Vote for larger healthcare spend in coming election
INDIAS HEALTHCARE SECTOR REMAINS DEPLORABLE & LARGELY NEGLECTED ………..K G Narendranath NEW DELHI
EVEN as some 20% of the world population in the 30 OECD countries benefits from about 90% of the worlds money spent on health, the developed countries continue to spend heavily on healthcare infrastructure and services. In contrast, in the last threefour years, public expenditure on health in India has risen only marginally not only in absolute terms but also as percentage of gross domestic product. This increase in spending is clearly not enough to take India anywhere near what could be considered a respectable slot on this front, leave alone correct the asymmetry.
About a year ago, Indias public spending on health was just over 1% of GDP and private spending, about 5%. We are aiming at increasing public expenditure on health to 2% of GDP by the end of the current Five-Year Plan. Compare this with the US current health spend of about 16% of GDP (which is projected to increase to 19% by 2017), of which about a half is public spending. China spent 5.6% of its fastgrowing GDP on health in 2003, and the figure has since risen significantly. In fact, Indias position would look hopelessly indefensible if per capita spending on health is reckoned it is just $80 compared to US about $4,900, UKs some $2,000 and Chinas $230. Policy managers do admit that we should aim at some 6% of GDP as public expenditure on health (till the time the necessary infrastructure is created), but this is hardly reflected in annual budgetary outlays.
Spending is but just one thing, more important than that is effective use of the money spent. And here, Indian situation is even more deplorable, which few wouldnt know. This is reflected in the countrys healthcare service delivery system which is in a shambles. Public healthcare has been on a serious decline during the last two or three decades because of non-availability of medical and paramedical staff, diagnostic services and medicines, notes the Planning Commission in one of its recent reports. This is why despite the high and sometimes prohibitive cost of accessing private healthcare services, there is an increasing, and mostly forced, shift from the public to private sector.
Bolstering of healthcare infrastructure hospitals and attendant facilities and clinical establishments is a prerequisite for efficient service delivery. Its redundant to emphasise on the pitiable conditions of our government hospitals especially primary and secondary centres. The country is also yet to have acceptable (minimum) standards for clinical establishments, forget about uniform standards. A very vexatious issue is the absence of qualified medical and paramedical staff. Government doctors are increasingly opting for the more gainful private sector and many among those who remain on government pay roll surreptitiously do private practice, in neglect of government duty. The government is not doing enough to arrest the flux. One idea being flagged is to legalise private practice of government doctors or alternatively grant them non-practising allowance. This might help retain doctors in government services. It is however unlikely that the service practices will improve as a result.
Drug testing and pathology laboratories in the country dont fully adhere to standards set by the national accreditation body. The Clinical Establishments Regulation Bill, introduced in Parliament, is yet to pass the muster. Only in the last few years has the government revamped the laws related to drug manufacturing, imports and clinical trials to make the relevant norms globally compatible. But even as the laws are now in place, there is really no guarantee that these are being unfailingly enforced. The drug regulatory establishment is simply not able to cope with the enormity of the challenge it is facing.
And if that is the case of the infrastructure and services standards, the medical insurance coverage in the country too is quite low. Insurance companies dont find the segment attractive enough. The National Commission for the Unorganised Sector had proposed a government-sponsored health insurance scheme that would cover all 30 crore BPL population. No action on this front is forthcoming so far.
As for drug prices, which is a significant factor in healthcare cost of Indians, the extant government controls are not of much use, as these are on a set of drugs that were selected some 15 years ago. Most of these drugs have therapeutic alternatives in the market and since patients go by the prescriptions, the benefit of price controls is often denied to them. The fact that the controlled segment in the retail pharma market has been steadily shrinking establishes beyond doubt the futility of price controls. It would have been much more useful for the low-income population if the government had encouraged production of generic (unbranded) medicines and distributed these through the public healthcare system.
Manifestoes of major political alliances in the coming Parliament election can give top priority to healthcare, for a change.
VITAL STATS Indias public spending on health was just over 1% of GDP and private spending, about 5%. In contrast, the US current health spend of about 16% of GDP, of which about a half is public spending. China spent 5.6% of its GDP on health in 2003
VITAL STATS Indias public spending on health was just over 1% of GDP and private spending, about 5%. In contrast, the US current health spend of about 16% of GDP, of which about a half is public spending. China spent 5.6% of its GDP on health in 2003