India needs to focus on long-term investment, not only episodes of care

• The Central and State governments have introduced several innovations in the healthcare sector in recent times, in line with India’s relentless pursuit of reforms.
• However, while the government’s goal is to increase public health spending to 2.5% of GDP, health spending is only 1.15-1.5% of GDP.
• To reach its target, the government should increase funding for health by 20-25% every year for the next five years or more.
• While the Interim Budget is responsive to the needs of farmers and the middle class, it does not adequately respond to the needs of the health sector.

Per capita spending on health

• Despite the doubling of per capita expenditure on health over six years, the figure is still abysmal.
• In India, allocation for healthcare is merely 2.2% of the Budget.
• Per capita spending on health in the Budget in India is Rs.458 (Rs.61,398 crore/ 134 crore, which is the population).
• Medicare and Medicaid come under ‘mandatory spending’ along with social security adjusting for purchasing power parity, this is about $30 — one-hundredth of the U.S.
• Yet, the $4,000-$5,000 per capita spending in other OECD countries is not comparable with India’s dismal per capita health expenditure.
• The Rs.6,400 crore allocation to Ayushman Bharat-PMJAY in the Interim Budget will help reduce out-of-pocket expenditure on health, which is at a massive 67%.
• This notwithstanding, per capita Budget expenditure on health in India is among the lowest in the world which requires immediate attention.

Health and wellness centres

• Last year, it was announced that nearly 1.5 lakh health and wellness centres would be set up under Ayushman Bharat.
• The mandate of these centres is preventive health, screening, and community-based management of basic health problems.
• The mandate should include health education and holistic wellness integrating modern medicine with traditional Indian medicine.
• Both communicable disease containment as well as non-communicable disease programmes should be included.
• History shows that where there is long-term commitment and resource allocation, rich return on investment is possible.

Prevention and its link to GDP

• NITI Aayog has proposed higher taxes on tobacco, alcohol and unhealthy food in order to revamp the public and preventive health system.
• This has not found its way into the Interim Budget.
• A focused approach in adding tax on tobacco and alcohol, to fund non-communicable disease prevention strategies at health and wellness centres, should be considered.
• Cancer screening and prevention are not covered.
• There is no resource allocation for preventive oncology, diabetes and hypertension.
• Increase of GDP alone does not guarantee health, since there is no direct correlation between GDP and health outcomes.
• However, improvement in health does relate positively to GDP, since a healthy workforce contributes to productivity.
• For various diseases, allocation should be realigned for disease management over a defined time period, not merely for episodes of care.
• Further, the health sector must be made a priority area, like defence.
• Since a major innovation in universal healthcare is being rolled out, it must be matched with a quantum leap in funding.
• Only if we invest more for the long-term health of the nation will there be a similar rise in GDP.

The Hindu