With 10.6% of the total amount in the Interim Budget is allocated to defence, only 2.2.% is allocated to healthcare. Despite several innovations in the healthcare sector in recent times, the government remains woefully short of its ambition to increase public health spending to 2.5% of GDP. At present, health spending is only 1.15-1.5% of GDP.
Concern – Per capita spending on health –
According to the National Health Profile of 2018, public per capita expenditure on health increased from ₹621 in 2009-10 to ₹1,112 in 2015-16. Despite the doubling of per capita expenditure on health over six years, the figure is still abysmal.
International comparisons –
- The U.S. spends $10,224 per capita on healthcare per year (2017 data). A comparison between two large democracies is telling: the U.S.’s health expenditure is 18% of GDP, while India’s is still under 1.5%.
- In India, allocation for healthcare is merely 2.2% of the Budget. Per capita spending on health in the Budget in India is ₹458 (₹61,398 crore/ 134 crore, which is the population). Adjusting for purchasing power parity, this is about $30 — one-hundredth of the U.S.
- Even though the ₹6,400 crore allocation to Ayushman Bharat-PMJAY in the Interim Budget will help reduce out-of-pocket expenditure on health, which is at a massive 67%. But per capita Budget expenditure on health in India is among the lowest in the world.
Response from Government –
- Last year, it was announced that nearly 1.5 lakh health and wellness centres would be set up under Ayushman Bharat. The mandate of these centres is preventive health, screening, and community-based management of basic health problems.
- The mandate should include health education and holistic wellness integrating modern medicine with traditional Indian medicine. Both communicable disease containment as well as non-communicable disease programmes should be included.
- An estimated ₹250 crore has been allocated for setting up health and wellness centres under the National Urban Health Mission. Under the National Rural Health Mission, ₹1,350 crore has been allocated for the same.
What should be done?
- NITI Aayog has proposed higher taxes on tobacco, alcohol and unhealthy food in order to revamp the public and preventive health system. This has not found its way into the Interim Budget.
- A focused approach in adding tax on tobacco and alcohol, to fund non-communicable disease prevention strategies at health and wellness centres, should be considered.
- Cancer screening and prevention are not covered. There is no resource allocation for preventive oncology, diabetes and hypertension. Prevention of chronic kidney disease, which affects 15-17% of the population, is not appropriately addressed.
- Due to lack of focus in preventive oncology in India, over 70% of cancers are diagnosed in stages III or IV. The standard health insurance policies cover cancer but only part of the treatment cost. As a consequence, either out-of-pocket expenditure goes up or patients drop out of treatment. It needs to be addressed immediately.
- The 1,354 packages for various procedures in PMJAY must be linked to quality.
- For various diseases, allocation should be realigned for disease management over a defined time period, not merely for episodes of care.
- Since a major innovation in universal healthcare, Ayushman Bharat, is being rolled out, it must be matched with a quantum leap in funding.
Only if we invest more for the long-term health of the nation will there be a similar rise in GDP.
Source – The Hindu