Healthcare is not just providing more free medicines and starting more hospitals. Finance minister Arun Jaitley’s Union Budget for FY17 increased allocation on health by 17% over last year. He also announced the launch of an expanded healthcare coverage plan through health insurance, aimed at giving poor people coverage for catastrophic medical expenses that would otherwise drive them deeper into poverty. This is a welcome measure and another step towards universal healthcare coverage.
A major health commitment in the Budget is the opening of 3,000 drug-stores—Jan Aushadhi Stores (JAS)—that will provide generic medicines to people at an affordable cost, which is a reiteration of an announcement first made in 2015. The government’s goals are laudable, but are they realistic? Since 2012, the government has managed to open just 164 stores, of which only 87 are functional, according to the JAS website.
Any increase in public spending on healthcare is always welcome. With India’s public health expenditure just over 1% of GDP—compared to 4.7% that China and Brazil spend, or 4.3% in South Africa and 3.2% in Russia—does this marginal rise make any difference? By the BRICS yardstick, India’s public spending is abysmally low. Also, the increase hides more than it reveals. An increase in the Budget doesn’t necessarily translate to better health practices or improved access. Over the last four years, Budgets have actually been declining or cut consistently—for every one step forward the government takes when it announces Budget allocations, it ends up taking two steps back later in the year when it revises them.
Health being a state subject, healthcare is decided by states who spend three quarters of that 1%, and the central government the remaining quarter. But close to 75% of all healthcare expenditure in the country—accounting for 4.1% of GDP—is borne by individuals, and over 60% out of that 75% as out-of-pocket expenses. Needless to say, poor people bear the greatest part of this burden. While private health insurance is expanding, the base is still relatively small.
Union Budgets and discussions on healthcare in India are primarily driven by policy-makers, medical associations and healthcare industries. But the interest of the patients, the most important stakeholders, is left out of these discussions.
India has 70 million people with rare diseases, 2.5 million cancer patients, 30 million diabetics, 60 million sufferers of mental ailments, and a very large number susceptible to cardiovascular diseases. The country carries a huge disease burden, and without policy interventions coupled with financial investment to improve the quality and accessibility of healthcare, the future looks bleak.
While all stakeholders have to play their parts, the government has to lead, and from the front, on two critical areas—providing universal healthcare coverage and creating sustainable financing for healthcare, which needs to include expansion of commercial and employer-led insurance. But good intentions need to be backed up with tangible actions that are meaningful to patients.
The National Health Assurance Mission included entitlement to free drugs and diagnostics to patients in government healthcare centres. The scheme was intended to mandate public hospitals to make available a basket of drugs and diagnostics free of cost. These drugs were supposed to include life-saving drugs and others picked from a list of essential medicines. Diagnostic tests were to include X-rays, blood tests, etc. But budget deficits, cuts and inadequate public financing led to these programmes being suspended.
In addition, patient safety, quality of treatment and patient rights are other areas that require government leadership, especially in the development and adoption of guidelines, setting standards for care, and implementation of processes across the board to build and sustain a patient-centric healthcare system.
The government should look at new ways of financing the increase in access and affordability of healthcare. For example, in his Budget speech the finance minister announced an additional cess on tobacco and alcohol. Using the proceeds of that tax for targeted measures that support sustainable healthcare financing would be a great next step. It’s all about making commitments, implementing and following through. Doing that has never been more urgent for patients, families and communities to ensure that a vibrant India is also a healthy India.
This government has recognised the need for deploying more financial resources in healthcare to improve access and affordability for patients. It has committed to increase public expenditure on healthcare from 1% to 2.5% of GDP in the next 2-3 years. On behalf of the hundreds of millions of patients in India, we hope this is not another good intention that fails to materialise. We also hope that the government develops a consultative process on where the patients want this money to be invested. Making patients at the core of decision-making both for curative as well as preventive aspects of healthcare is the only sustainable option to manage the healthcare needs of such a vast population.
The author is CEO, DakshamA Health & Education, and chairperson of the Indian Alliance of Patient Groups (IAPG)