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