Healthcare Spending Is Losing out to Health Insurance, Say Activists

Concerned activists are worried that the misplaced focus on health insurance will result “largely in transfer of public funds into private hands without any matching health outcomes or financial protection".

New Delhi: Calling the possible consequences of the recently announced budget “catastrophic,” public health activists have criticised the allocations made to healthcare.

Activists are especially worried about the government’s heavy focus on health insurance, which they say is coming at the expense of funding several other core health care verticals.

In a statement from the Jan Swasthya Abhiyan (JSA), the doctors and other public health professionals have said that the insurance model comes “at huge and disastrous costs of the public provisioning of health”.

The three main issues they raise are: the budget is under funded overall; focusing on health insurance is a misplaced priority; and that there little attention has been paid to women’s issues.

For example they explain that the National Health Mission (NHM) has been neglected year after year. In 2014, NHM was allocated 61% of the total health budget. This has dropped to less than half – at 49% – in this current 2019 budget.

The Ayushman Bharat programme, which has captured policy formulation and public conversations, has two parts. The one stressed on the most is the insurance component, which promises a cover of Rs 5 lakh per family for tertiary and in-patient care. The other is the government’s promise to improve health and wellness centres (HWCs) for primary care.

But here too, JSA says that although the HWCs have received a boost, getting Rs 1,600 crore, “this is a mere fraction of what is needed to achieve the goal announced by the government last year”. The government had promised to convert 1.5 lakh sub centres into HWCs.

Also read: India’s Defence Budget is Nearly Five Times the Health Budget

Much of this money used to upgrade HWCs is a capital expenditure. But it is not just sub centres or HWCs that are in disarray, health services all through the supply chain need a boost to infrastructure and equipment.

However, capital expenditure has been reduced in this budget by 43%, says JSA, in relation to the actual capital expenditure of last year. The budget allocated for establishing new medical colleges and upgrading district hospitals has also declined by 40% over its expenditure last year.

“These stagnant and declining allocations put us squarely on track to losing the gains that were achieved through NHM in its first decade,” notes JSA. It is these sustained and concentrated efforts that helped India achieve some of the Millennium Development Goals. India is still trying to achieve many of the Sustainable Development Goals.

The health budget has increased by about 13% this year, which amounts to an increase of about Rs 7,000 crore. But the government’s insurance component alone has been allocated Rs 6.400 crore.

Thus the insurance component has seen an increase of 167% from its allocation of last year.

JSA says this is “unprecedented in the health sector” and is worried that this will result “largely in transfer of public funds into private hands without any matching health outcomes or financial protection”.

Minimal attention paid to women’s health

JSA also drew attention to acting finance minister Piyush Goyal’s declaration that there should be “women-led development”. However as per their analysis, the programmes that are relevant to women’s health have been neglected.

For example, the reproductive and child health component in the NHM has dropped. This component includes core health concerns like immunisation and disease control. This has been cut by Rs 4,200 crore.

Also read: Budget 2019: Ayushman Bharat Gets Rs 6,400 Crore, But to Benefit Private Sector

The maternity entitlement and wage compensation scheme for women was cut by half last year, just between the budget estimate and revised estimate of the same 2018-2019 budget itself – it went from Rs 2,400 crore to Rs 1,200 crore.

“It is apparent that the last five years of NDA government have been characterised by a neglect of public health system and primary care on one hand and promotion of for-profit private sector,” says the statement.