Insurance alone cannot be the panacea for India’s ailing health sector

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New Delhi | February 6, 2019 2:41 PM

Focusing on insurance which may largely benefits private sector, while ignoring public health infrastructure and public provisioning can not be regarded as a pro-poor policy, Ghosh and Qadeer wrote.

Representative Image (Reuters)

At a time when India’s ailing public health sector demands strengthening of primary health care system, Narendra Modi government has once again presented a budget with misplaced priorities. The increase in allocation to health sector in Budget 2019 should have been directed towards reviving primary health care, rather than at Ayushman Bharat insurance scheme, which does not cover a majority of the treatments, Sourindra Ghosh and Imrana Qadeer wrote in The Indian Express this week.

There has been an increase of more than Rs 7,000 crore on health sector in Budget 2019 compared with last year, which amounts to a 9.2 per cent increase in real term, Ghosh (PhD scholar at the Centre for Economic Studies and Planning, JNU) and Qadeer (Distinguished Faculty at Council for Social Development, Delhi.), wrote. However, most of the increase in expenditure has gone towards funding the Pradhan Mantri Jan Arogya Yojana (PMJAY), which provides Rs 5 lakh annual coverage for in-patient care to 10 crore poor families.

On the other hand, the allocation to National Rural Health Mission (NRHM) has been reduced in real terms. Its share in the health component of the budget has declined sharply over the past four years. Meanwhile, National Urban Health Mission(NUHM) too has received a paltry amount. Even under NHRM, the money to be spent on controlling communicable diseases like TB, diarrhoea, pneumonia and hepatitis has been reduced.

According to the National Sample Survey 2014, 97 per cent of illnesses in India are treated in out-patient care centers, which accounts for 63 per cent of the overall medical expenditure. Therefore, most of the expenditures are not even covered by the insurance scheme for in-patient care.

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In this context, the funds should have been used to improve the worn-out public sector district hospitals, community health centres, primary health centres and sub centres in underserved areas, rather than on insurance, Ghosh and Qadeer wrote.

The revised estimates for the 2018-19 reflect under-utilisation of funds by various programmes. National Rural Drinking Water Mission and the Pradhan Mantri Matru Vandana Yojana have utilised only 78 per cent and 50 per cent of the allocated funds, respectively.

Swachh Bharat Mission (rural), also did not fully utilise the Rs 15,343 crore allocated to it in the budget 2018-19. Its allocation has been further reduced to Rs 10,000 crore for 2019-20. The neglect of the ICDS has not only continued but also accelerated since 2014. This is evident from the fact that this year’s allocation for the scheme, in real terms, remains below the expenditure of 2013-14.

Focusing on insurance which may largely benefits private sector, while ignoring public health infrastructure and public provisioning can not be regarded as a pro-poor policy, Ghosh and Qadeer wrote.

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