On Budget 2023: Health in Amrit Kaal

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• Recently, 2023-24 Union Budget speech, the finance minister announced that the total central government budget for health will be roughly be Rs 615 for every citizen.

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• About:
  • In her 2023-24 Union Budget speech, the finance minister announced that the total central government budget for health will be roughly Rs 86,175 crore ($10 billion) — that is, roughly Rs 615 for every citizen. 
    • This is a 2.7 percent increase from the previous fiscal year and lower than the rate of inflation.
    • In real terms, the central government’s health spending has declined. 
• Significance of budgetary spending on health:
  • The $10 billion spent by the central government may be a small fraction of overall health spending but it is consequential as it pays for: 
    • Immunisation, newborn and child health and nutrition, maternal health, infectious disease control, health systems and training. 
  • This spending by the government purchases far more health than out-of-pocket or private spending by Indian citizens.

Issues with the lower budgetary allocations on health

• Burden of healthcare in India:
  • Vaccinating a single child against all childhood illnesses costs at least Rs 1,600.
  • A day of hospitalisation at a public hospital is estimated at Rs 2,800. 
    • At a private hospital, it is Rs 6,800. 
  • Add to these the expenses for supporting women through deliveries, control of infectious disease, primary healthcare, and much more.
  • It is, therefore, no surprise that the system fails the most vulnerable and they are forced to turn to the expensive private sector.
• For elderly and sick: 
  • The poor, elderly and sick are already at a disadvantage and the burden of health expenditure makes this even worse.
• Increasing poor and non-poor gap:
  • A greater proportion of disposable incomes is taken away from a poor household as compared to a non-poor one, further broadening the gap between the two. 
    • If sickness hits a working member of the household, she/he must often withdraw from active employment and their main source of income dries up at the time when they urgently need more money for treatment.
    • Households have to often sell or mortgage their productive assets, such as land and cattle, to cover the treatment costs.
      • This further reduces their capacity to bounce back. 
  • According to the WHO, 55 million people fall into poverty or deeper poverty every year due to catastrophic expenditures on health.
• Lesser spending than the Lower and Middle-Income Countries:
  • India currently spends about Rs 8 lakh crore or about 3.2 percent of its GDP on health. 
  • This is much lower than the average health spending share of the GDP — at around 5.2 percent of the Lower and Middle Income Countries (LMIC).
  • Comparing the data:
    • Of this, the government (Centre and states put together) spends about roughly 1.1 percent of the GDP. 
    • Contrast this with the government health expenditure in countries like China (3 percent), Thailand (2.7 percent), Vietnam (2.7 percent) and Sri Lanka (1.4 percent).

Suggestions

• Rationalising NHM spendings:
  • The National Health Mission allocates less than 3 percent to non-communicable diseases (NCD) flexipool. 
    • In comparison, the allocation for communicable diseases is three times more.
  • The burden of disease from NCDs accounts for more than half of the total burden of disease. 
  • Greater focus on communicable diseases is driven by past epidemiological patterns and should be rebalanced now to pay attention to non-communicable diseases.
• Balancing Urban and poor health care:
  • Public health and primary health care focus on rural areas. 
  • Urban areas have poorly developed infrastructure for primary care even if secondary and tertiary health care services are better. 
    • For example, immunisation coverage is now lower in urban India than in rural India. 
  • A third of the country now lives in urban areas and greater resources are needed to improve health here.
• Focussing on Health research:
  • Health research has been neglected for too long.
  • The bulk of the resources provided to the Indian Council of Medical Research goes towards maintaining a large payroll of scientists and the output is poor.
  • India should follow the example of countries where government-funded health research is conducted at academic institutions, and the government’s role is to make grants and not to carry out the majority of research. 
    • Competitive funding will encourage the best research and the example of the Wellcome Trust/DBT-India Alliance in promoting the culture of competitive grants can be replicated across the system.

Way ahead

• This is not an example of efficient use of resources when the country spends too little on health, too many people suffer the consequences of ill health.
• The health (and education) of Indians is the most important determinant of what the country can achieve during the next 25 years of Amrit Kaal. 
• We must find ways to both find more money for health, and also more health for the money to ensure that all Indians achieve their true potential.

Source: IE