Healthcare in India needs a rapid overhaul and many in the sector hope that the Union Budget would be able to galvanise this with an increase in spending in healthcare.
According to the medium term expenditure projection statement presented in Parliament by the Ministry of Finance earlier, the government had allocated Rs 52,800 crore (budget estimates) in the health sector. This interim budget didn't focus on the government's flagship scheme, the National Health Mission, with it receiving a marginal increase of Rs 1,600 crore against 1,400 crore in 2018-19.
Recently, a NITI Aayog report painted a grim image of two India’s when it came to healthcare. On the one hand, Kerala, Andhra Pradesh and Maharashtra topped the chart on the basis of overall performance, while five states — Bihar, Uttar Pradesh, Uttarakhand, Madhya Pradesh and Odisha — saw a decline in the overall health index score and “only about half the states and union territories had an improvement in the overall score between 2015-16 and 2017-18, according to the second edition of health index launched by NITI Aayog.
The health index is a composite measure of states and union territories calculated on the basis of health indicators with weightage on the basis of outcome. In other words, the index is supposed to prove a comprehensive view of health outcomes, while taking into account the efficacy of governance, policies, processes and interventions. The report was prepared in collaboration with the ministry of health and family welfare (MoHFW) and the World Bank.
As of 2018, the country spent a little over 1% of its GDP on health, the National Health Profile (NHP) data revealed. India's per capital expenditure on health rose from Rs 621 in 2009-10 to Rs 1,112 in 2015-16.
This is in spite of India being the world's sixth-largest economy. The United Kingdom, for instance, spent 9.6% of its GDP on health in 2017, while the United States’ health expenditure is around 18 per cent of its GDP.
"The Ayushman Bharat scheme can significantly reduce this,” said an official of the ministry, while adding that it had the potential to reduce out-of-pocket expenditure. However, other problems remained — over-dependence on a few institutions, delay in access to treatment and a crumbling primary care infrastructure.
To address this, experts said, the government was likely to focus on healthcare access in areas where people live, instead of relying on a smattering of institutions located in big cities. The next stage of the Ayushman Bharat scheme will be the setting up of 1,50,000 health and wellness centres under the scheme, that will focus on screening, community-based management of basic health issues and preventive treatment.
However, the high cost of medicines in India remains a problematic issue, said doctors. According to studies, nearly 70% of healthcare expenses are paid by Indians from their own pockets — one of the highest globally.
This is compounded by the lack of preventive treatment. The National Health Profile 2018, released by the Central Bureau of Health Intelligence, points out that without access to preventive oncology, over 70 per cent of cancers are diagnosed after reaching stages III or IV, where treatment is unlikely to succeed and is very expensive.
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