Ahead of the general elections, the medical fraternity has complained of minor boost to the health sector, with a meagre 2.1% GDP expenditure on healthcare according to the Economic Survey FY23 report tabled in the Parliament by the Union finance minister last year. Dr RV Asokan, National President, Indian Medical Association (IMA), in a conversation with Ashish Srivastava, lays out the demands of the medical fraternity before the politicos, urging them to emphasise the necessity of public health.
Excerpts:
IMA has repeatedly urged politicians to focus on health in their election manifestos. The GDP expenditure on healthcare in India lags behind that of many countries, especially at a time when we are witnessing a severe public health crisis in the form of the Covid pandemic. Do you think public health is absent from the political discourse?
Health remains a blind spot. Substantial issues like health and education should become key determining factors in the general elections. Health being a state subject does have some bearing in state assembly elections. However, during parliamentary elections, other issues have dominated the discourse. Public expenditure on health in the country is 2.1 % of the GDP. If other health determinants like drinking water are excluded, expenditure on health itself has remained stagnant. The IMA’s major demand in the Health Manifesto will be to increase this share. We will press the government to increase this to at least 2.5%. Unless it rises, it would not be possible to provide universal healthcare. Infrastructure and human resources in the public health sector needs to be augmented.
While the Union government boasts of the Ayushman Bharat scheme (AB-PMJAY), the IMA has been critical of it. What are your concerns?
Ayushman Bharat has to be re-envisioned. Care in government hospitals is free for patients anyway. How is a patient benefited by channelling funds to government hospitals, that too through insurance companies? AB-PMJAY should be for exclusive strategic purchase from the private sector for providing additional services to the poor. The government should fund its hospitals directly outside the Ayushman Bharat scheme. Small private hospitals in tier-2 and tier-3 cities are on the verge of shutting down because of scarcity of resources. Meanwhile, the government injects funds into already funded government hospitals. The exclusion of several procedures for private hospitals under the AB-PMJAY does not inspire confidence. Around 66% of patient care is provided at government hospitals. Why is there a need for Ayushman Bharat in the government sector? Public hospitals are already free, more than 60% of the scheme's money is going to the funds of government hospitals. What is the point of paying 15% to insurance companies?
Why is the IMA opposing the new NMC (National Medical Commission) logo, asking for it to be religion-neutral? The previous logo had the same picture but in black and white.
Honestly, we must have overlooked it earlier. If we had spotted it, our response would have been the same. IMA stands aligned with the Constitution of India. The new logo of the NMC is in contradiction with our fundamental values as doctors. It is not in conformity with the oath and duty of doctors, which is not towards any particular religion. The logo of any national institution ought to capture the aspirations of all citizens in an equal manner and, by remaining neutral in all respects.
The medical fraternity has been demanding a central protection law for Indian Medical Services along the lines of UPSC. What is the response from the Centre so far on these developments and how do you plan to proceed with these demands?
Our demands have been met with silence from the Union government. But we remain undeterred. We will persist. We will take our demands before the people.