The Economic Survey 2023-24 underscores a troubling stagnation in government spending on health with allocations remaining at a mere 1.9% of GDP for 2022-23. Despite government assertions of advancements in the health system, experts argue that these investments are insufficient.
In an interview with the newindianexpress.com, Dr RV Asokan, President of the Indian Medical Association, noted that the health sector received only a 1.7% budget increase, inadequate for addressing the country's healthcare needs. Government investment remains at 1.1% of GDP, effectively decreasing when inflation and economic growth are considered.
The lack of promotion for HPV vaccination in the recent budget raises significant concerns about cervical cancer prevention. Programs such as HPV vaccination and sickle cell interventions, announced in previous budgets, are yet to be implemented, leaving preventive healthcare lacking.
Funding for the Ayushman Bharat scheme is minimal, hindering its capacity to support the poorest 40% of the population. Dr. Asokan suggests that the Pradhan Mantri Jan Arogya Yojana (PMJAY) should be reserved for strategic purchases from the private sector due to chronic underfunding.
Reduced funding for the Ayushman Bharat Digital Health Mission threatens the digitization of health records. Dr. Asokan emphasises the need to address issues of legality and data security urgently.
While there is increased funding for the National Health Mission (NHM), it may not sufficiently address primary healthcare challenges, particularly maternal and child health. Dr. Asokan recommends that the Ministry of Health integrate NHM functions directly to improve efficiency.
Strategic Recommendations
To ensure sustainable improvements, Dr. Asokan advocates for a tax-funded, public-sector-driven universal healthcare system, supported by strategic private sector purchases. He argues that private-public partnerships cannot replace the foundational role of the public sector in healthcare.
For meaningful progress in India's healthcare system, prioritising health in budget allocations and leveraging public infrastructure are essential. Increased public investment and strategic engagement with the private sector are crucial for delivering effective healthcare services.
Dr. Asokan also highlights the disparity in healthcare infrastructure and services between states, noting that southern states have better systems in place. Primary Health Centres (PHCs) and sub-centres, the last health outposts, have seen no new openings and remain stagnant in numbers. These centres, based on the Bhore Committee's recommendations from 1946, need to be re-envisioned and restructured to meet current population and human resource needs, including posting doctors in sub-centres.
Dr. Asokan criticises the current funding, stating that all governments are neglecting healthcare due to a lack of political will and understanding. He estimates that 5% of GDP, approximately 17 lakh crores in a 4 trillion economy, is necessary for adequate healthcare funding. Currently, the health sector is allotted around 87,000 crores, which is about one-fiftieth of the total budget.
Taking PMJAY as an example, Dr. Asokan points out that while the vision is commendable, the scheme is poorly conceived and underfunded, with 66% of the funds reserved for the government sector, diminishing the scheme's impact.
The Right Healthcare Model
The current trend towards an insurance model, similar to the one in the US, is a failed approach according to Dr. Asokan. Instead, he advocates for a tax-funded model like the NHS in the UK, supplemented by small and medium hospital sectors, an intermediary between the for-profit corporate and government sectors, which the UK model lacks. This would provide a basic healthcare package for everyone, ensuring Universal Health Care (UHC), not just Universal Health Coverage (UHC).
Universal Health Care vs. Universal Health Coverage
Universal Health Care (UHC) refers to a healthcare system where everyone has access to essential healthcare services without financial hardship. It emphasises:
1. Equitable access
2. Comprehensive benefits
3. High-quality services
Universal Health Coverage (UHC), on the other hand, focuses on ensuring financial protection against healthcare costs. It aims to:
1. Ensure access to necessary healthcare services
2. Protect people from financial ruin due to medical expenses
3. Reduce out-of-pocket payments
Key Differences
1. Scope: UHC encompasses the entire healthcare system, while UHC focuses specifically on financial protection.
2. Emphasis: UHC emphasises access, quality, and equity, whereas UHC prioritises financial risk protection.
3. Metrics: UHC is often measured by access metrics (e.g., coverage rates), while UHC is measured by financial protection metrics (e.g., out-of-pocket spending).
Universal Health Care is a broader concept that encompasses the overall healthcare system, while Universal Health Coverage is a specific aspect that focuses on financial protection against healthcare costs.