By Dr. Gyan Pathak
The past three years under the shadow of COVID-19 has indisputably exposed the weakness of healthcare sector that resulted in great loss of lives and livelihood, but it is still waiting to be treated as priority sector by the Narendra Modi Government. India’s public health expenditure is still woefully insufficient to deal with the present and projected health related disasters caused by both communicable and incommunicable diseases, and the country is not on track to be prepared for any future health emergencies.
It is reflected in the public health expenditure of the country that was only 2.1 per cent of the GDP in 2021-22, as against 1.8 per cent in 2020-21 the year of COVID-19 outbreak. In the pre-pandemic year 2019-20 it was only 1.3 per cent as against the National Health Policy, 2017 target of 2.5 per cent to be achieved by 2025. Since the National Health Policy 2017 does not reflect the requirements of the present because it was framed three years before the pandemic, the Centre needs a fresh assessment of the situation and revising its target upwardly along with considerable increase in funding.
The Centre must not try to push the real issues in the healthcare sector under the carpet by the public sectors schemes like Ayushman Bharat Yojna which is merely a health insurance scheme that comes into operation only when a patient is hospitalized. Most of the patients are therefore not covered under such schemes and they suffer from lack of doctors, nurses, and even access to public health facilities. They cannot afford the high cost of private hospitals and doctors, and even if they could, the number of health professional and infrastructure are too little to be able to provide proper care to all patients.
The Union Budget 2022-23 had earmarked only Rs86,200 crore for healthcare sector and that too was driven by increased allocation to centrally sponsored public health schemes such as Pradhan Mantri Swasthya Suraksha Yojna (PMSSY), Human Resources for Health and Medical Education, and PM Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) among others to continue building sustainable healthcare infrastructure. However, the requirement is much more than what was allotted as a budgetary provision. Needless to say that the forthcoming budget needs to do much more for health infrastructure and healthcare education and training.
To increase the number of health professionals and infrastructure, Modi government has come out with some very bad ideas, one of them is privatization of district hospitals in the country. Temptation is being given that the private sector would run those hospitals more efficiently and they would also open medical colleges which would enhance number of medical professionals by providing education and training. Here again the government is trying to push the real issue facing the people of the country under the carpet of such schemes. Since privatization of district hospitals would make medical care more costly there, it would indirectly block access of common people by making it unaffordable.
The budget 2023-24, therefore, must not opt for such schemes, but must boost public infrastructure in both the towns of the country and rural areas. With just 0.6 doctors and 0.9 hospital per 1000 people at present, the entire healthcare sector presents a huge hurdle for the common people in the country in accessing healthcare. Modi government must try to overcome this huge challenge by meeting huge investment needs to reach the recommended level of 44.5 skilled health workers per 10,000 people as per WHO to meet Universal Health Coverage to all.
One thing the budget can do is reducing the ever rising cost of medicines and diagnostic tests. It could be done in various ways that may included putting a cap of price and reducing taxes.
Since healthcare sector has already become one of the largest sectors, both in terms of revenue and employment, and is growing at a brisk pace, Union Budget 2023-24 should now declare it a priority sector, and should try to change its focus from the present limited secondary, tertiary, and basic primary health to full medical coverage for the common people, since the majority of secondary, tertiary, and quaternary care are chiefly provided by private sector which are chiefly concentrated in the bigger cities. Such facilities should be created in smaller cities also by public funding, since private sector in not interested in such efforts on account of less profitability.
Since healthcare industry has been estimated growing at about 22 per cent CAGR between 1016 and 2022, health segment insurance grew by 33.33 per cent in share of total gross written premiums earned, medical tourism market size is expected to reach $13.42 billion by 2026, e-health market size is estimated to reach 10.6 billion by 2025, the Union Budget 2023-24 must not hand over everything to private sector only for profit of the private national and multinational companies. Without considerable increase in public sector investment common people would suffer.
Two areas are of great concern – increasing the number of health professionals and reducing the cost of treatment. Human resources for health and medical education was allotted only Rs7,500 crore last year which was a pittance which needs to be considerably enhanced this year. As for reducing cost of treatment the Centre needs stricter price control which can be done through increasing public health facilities – both hospitals and diagnostic test centres – and implementing control mechanism for both drugs and medical tests. (IPA Service)
