National Policy Soon to Ensure Good Health

Will Nadda Deliver ?

 By Bodhi Shri

Union Health Minister J P Nadda

Health and happiness is not only a driver of economic growth but also necessary for evolution of a harmonious society, and thus it should be a goal in itself for any governance system. India currently finds that despite so much advancement in medical technology, discoveries of new medicines and development of new high-tech based diagnostic tools and coming into existence of so many big government and corporate hospitals, people are still suffering from so many diseases and proper health care is not available to them. 

     Government currently endeavours to give final shape to the new National Health Policy to determine how all countrymen can be provided health care at an affordable cost. Currently, the ground reality is that healthcare services are catastrophically high, much because more than seventy percent healthcare facilities are in the private sector, who assumes healthcare only as a business rather than an humanitarian enterprise. Massive growth of tertiary care hospitals in the private sector has no doubt contributed to national growth by way of medical tourism, but for the common people this has only made tertiary health care even more prohibitive. Will the new National Health Policy take care of all these concerns?    

Previous two national health policies of 1983 and 2002 have been successful to achieve their targets to some moderate extent. They contributed in raising life expectancy in the country; also helped reduce population growth rate. A few diseases like polio have been eliminated. Incidence of Leprosy is getting reduced. There are signs of success in controlling AIDS, kala-azar, lymphatic filariasis, malaria, but the situation on the front of TB, dengue, viral encephalitis, chikungunya is not satisfactory. This apart the new phenomenon is that non-communicable diseases are on the rise. The draft National Health Policy mentions that 75 percent of all communicable diseases are not covered into any national health programme. The overall disease burden of non-communicable diseases is 39 percent and of injury-related around 11 percent. And the bigger issue amidst continuing ill health, diseases, premature death is inaccessibility of health care facilities in many parts of the country and unaffordable to majority of Indians, no matter they are in rural or urban areas.  

     A new phenomenon is increasing urbanisation as people from rural areas migrate in large numbers, but a very large percent of such people live in slums. Today, about 31 percent of our population lives in urban areas and 17 percent of this urban population lives in slums. They might be living in cities with big corporate hospitals, but for them modern health care facilities remain out of bound. Realising this, perhaps, the outgoing UPA government had launched National Urban Health Mission (NUHM) in 2013 with special focus on urban poor and marginalised population groups like rickshaw pullers, street vendors, railway and bus station coolies, homeless people, street children, and construction workers. 

     Modi government’s proposed National Health Policy seems to retain this focus. But to implement this policy would require huge funding from the Centre. The health comes in the concurrent list and the Centre would be obliged to contribute to the extent of 75 percent and the rest would be provided by states and union territories. In Uttarakhand, Himachal Pradesh and Jammu & Kashmir Centre’s contribution under NUHM was fixed at 90 percent.

Healthcare sector in India is growing very fast 

India has succeeded in absorbing latest medical technologies developed anywhere in the world quite rapidly, but their affordability to most of the population is suspect due to high costs. There is tremendous increase in number of hospitals in the private sector, , of all types, big and small,  contributing in the growth rate of the country, making India a hub for medical tourism, but for the countrymen due to high costs they remain inaccessible. In emergency even poor people do go to them but to find ultimately their savings and assets badly dented. 

     The new National Health Policy has to look at this aspect seriously while making efforts to help health care sector remain as an engine of growth and job-creation. The health care industry is growing at 15 percent compounded annual growth rate and this has been estimated to reach 21 percent in the next decade. Recently with the passage of the Insurance Bill which has increased the FDI limit to 49 percent from 26 percent in the insurance sector, the growth of health sector may even be better than estimated.

     The private health care industry is valued today at Rs 240,000 crore and it is expected to become twice bigger by the start of the next decade. Half of this amount is related to hospital and clinical care. The private health care constitutes nearly 80 percent of outpatient care and about 60 percent of inpatient care. An interesting feature of this is that 72 percent health care enterprises are owned by single professional (a doctor), but the situation has started changing and number of employing enterprises in private sector is increasing. However, the National Sample Survey Organisation in its 60^th round revealed that public sector health units were more efficient and truly the value for money. Will the present government in the Centre would pay attention to this aspect and allocate sufficient money in this sector? This definitely will go a long way in improving efficiency of the money spent on health care.  

     No matter what Congress detractors might say, the fact is that the ten year average growth rate had been the highest ever recorded in the country during the UPA regime. Despite this high growth in economy, share in healthcare spend in the country did not improve. Total spend in healthcare is 4.1 percent of the GDP and in this government spending is only 1.04 percent of the GDP though the National Health Policy, 2002 had envisioned it to increase it to 2-3 percent. This shows government spending is only one fourth and the rest comes from individuals’ pockets. Central government spends only Rs 325 per person in a year on health while states spend Rs 632 per person. Individuals on an average have to spend Rs 3,700 per year out of his own pocket to get health services. 

     In India government’s share in health expenditure is 30 percent of the total while developed countries like UK, Japan, Sweden, France and Germany spend more than 76 percent, a few countries upto 86 percent. Health activists have demanded the public health expenditure should be raised to minimum 4 percent of the GDP. Seeing the target of NHP-2002 of 2 percent of GDP could not be met, the current draft policy has proposed to raise it to 2.5 percent of the GDP. 

     The paradox is the good health of people contribute in economic growth, but this is not reciprocated in higher healthcare spend. The result is in 2011-12, people in rural areas were spending 6.9 percent of their household expenditure on healthcare alone which is quite high seeing the income levels in rural areas. It was 5.5 percent in urban areas also. Since government hospitals and dispensaries are fewer than needed and remain over-crowed, people per force go to private hospitals or clinics. 

     There are eight states like Andhra Pradesh, Karnataka, Tamilnadu, Maharashtra etc, where the state governments have introduced health insurance schemes for people living below poverty line to meet their hospitalisation expenditure to the extent of Rs 30,000. With this insurance they can afford to enter in private hospitals also to seek treatment. Central government also launched a similar Rashtriya Swasthya Bima Yojna in 2008 under which a family was required to pay a maximum sum up to Rs 750 per year. The biometric enabled smart card ensured that only real beneficiaries got the benefit. The scheme was unique in the sense it could be used in any RSBY-empanelled hospital across India. Yet 75 percent population of the country is out of such insurance coverage. Not all people below poverty line have been included under this government insurance scheme. The situation becomes even more pathetic when it is found that the RSBY card-holders do not know about how to use the card and in what circumstances. 

     Meanwhile there are suggestions from several quarters to merge all state and central schemes into one and improve the delivery of healthcare services under this public insurance system.

(Note: The article was first published in the Lokayat magazine:April, 2015)