Health and the Union Budget: IMA’s Viewpoint
New Delhi, February 24, 2016: India continues to have a high burden of diseases despite the various health program and policies, which have not been able to achieve the desired goals and objectives.
A High-level expert group (HLEG) on Universal Health Coverage (UHC) constituted by Planning Commission of India submitted its report in Nov 2011 for India by 2022. The recommendations for the provision of UHC pertain to the critical areas such as health financing, health infrastructure, health services norms, skilled human resources, access to medicines and vaccines, management and institutional reforms, and community participation. Planning commission has estimated that 3.30 lakh crores has to be spent in 12th FY period (2012-2017) to achieve the goal of UHC by 2022. We are already into fourth year of the 12th FYP and yet only a meager proportion of this amount has been budgeted so far on an annual basis.
Public spending on health - It is believed that an important factor contributing to India’s poor health status is its low level of public spending on health, which is one of the lowest in the world. In 2007, according to WHO’s World Health Statistics, India ranked 164 in the sample of 191 countries in per capita terms. This level of per capita public expenditure on health was less than 30% that of China (WHO, 2010). Also, public spending on health as a percent of GDP in India has stagnated in the past two decades, from 1990–91 to 2009–10, varying from 0.9-1.2% of GDP.
“If we look at the world health delivery models, most of the developed countries are health care providers, e.g. UK and most of the European countries, Australia etc. Some countries like United States are health care facilitators. India is neither a health care provider nor a facilitator. This is obvious from the budget allocations over the years, which have stagnated around 1%. India should have set apart at least 5% of the GDP for health care. India is neither a health care facilitator since the private sector which provides 70% of the health care is not, in anyway, supported by the Government. On the other hand, the government is bringing more and more regulations which affects financial viability of the private health care institutions and denial of health care through the private sector. 80% of health expenditure of our population is out-of-pocket”, Dr SS Agarwal, National President IMA & Padma Shri Awardee Dr KK Aggarwal, President HCFI and Honorary Secretary General IMA said.
A few of IMA’s suggestions for the Union budget:
- To increase the public expenditure on health from the current level of 1.2% GDP to at least 5% by the end of the 12th.
- To ensure that a minimum of 55% of health budget is spend on primary, 35% on secondary and a maximum of 10% on tertiary care services as against the current levels of 49%, 22% and 28% respectively
- Separate funds should be allocated for national disease control programs. Presently these programs cover only 15% of disease burden. Lifestyle diseases, re-emerging communicable diseases, health problems of the elderly, mental health, rare diseases, orphan drugs, etc. should receive adequate funds.
- There are 6000 rare diseases identified in India with 6 million people suffering from it. Recently, in a Judgment, the Supreme Court observed that all doctors should be aware about rare diseases. Two more Delhi High court Judgments by Justice Manmohan Singh have clearly defined that under Articles 14 and 21 of the Constitution, every person suffering from rare disease has the right to receive medical treatment free of cost from the State Govt.
- Special funds should be allotted for research and surveillance of epidemics like virology centers, research studies on possible newer epidemics like Ebola.
- There should be a separate budget to train 100% of general public in CPR. With this, more than 20 lakh deaths can be avoided even in the absence of medical professionals.
- Any outbreak is a national calamity for which a separate budget should be earmarked and should be supported by the national government. During the outbreak, the Govt. should provide charges for hospitalization, investigations and drugs to the effective person in the Govt. sector and reimburse at CGHS rates in the private sector. Also each death in the outbreak should be suitable compensated.
- Separate budget to treat all emergencies and the cost to be reimbursed at CGHS rates to any one providing the service.
- Funding of research centers should be increased and ensured, particularly health issues related to pilgrimages, mass gatherings, religious festivals and natural disasters and health impact of industrialization.
- Funding of special health issues among the tribal, coastal population, industrial townships should be separately earmarked.
- Food safety needs to be addressed with special fund for research and surveillance • Vaccine development and introduction to national vaccination schedule of new vaccines should be supported.