Budget 2018: Expectations of the health sector from the Budget were set by the National Health Policy (NHP) and the three-year action plan of the NITI Aayog released in 2017. The NHP envisioned a rise in public funding for health, increasing to 2.5% of the GDP by 2025. The action plan is aimed at reducing the out-of-pocket spending on health to 50% by 2020 from 63.4% at present. For both of these targets to be reached, the Budget had to signal the beginning of a steady annual rise in the allocation for health. The NHP prioritised strengthening of primary healthcare, with 70% of health expenditure being directed there. Strategic purchasing of services from public and private providers was also proposed through government-funded programmes. Two major health initiatives have now been bracketed under a new Ayushman Bharat scheme.
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The primary care component will provide Rs 1,200 crore to activate 1.5 lakh health and wellness centres which will act to promote community health, prevent diseases, provide basic clinical services, essential drugs and diagnostics free of cost. Apart from the current ambit of the National Health Mission (NHM), these centres will also extend services to detection and chronic care of non-communicable diseases.
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The second component markedly enhances yearly coverage to Rs 5 lakh for secondary and tertiary care hospitalisation to 10 crore poor and vulnerable families under the National Health Protection Scheme. This was first proposed in the 2016 Budget as an revamp of the Rashtriya Swasthya Bima Yojana, but the coverage remained pegged at a meagre Rs 30,000 per year per family. Now it will become the world’s largest health insurance programme. The challenge of primary care will be the paucity of health service providers. Unless the budget of the NHM is substantially augmented, the number of frontline health workers and allied health professionals will fall short of need.
President, Public Health Foundation of India