Health Spending in India

In News

• The Union government’s healthcare spend dropped to 1.28 percent of the Gross Domestic Product (GDP) in 2018-19 from the previous year’s figure of 1.35 percent.

Key Findings

• Fall in expenditure: 
  • According to the National Health Accounts Estimates 2018-19, the total health expenditure — the total money spent on healthcare by the government, people, private entities and external funding — has fallen from 3.9% of the GDP to 3.2% in five years ending in 2018-19.
  • The decline in proportion to GDP has happened despite an increase in the government’s share of the country’s total health expenditure — from 29 percent in 2014-15 to 40.6 percent in 2018-19.

• Spending on Health Schemes: 
  • Government spending on health schemes contributed 9.6 percent of the total health expenditure, as against 9 percent the previous year. 
  • Ayushman Bharat was rolled out in the September of the same year to which the report pertains. Hence, this proportion is likely to increase in the subsequent reports.
• Increasing Non-Government Spending: 
  • Other than government spending and people spending out-of-pocket, private health insurance accounted for 6.6 percent of the total health expenditure, against 5.8 percent the previous year.
  • There have been huge increases in the premiums over the last few years. 
  • People paying for healthcare expenses out-of-pocket made-up 48.2 percent of the total health expenses in the year 2018-19, a small drop from 48.8 percent the previous year. Out-of-pocket expenses have now decreased substantially from the 62.6 percent seen during 2014-15.
  • There is no on-ground explanation for the drastic drop in out-of-pocket expenditure. This drop has been worrying many,

Challenges with Health Sector

• Lack of Infrastructure: India has been struggling with deficient infrastructure in the form of lack of well-equipped medical institutes and less-than-adequate human resources. 
• Shortage of Manpower: Shortage of efficient and trained manpower and the situation remains worrisome in rural areas.
• Adversely Affects the Poorest: 
  • The chronic under-funding of the healthcare sector affects the poorest. 
  • Bad infrastructure in public facilities, long queues at hospitals such as AIIMS, or issues with accessing the facility leads to even the poorest spending out of pocket and going even to unlicensed practitioners.
  • The share of the richest 20 percent of the population in total public sector subsidies is nearly 31 percent, almost three times the share of the poorest 20 percent of the population.
• Huge Patient Load: Even prior to the outbreak of the Covid-19 pandemic, healthcare facilities had been feeling the strain due to unmanageable patient-load. 
• Large Out-of-Pocket Expenditure: High out-of-pocket expenditure remains a stress factor. It is estimated that public funding accounts for only 22% of the expenses on healthcare in India. Most of the remaining 78% of private expenditure is out-of-pocket expense. 

Recent Government Initiatives

• The Union Budget 2022-23: 
  • Rs. 86,200.65 crore was allocated to the Ministry of Health and Family Welfare (MoHFW).
  • Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) was allocated Rs. 10,000 crore
  • Human Resources for Health and Medical Education was allotted Rs. 7,500 crore.
  • The National Health Mission was allotted Rs. 37,000 crore 
  • Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) was allotted Rs. 6,412 crore.
• Ayushman Bharat Digital Mission:
  • In September 2021, Prime Minister of India launched the Ayushman Bharat Digital Mission. 
  • The mission will connect the digital health solutions of hospitals across the country with each other. 
  • Under this, every citizen will now get a digital health ID and their health record will be digitally protected.
• The Ministry of Health has issued guidelines to states to establish a public health cadre.
• In November 2021, the Government of India, the Government of Meghalaya and the World Bank signed a US$ 40-million health project for the state of Meghalaya. 

Way Ahead

• Three Es: 
  • The existing scenario suggests that public healthcare service should ensure three “Es- Expand – Equity – Excellence”. 
• Family Health Teams (FHT): 
  • Like in Brazil, India needs Family Health Teams (FHT) accountable for the health and wellbeing of a dedicated population.
  • The FHTs must consist of a doctor with a diploma in family medicine and a dozen trained personnel.
• Expansion of Tertiary Care: 
  • Access to adequate health care would need expansion of tertiary care facilities. 
  • Tertiary care should be equitably distributed to different segments of population. 
• Addressing Imbalances: 
  • The setting up of new facilities will have to address imbalances at three levels- Regional, specialties, and ratio of medical doctors to nurses and other healthcare professionals. 
• Right Positioning: 
  • India needs to move beyond the doctor-led system and paramedicalise several functions. 
  • E.g. Instead of “wasting” gynaecologists in CHCs, midwives can provide equally good services except surgical, and can be positioned in all CHCs and PHCs. 
  • This needs to be acknowledged and trained persons appropriately positioned based on patient load and disease burden.

• Quality Medical Education: 
  • The expansion in the next five year plan must be systematic whose contours must be based on infusing quality in the future medical education and care.
• Public Health Cadre: 
  • More immediately, there must be a public health cadre manning the posts at the PHC and CHCs consisting of sub-specialists in family medicine, public health and public health management. 

• Comprehensive Review: 
  • Bringing such a transformative health system will require a comprehensive review of the existing training institutions, standardising curricula and the qualifying criteria. 
  • It is time our political systems listen to peoples’ voices for a family doctor to ensure their everyday needs — and not easy options like privatisation, commodification and medicalisation of the system. 

Source: IE