Health Budget should focus on Universal Health Coverage, post-Covid challenges says J.A. Jayalal president of IMA Budget has always been an important event for every government. In the past, every time the economy has always remained the key focus of the budget. Will this year be the same again or the pandemic will force the government to change the perception and the focus towards healthcare after economy keeping in mind the challenges in short and long run.
In 2021, it is expected that this time the government should redefine it approach towards healthcare. It is unfortunate that India being one of the largest and fastest growing economies in the world has not paid the required attention towards healthcare. In the last year, budgetary allocation for the health sector was Rs 69,000 crore which was just one per cent of GDP. As per WHO estimate, India ranks 184th out of 191 in terms of GDP per cent spend on healthcare.
India’s total healthcare spending (out-of-pocket and public), at 3.6 percent of GDP is very low as compared to OECD countries where average spending was 8.8 percent of GDP in 2018. However the figure for the developed nations like USA is more than 16 per cent, France 11.2 per cent, Germany 11.2 per cent and Japan more than 10 percent. Also India’s spending is the least among BRICS countries. Therefore, Covid-19 pandemic crisis is a wake-up call for investing more in the healthcare sector.
Health Budget should focus on Universal Health Coverage…
According to Laparoscopic surgeon J.A. Jayalal, National President of the Indian Medical Association (IMA) who also chairs the UNESCO Bioethics in India, “Food security, Primary Education, Primary Justice and Primary Healthcare are the minimum requirement of common man. Health care needs coordinated effort of all health providers. The benchmark set for the standard health are Accessibility, Affordability (by subsidy or other means) and Quality (in delivery of health care and education) health care for all. The accepted health standards are: equitable distribution between urban and rural India and amongst the states. More than 60 percent doctors and 84 percent hospital beds are in cities where only 20 percent population resides. Private and public health should support each other. Public Health is the responsibility of the state yet the investment is comparatively low. Disease burden is 21 percent of the world.”
On fund allocation, he says, “The budget for the Health sector must be increased to 3.5 per cent of GDP. Additional allocation for Covid vaccination program is a must. Ayushman Bharath program to provide Rs.5L coverage to 40cr citizens and 1,00,000 wellness centres require fund allocation to the tune of 50,000 crores compared to present allocation of 6000 Cr.PPP must be encouraged, there should be provision for incentives for healthcare providers such as income tax rebate, medicine and instruments at lesser cost. To strengthen the complementary roles of Public and private sectors in health care, sustainable model/s should be worked out, for re-imbursements to private hospital, in cases where emergency care is provided by the private sector. Government should allocate funds for such reimbursement. For better health care for the people, the requirements in infrastructure and basic health facilities need immediate attention. Health Budget 2020 should focus on Universal health coverage.
On infrastructure and Tax, he says, “Health should be given infrastructure status and should be notified. No commercial rate for electricity and water consumption. It should be flat domestic rate without any slabs. There should be Tax exemption for life saving equipments and drugs. Machines or equipments (including endovascular stents, surgical brushes, PDS Plates, medical grade PVC sheeting for manufacture of continuous ambulatory peritoneal dialysis system, should also be either duty free, or a reduction in taxation is recommended (customs as well as excise).
Service Tax on medical insurance should be removed and Tax rebate on Preventive health check-up and health insurance should be increased. Tax rebate should be provided for Research and Development. Special incentives should be provided for R & D. Hospital should not be treated as “commercial venture”; property tax and land taxes should be charged at normal rates.”
He adds, “Products that are indigenously manufactured and compatible with their costlier counterparts, should be encouraged as an option, through CGHS and other Government run health schemes; a fixed proportion of such health care products in these programs could be a useful step in cost cutting. Amount allocated for the health projects are not spent or utilized optimally; timely disbursement of the funds for the projects are essential, reform measures must be taken. Quarterly audit should be implemented and expenditure as per plan must be monitored; organizations that could spend the funds effectively should be awarded. For telemedicine and mobile unit separate funds must be allocated.”
“The elderly should be included under medical insurance cover. Soft loan for medical education and for opening of medical establishments. To encourage medical tourism, Visa procedures should be made easier for overseas patients seeking treatment in India. This could be a robust step towards attracting flow of funds by offering state of art medical care, to foreign beneficiaries. The deficit in the area of skilled workers in health sector especially in some states, as well as care providers in community settings(such as attendants to geriatric and other special groups ) should be addressed through increasing training institutions devoted to this purpose, in addition to existing programs provided by medical colleges,” he said on facilities and benefits.
He also feels, “There should be no compromise on quality and skill: Medical colleges and training centers to increase man power to be set up in backward areas. AIIMS for states only will not suffice Central funds to be provided in budget. As a step towards equitable distribution of tertiary health care, upgradation of district hospitals to medical colleges or super specialty hospitals should be considered. Seats for medical education should be proportionately increased, to equip such hospitals with healthcare professionals possessing requisite skills, in all categories. Central government should recruit doctors and other healthcare personnels and deploy in backward areas.”
Health Budget should focus on Universal Health Coverage,ie. “Compulsory medical insurance for all the Indian Medical Doctors“
“Compulsory medical insurance for all the Indian Medical Doctors at subsidized rates. Safe drinking water and sanitation must be accessible universally. Services in the areas of maternal and child health, Mental health, geriatrics and cancer, rehabilitation and treatment of disabled should be further strengthened. Use of Generic drugs should be encouraged and they should be made widely available, while monitoring the retail price of such drugs. Micro insurance (low premium for low income group, also for senior elderly people) must be addressed. Rare disease policy to be defined and fund earmarked for management of rare diseases (like liposomal storage disease etc),” he demanded.