath services are taking a form of catastrophic out-of-pocket expenditure on heath services (because dian heath care system is not universa and we deveoped). The underdeveopment of heath care system in dia puts high economic pressure on househods to make catastrophic out-of-pocket expenditure on heath services. The high eve of outof-pocket expenditure on heath care services affects vunerabe sections of the society more severey because they are economicay (resource) poor and high cost of heath services push them into poverty and debt trap. The tabe 1.3 shows the pattern of institutiona and non-institutiona heath expenditure across the socia groups in UP and MP. rura sector, the monthy per capita institutiona heath expenditure has increased across socia groups in UP and MP except in STs in MP during both UP and MP, the monthy per capita institutiona heath expenditure of Other socia groups has increased rapidy than of rest of socia groups during and , the monthy per capita institutiona heath expenditure was 9.93 of STs, of SCs, 21.2 of OBCs and of Others in UP whereas in MP, it was owest in STs (3.08) and highest in Other (28.77) socia groups. It is cear from the tabe that the institutiona heath expenditure was ow among the deprived sections of economy in both states in both years. The monthy per capita non-institutiona heath expenditure is much high in comparison to institutiona heath expenditure across socia groups in both states in both years. rura sector, a socia groups are spending much of their income on non-institutiona heath services in both states. The non-institutiona heath expenditure has increased across the socia groups except in Others in UP (in other, it fe from in to in ) during and One possibe reason behind this is that introduction of Nationa Heath surance Scheme in 2007, which covers institutiona heath expenses. Due to this scheme, the persons from Other socia group prefer to incur institutiona heath expenses. MP, monthy per capita noninstitutiona heath expenditure has increased sharpy across socia groups. The non-institutiona heath expenditure of STs has increased by 10.93% annuay, from in to in (which is highest). But, the annua growth in noninstitutiona heath expenditure across the socia groups has been much high in MP than UP , monthy per capita non-heath expenditure was 49.7 of OBCs, of STs, of Others and of SCs in MP. rura area, the percentage of rea MPCE on institutiona heath expenses has increased and on non-institutiona heath expenses has decreased across the socia groups in UP whereas in MP, the percentage of rea MPCE on both institutiona and non-institutiona heath expenses has decreased across the socia groups during and UP, persons from marginaized socia groups were spending esser percentage of their rea MPCE on institutiona heath. Athough, the percentage of rea MPCE on institutiona heath services has increased across the socia groups in rura UP during and , the percentage of rea MPCE on institutiona heath services was 1.38% of STs, 2.11% of SCs, 3.26% of OBCs and 4.50% of others in UP, which indicated the deprived section of society are spending esser percentage of their income on institutiona heath services. case of the percentage of rea MPCE on non-institutiona heath services, it has decreased across the socia groups in rura UP but sti the marginaized sections of economy are spending more on non-institutiona heath services than institutiona heath services in rura UP , the percentage of rea MPCE on non-institutiona heath services was 6.68% of SCs, 6.37% of OBCs, 4.97% of Others and 4.43% of STs in rura UP which ceary indicates that the deprived sections are spending arger percentage of their rea MPCE on non-institutiona heath services than institutiona heath services. case of rura MP, the percentage of rea MPCE on institutiona heath services has decreased across the socia groups except Others during and And, in case of the percentage of rea MPCE on non-institutiona heath services it has increased across the socia groups in rura MP , percentage of rea MPCE on non-institutiona heath services was 10.80% of Vo (3), Issue-4, Apri IJSIRS 91

8 OBCs, 9.50% of Others, 9.07% of STs and 8.86% of SCs, which is much higher than the percentage in This ceary indicates that the heath care system in rura MP is not we deveoped and existing heath care system is performing poory. This has resuted in high out-of-pocket expenditure on noninstitutiona heath services by deprived socia group which push them in poverty and debt trap. The poorer househods are spending a arge part of their tota budget on heath care services (Jogekar, 2008). both states, the deprived sections of the economy finance their expenditure on heath services (both institutiona and non-institutiona) by past saving of househod, seing productive assets and borrowing from money enders at high rate of interest and this approach of financing heathcare expenses push them into debt trap and vicious cyce of poverty (Damme, et a., 2004 and Sinha, 2014). urban sector, the monthy per capita institutiona heath expenditure has increased across socia groups except in STs, and in case of non-institutiona heath expenditure it has decreased across socia groups except in STs in Uttar Pradesh. The maximum increment in the monthy per capita institutiona heath expenditure has take pace in Others, it rose by 10.33% annuay (from 9.36 in to in ) and minimum increment has take pace in OBCs, it rose by 1.68% annuay (from 9.05 in to in ). case of the monthy per capita non-institutiona heath expenditure, highest fa has been taken pace in SCs, it fe by -3.81% annuay (from in to in ) and owest fa has been observed in OBCs, in OBCs socia group it fe by -0.45% annuay (from in to in ). Thus, it is cear that in urban Uttar Pradesh, the pattern of heath expenditure is changing from non-institutiona to institutiona heath services across socia groups because the monthy per capita non-institutiona heath expenditure has been decreasing across the socia groups and the monthy per capita institutiona heath expenditure has been rising across the socia groups. The main reason behind this change is that the heath care faciity is urban UP is we deveoped and aso we functioning that is why peope from a major socia groups are preferring to avai institutiona heath care services. urban MP, the monthy per capita institutiona heath expenditure has decreased across the socia groups except Others (in Other it rose by 5.87% annuay, from in to in ) and the monthy per capita non-institutiona heath expenditure has increased across the socia groups except in STs during and The rising non-institutiona heath expenditure indicates that pubic heath care system is not we deveoped and existing heath care faciities are performing poory. As far as percentage of rea MPCE on institutiona and non-institutiona heath expenditure in urban areas is concerned, in UP, percentage of rea MPCE on institutiona heath expenditure has increased across the socia groups except for ST (in STs it fe from 0.50% in to 0.3% in ). The percentage of rea MPCE on institutiona heath expenditure has increased from 0.43% in to 2.0% in in SCs, from 0.78% to 1.9% in OBCs and from 0.78% to 2.6% in Others. case of non-institutiona heath expenditure, the percentage of rea MPCE has increased sharpy across socia groups except in Others (in case of other, it fe from 4.31% in to 3.8% in ). It means the marginaized socia groups in urban UP are spending a arge part of their budget on heath services and this catastrophic outof-pocket heath expenditure eaves esser part of budget to spend on other human capabiity buiding inputs. MP, the percentage of rea MPCE on institutiona heath expenditure has decreased across socia groups except in Others (in Others, it rose from 1.82% in to 2.44% in ). case of non-institutiona heath expenditure, the percentage of rea MPCE has decreased sharpy in STs (from 11.55% to 5.94%) and aso decreased in OBCs (from 5.17% to 4.675), and in case of Others and SCs it increased during and Thus, in both states the deprived sections of economy are spending a arge part of their income on heath care services, despite having ess income and ack of financia and physica assets. both sectors (rura pus urban), the monthy per capita institutiona heath expenditure 92 Vo (3), Issue-4, Apri IJSIRS

9 has increased across the socia groups in UP and it rose by 9.58% annuay in Others (from 8.96 to 26.87), by 5.60% annuay in SCs (from 4.25 to 8.17), by 5.26% annuay in STs (from 3.83 to 6.06) and owest increment have taken pace in STs. case of monthy per capita non-institutiona heath expenditure, it decreased across the socia groups during and but sti the absoute amount of expenditure is much higher on noninstitutiona heath services than institutiona one. UP, each socia group has been spending a arger part of its budget on non-institutiona heath services , monthy per capita noninstitutiona heath expenditure was 33.7 of Others, of OBCs, of STs and of SCs and this amount is much higher than expenditure on institutiona heath services by each socia groups in state. MP, during and , the monthy per capita rea institutiona heath services has decreased across the socia groups except in Others (in Others, it rose by 5.77% annuay, from 13.5 to 26.48) and maximum reduction in the monthy per capita rea institutiona heath services has been observed for STs, in which it fe by -2.23% annuay, from 4.21 to 3.21). case of monthy per capita non-institutiona rea heath expenditure, it has increased across the socia groups and highest increment has taken pace in STs, in which it rose by 7.39% annuay (from to 44.41). MP aso, the monthy per capita rea expenditure on noninstitutiona heath expenditure is much higher than on institutiona heath expenditure in each socia group. Thus, we can say that the cost of heath care services in both economicay and sociay backward states has been rising sharpy and peope from each socia group are spending a big part of their househod budget on heath care services. dian context, the private sector is emerging as giant payer in providing heath care services at high price. The backwardness and mafunctioning of pubic heath care system is aggravating the pight of deprived sections of the economy, because due to ack of financia protection against heath shocks and ack of better performing pubic heath care system, peope are incurring high cost on the treatment of heath reated probems. The catastrophic out-ofpocket heath expenditure has been affecting the deprived section of society more severey than their richer counterpart. The share of non-institutiona heath expenditure in tota heath expenditure is much more than 70% in both the states and the noninstitutiona heath expense does not incude any government supported heath insurance schemes. The high cost of heath care services (which is refected through high out-of-pocket heath expenses on both institutiona and non-institutiona heath services) puts more financia burden on the marginaized socia groups and pushes them into vicious cyce of poverty and debt trap (Narayanan et a. 2000, Amakom and Ezenekwe, 2012 and Kumar et a., 2014). The poor may be driven into vicious cyce of poverty after paying high cost for heath care. A severe i heath that afficts the breadwinner of the famiy may competey impoverish the famiy especiay those who se their abour on daiy basis to provide food for their famiies. Even the non-poor may be impoverished by arge random out-of-pocket payment arising from unanticipated i heath. 2 The high cost of heath services can be reduced by providing financia protection against heath shocks through heath insurance schemes and by strengthening pubic heath care system. 2 Amakom, U. and Ezenekwe U. (2012): Impication of househod catastrophic out-of-pocket heath spending in Nigeria. Journa of Research in Economics and ternationa Finance, Vo 1(5) pp Vo (3), Issue-4, Apri IJSIRS 93

10 Tabe 1.3 Pattern of private expenditure on heath across the socia groups in and (figures of and are adjusted from CPI defator). RURAL Uttar Pradesh RURAL Madhya Pradesh Years Non- * Non- * Non- * Non- * ST SC OBC OTHER ALL URBAN Uttar Pradesh URBAN Madhya Pradesh Non- * Non- * Non- * Non- * ST SC OBC OTHER ALL OVERALL Uttar Pradesh OVERLL Madhya Pradesh Non- * Non- * Non- * Non- * ST SC OBC OTHER ALL *Stands for stitutiona heath expenditure and** stands for Non-institutiona heath expenditure. Source: Cacuated from NSSO 55 th and 68 th round, Unit eve data. 94 Vo (3), Issue-4, Apri IJSIRS

11 Tabe 1.4 Percentage of rea MPCE on institutiona and non-institutiona heath services Percenatge of Rea MPCE on institutiona heath services Percenatge of Rea MPCE on non-institutiona heath services Uttar Pradesh Madhya Pradesh Uttar Pradesh Madhya Pradesh Rura n Tota Rura n Tota Rura n Tota Rura n Tota ST SC OBC OTHE R ALL Uttar Pradesh Madhya Pradesh Uttar Pradesh Madhya Pradesh Rura n Tota Rura n Tota Rura n Tota Rura n ST SC OBC OTHE R ALL Source: Cacuated from NSSO 55 th and 68 th round, unit eve data Tota Figure 1.3a: Annua growth rate in monthy per capita institutiona heath expenditure ( and ) ST 5.00 SC UP MP UP MP UP MP RURAL URBAN TOTAL OBC OTHER ALL Vo (3), Issue-4, Apri IJSIRS 95

12 Source: Cacuated from NSSO 55 th and 68 th round, unit eve data Figure 1.3b: Annua growth rate in monthy per capita non- institutiona heath expenditure ( and ) UP MP UP MP UP MP RURAL URBAN TOTAL Source: Cacuated from NSSO 55 th and 68 th round, unit eve data ST SC OBC OTHER ALL Concuding Remarks As many economists have suggested that the education and heath care services shoud be provided by states without any cost to a the citizens of the country. Form the above anaysis it is cear that sti the expenditure on educationa services in UP and MP are high because education is free ony up to eementary eve (from cass I to VIII). The cost of education beyond the eementary eve is rising sharpy and high cost of education discouraged househod (especiay marginaized socia groups) to pursue education. Due to this, persons from deprived socia groups are avoiding costy education and compeed to enter into abour force for surviving themseves and their famiy. The educationa and economic backwardness of deprived socia groups puts severe constraints on the househod s abiity to invest on educationa services which generay opens better job opportunities for the househods. High cost of educationa services consumes arger part of househod s budget and eaves ess budget for expenditure on other basic needs. The pattern of heath expenditure (institutiona and non-institutiona) aso ceary indicates that the monthy per capita heath expenditure has increased across the socia groups during and The rising costs of heath services have aggravated the catastrophic out-of-pocket heath expenditure. The monthy per capita non-institutiona heath expenditure is much more than institutiona heath expenditure across a the socia groups. It is because, the institutiona heath expenditures are more costy than noninstitutiona heath services and to a esser extent; it is covered by some government supported heath insurance schemes. But, the rapidy rising noninstitutiona heath expenditure puts more financia burden on the househods and consumes a bigger part of the househod s budget. The high cost of heath services (both institutiona and non- 96 Vo (3), Issue-4, Apri IJSIRS

13 institutiona) are affecting every sections of the economy but the deprived socia groups are being affected more severey by high cost of heath services. The mafunctioning pubic heath care system and ack of financia protection against any heath shocks have acceerated the vunerabiity of marginaized sections of economy in both states. The high cost of heath services, which is refected through catastrophic out-of-pocket heath expenditure, is aso responsibe for high incidence of poverty and indebtedness of deprived socia groups in both states. Because the poor persons finance their heath expenditure by past saving, seing productive assets, borrowing from reatives and moneyenders at high rate of interest and most of the poor do not sette their debt which push them into debt trap and vicious cyce of poverty. Poicy Impication The cost of educationa services shoud be checked by government and the government shoud make education free up to higher secondary eve and aso technica and ski formation curricuum shoud be incuded in syabus. The quaity aspect of educationa services of pubic supported institutions and schoos shoud be enarged by strong monitoring on absentee teachers and maintaining good teacherstudent ratio. The high out-of-pocket heath expenditure can be reduced by (1) raising the pubic investment in creating a vibrant and we-functioning pubic heath care sector which provide equa heath services to a section of society that is universaizing heath care system, (2) universaizing forma and pubicy financed heath insurance coverage and (3) controing drugs prices and ensuring greater avaiabiity of drugs at pubic heath care centre (institutions). These poicy measures wi hep in both raising status of human deveopment and breaking vicious cyce of poverty and debt trap of marginaized socia groups. References John J. (2007), A comparative study on Private Consumption Expenditure Estimates in dia, Reserve Bank of dia Occasiona Papers, vo 28, no. 1, Summer 2007 Tiak, J.B.G. (2009), Househod Expenditure on Education and Impications for Redefining the Poverty Line in dia, A draft to Panning Commission, Government of dia. Avaiabe at panningcommission.gov.in/reports/genrep/tiak.pd Tiak, J.B.G (2002), Determinats of Househod Expenditure on Education in Rura dia Working paper series no. 88, Nationa Counci for Appied Economic Research, New Dehi. Becker, Gary S. (1964) Human Capita. New York: Nationa Bureau of Economic Research Mehrotra, S. (ed.) (2005) The Economic of Eementary Education: The Chaenga of Pubic Finance, Private Provision and Househod Costs. New Dehi, Sage. Mehrotra, S. et a. (2005) Universaizing Eementary Education in dia: Uncaging the Tiger Economy. New Dehi: Oxford. Tiak, J..B.G (2002) Education and Poverty, Journa of Human Deveopment 3 (2) (Juy) Tika, J.B.G. (1996) How free is free Primary Education in dia? Economic & poitica weeky, Schutz, T.W. (1961) vestment in Human Capita, American Economic Review 51 (1) March:1-15. Chowdhury, S. (20114). Pubic Retreat, Private Expenses and Penury A Study of Iness duced Impoverishment in n dia. Avaiabe at df. Issa, H., & Ouattara, B. (2005). The Effect of Private and Pubic Heath Expenditure on fant Vo (3), Issue-4, Apri IJSIRS 97

14 Mortaity Rates : does the eve of deveopment matters? Avaiabe at es/stories/1.../21-37.pdf Aam, K., & Maha, A. (2014). Economic impacts of heath shocks on househods in ow and midde income countries: a review of the iterature. Gobaization and Heath, 10(1), 21. Van Damme, W., Van Leemput, L., Por, I., Hardeman, W., & Meessen, B. (2004). Out-ofpocket heath expenditure and debt in poor househods: Evidence from Cambodia. Tropica Medicine and ternationa Heath, 9(2), Srinivisan, R. (2013). Heath Care in dia - Vision Panning Commission, Government of dia. panningcommission.nic.in/reports/genrep/bkpa p2020/26_bg2020.pdf. Rama Jogekar (2008). Can surance Reduce Catastrophic Out-of-Pocket Heath Expenditure? IGIDR, Mumbai, pdf. Heijink, R., Xu, K., Saksana, P., & Evans, D. (2011). Vaidity and Comparabiity of Out-ofpocket Heath Expenditure from Househod Surveys : A review of the iterature and current survey instruments. Word Heath Organization Discussion Paper, Counrty Brief (2010). The Impact of Out-of- Pocket Expenditures on Poverty and equaities in Use of Materna and Chid Heath Services in Bangadesh Evidence from the Househod come and Expenditure Surveys , ADB. Pa, R. (2010). Anaysing Catastrophic OOP Heath Expenditure in dia : Concepts, Determinants and Poicy Impications Anaysing Catastrophic OOP Heath Expenditure in dia : Concepts, Determinants and Poicy Impications. dira Gandhi stitute of Deveopment Research, Mumbai, (February). Amakom, U., & Ezenekwe, U. (2012). Impications of househods catastrophic out of pocket ( OOP ) heathcare spending in Nigeria, 1(November), Journa of Reasearch in Economics and ternationa Finance vo1(5) Monda, S., Kanjia, B., Peters, D. H., & Lucas, H. (2010). Catastrophic out-of-pocket payment for heath care and its impact on househods : Experience from West Benga, dia. Avaiabe at Ministry of Heath and Famiy Wefare. (2015). Nationa Heath Poicy 2015 Draft (paced in pubic domain for comments, suggestions, feedback), Government of dia, New Dehi. Chowdhury, S. (undated), Heath Shocks and the n Poor: A Case Study of Sums in Dehi. Avaiabe at Rao, M. G., & Choudhury, M. (2012). Heath Care Financing Reforms in dia. Avaiabe at wp_2012_100.pdf Copyright 2015, Ram Singh. This is an open access refereed artice distributed under the creative common attribution icense which permits unrestricted use, distribution and reproduction in any medium, provided the origina work is propery cited. 98 Vo (3), Issue-4, Apri IJSIRS