By Moa Jamir
If one recent dataset deserves close public attention, it is the latest National Sample Survey (NSS) 80th Round on Household Social Consumption: Health. Beyond rhetoric and policy claims, the NSS offers a rare window into how people in Nagaland actually seek treatment, where they go when sick, and how much they pay. The findings are both reassuring and concerning.
The reassuring part is clear: public healthcare remains the backbone of Nagaland. According to the survey, 74.5% of all hospitalisation cases in Nagaland were treated in public hospitals, more than double the national average of 36.7%. In rural Nagaland, dependence was even higher at 78.2%. For non-hospitalised treatment too, public facilities dominated. In rural areas, 84.6% of treated ailments were handled by government hospitals or public institutions, the highest share among states in India. Even urban Nagaland recorded 56.7%, far above the national urban average of 25.2%.
These figures matter. They challenge the assumption that public hospitals are peripheral or optional. In Nagaland, they are central to survival. This reliance is not merely a matter of trust. For vast majority, it is the only viable option and the healthcare access in the State, otherwise, would be precariously weakened. Besides, overall average out-of-pocket medical expenditure (OOPME) per hospitalisation case and total medical expenditure per hospitalisation were below national levels.
But the troubling part of a nuanced reading of the NSS is affordability.
Despite heavy dependence on public institutions, the cost burden remains high in key areas. The average expenditure per hospitalisation case (excluding childbirth) in Nagaland was Rs 16,420, compared to the All-India average of Rs 7,402.
Routine care is also expensive. The average OOPME for non-hospitalised treatment in rural Nagaland was Rs 1,828, while urban Nagaland stood at Rs 1,626, both significantly above national averages. This is no minor statistic. Non-hospitalised treatment includes common expenses such as consultations, medicines, tests, recurring treatment, fever, infections, and follow-up care. If routine treatment itself is costly, people delay care, self-medicate, or ignore symptoms until illness worsens.
The NSS also found Nagaland’s hospitalisation rate (excluding childbirth) at 16 per 1,000 persons, well below the national average of 29. While several factors may explain this, it can also indicate delayed admissions, poor access, limited capacity, or inability to bear treatment costs. Incidentally, urban Nagaland recorded a notable share of treatment being sought from informal healthcare providers (17.7%), raising serious questions about gaps in convenience, affordability, regulation, or confidence in formal systems.
This is where the recent findings of the Comptroller and Auditor General of India (CAG) become impossible to ignore. Audit reports pointing to shortages in workforce, weak infrastructure, equipment gaps, medicine shortages, and underperforming health facilities help explain why dependence on public hospitals does not automatically result in affordable or effective care. When hospitals lack doctors, diagnostics, drugs, or functionality, patients go elsewhere, including referrals outside the state.
Schemes such as the Chief Minister's Health Insurance Scheme may offer valuable relief and deserve recognition. However, insurance cannot compensate for dysfunctional systems. Financial coverage means little if patients must still travel long distances, purchase medicines privately, or wait for unavailable services. Besides, the persistence of high treatment costs in government hospitals despite such insurance may indicate limited beneficiary or treatment coverage, or charges that continue to fall outside the scheme’s protection.
Nagaland’s lesson from the NSS is straightforward: public healthcare remains the primary pillar for most people, not merely out of preference, but because it is the lifeline. If nearly three out of four hospital patients already use government facilities, strengthening them is neither charity nor symbolism; it is sound public policy. The State must now match that dependence with quality, efficiency, and affordability
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