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The Hindu Daily Editorial DiScussion 7/2/19 By - Ashish Singh
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We need a leap in healthcare spending GS PAPER 2 Issues relating to development and management of Social Sector/Services relating to Health 1y HEALTHCARE SECTOR
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. The total allocation to healthcare is 161398 crore. While this is an increase of 7.000 crore from the previous Budget, there is no net increase since the total amount is 2.2% of the Budget, the same as the previous Budget. The increase roughly equates the t6,400 crore allocated for implementation of the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PMJAY)
Per capita spending on health According to the National Health Profile of 2018, public per capita expenditure on health increased from 621 in 2009-10 to f1,112 in 2015-16. These are the latest official numbers available, although in 2018 the amount may have risen to about 1,500. This amounts to about $20, or about $100 when adjusted for purchasing power parity. Despite the doubling of per capita expenditure on health over six years, the figure is still abysmal
The U.S. spends $10.224 per capita on healthcare per year (2017 . A comparison between two large democracies is telling: the U.S.'s In Budget terms, of the U.S. Federal Budget of $4.4 trillion, spending To understand why, let's compare this with other countries. data). health expenditure is 18% of GDP, while India's is still under 1.5%. on Medicare and Medicaid amount to $1.04 trillion, which is 23.5% of the Budget. Federal Budget spending per capita on health in the U.S. is therefore $3.150 ($1.04 trillion/ 330 million, the population).
. In India, allocation for healthcare is merely 2.2% of the Budget. . Per capita spending on health in the Budget in India is?458 61398 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
Admittedly, this runaway healthcare cost in the U.S. is not to be emulated, since . Yet, the $4,000-$5,000 per capita spending in other OECD countries is not . The rate of growth in U.S. expenditure has slowed in the last decade, in line with . The t6.400 crore allocation to Ayushman Bharat-PMIAY In the Interim Budget will . This notwithstanding, per capita Budget expenditure on health in India is among . This requires immediate attention. comparable developed countries spend half as much per capita as the U.S. comparable with India's dismal per capita health expenditure. other comparable nations. help reduce out-of-pocket expenditure on health, which is at a massive 67%. the lowest in the world.
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. An estimated 250 crore has been allocated for setting up Health and wellness centres under the National Urban Health Mission
History shows that where there is long-term commitment and resource allocation, rich return on investment is possible. For instance, AlIMS, New Delhi is the premier health institute in India with a brand value because of resource allocation over decades AlIMS Delhi alone has been allocated nearly 13,600 crore in the Interim Budget, which is a 20% increase from last year. Similar allocation over the long term is needed in priority areas.
There is no resource allocation for preventive oncology, diabetes and hypertension . Prevention of chronic kidney disease, which affects 15-17% of the population, is not appropriately addressed. . The progressive nature of asymptomatic chronic kidney disease leads to enormous social and economic burden for the community at large, in terms of burgeoning dialysis and transplant costs which will only see an exponential rise in the next decade and will not be sustainable unless we reduce chronic kidney disease incidence and prevalence through screening and prevention.
The insistence to prefix Ayushman Bharat to existing State names and the despatch of a personalised letter to 7.5 crore families with only the Prime Minister's photograph were seen as attempts to attribute the entire credit to the current administration, though State governments are equal partners -funding 40% of the scheme, bearing the responsibility of its implementation and covering double the number of beneficiaries.
Given that the Central government transfers funds to States through the Finance Commission, Central Sector Schemes and the Centrally Sponsored Schemes, it is expected of the National Health Agency (NHA) to build an institutional architecture, standardise procedures, costs and access all data for effective monitoring. This is important as it is accountable to Parliament and the Comptroller and Auditor General for the proper utilisation of allocated funds. But such standardisation can stifle innovation and entail costly structures that may not accommodate local conditions, preferences, and cost-effective solutions. Instead, when funds are provided, subject to achieving certain goals, States have scope to innovate, model the design to fit their context, resource base, epidemiological status, level of development, take total ownership and be accountable for outcomes.
The NHA's approach does not appear to be built on consensus. Its model consists of outsourcing the vital functions of pricing services, pre-authorisations, scrutiny of bills, grievance redressal, and fraud detection to private companies and third-party administrators. . This may increase administrative costs from the current 6% to 30%, as seen in the Medicare scheme of the U.S.
* Besides, the policy of providing fiscal incentives to the private sector to establish hospitals in deficit areas without insulating government- owned facilities or the small and marginal hospitals that together provide 95% of hospital care will tighten the grip of corporates on secondary and tertiary markets. This will result in cost escalations more so because of the rapid consolidation and aggregation of tertiary hospitals by foreign financial conglomerates and private equity funding agencies, impacting prices, access to tertiary care and the very sustainability of the NHPS.