Union Budget for 2011-12 is analyzed from various angles to ascertain the government policy tilt towards corporate big-wigs on the one hand and omni-present and much neglected aam admi.
A report by the Centre for Budget and Governance Accountability says poor allocation of fund to key social sector showed the government's lack-lustre approach to inclusive growth. For example, the overall outlays have hardly increased for health sector. When taken as a proportion of the country's GDP, public spending on health has increased from 0.32 per cent in 2010-11 to 0.34 per cent in 2011-12. When analysed as a share of the total Union government's expenditure comprises a mere 2.42 per cent. Allocations for National Rural Health Mission have shown a slight increase from Rs.15,037 crore 2010-11 to Rs.17,924.76 crores in 2011-12.
Kerala Chapter of the Indian Medical Association described the tax on services at air-conditioned hospitals, and diagnostic centers as "salt tax". Some medical professionals also characterized the proposal as "misery tax." Finance Minister Pranab Mukherjee, in his budgetary proposals, has imposed 5 per cent service tax on treatment in private hospitals, paid either by individuals, insurance companies or firms. The same levy would be applicable to diagnostic tests of all kinds.
The worst affected will be preventive health check ups. At present, the numbers are low because people think getting a preventive check up is futile, not knowing that preventing a disease is better than treating one. Now, they won't come forward even more because of an additional service tax, says a senior doctor.
The benefits of economic growth over the past two decades, while substantial, have not translated into health security for people in India. Many countries in Asia, including even those with lower per capita income, are tending to outperform India in health and healthcare. Even now, India lacks a primary healthcare system that offers effective and affordable protection to all against common illnesses.
India’s public spending on health is among the lowest in the world. This has led to an extremely high burden of private out-of-pocket health expenditures, which a huge part of the population cannot afford, and which even fails to guarantee reliable healthcare because of inescapable difficulties of the market for medical attention and care.
Influential policy makers in India seem to be attracted by the idea that private healthcare, properly subsidized, or private health insurance, subsidized by the state, can meet the challenge.
According to a report of the National Rural Health Mission, only 10 per cent of Indians have some form of health insurance and around 40 per cent have to borrow money or sell their assets to meet their healthcare expenses. More than 25 per cent of the people slip below the poverty line because of hospitalization due to a single bout of illness.
India bears 20 per cent of the world’s disease burden, but has only six per cent of the world’s hospital beds. Hospital beds per 1000 population in India are less than 50 per cent of that in developing countries such as Brazil and China and less than 35 per cent of the world average. The ratio of doctors to population is also measly.
At the ninth Kolkata Group workshop, chaired by Professor Amartya Send, forty five participants from different walks of life, including social scientists, policy makers and development experts, convened to assess the dimensions of social equity in India, especially as related to poverty, elementary education, and public health, adopted the ‘Kolkata Declaration’ which demanded universal entitlements to publicly provided primary healthcare for all, and stressed that at least 3 per cent of the country’s gross domestic product(GDP) should be devoted to healthcare.
The World Health Organisation makes a timely intervention by calling for reforms in the way nations finance healthcare in its World Health Report--Health systems financing:the path to universal coverage. The Report says any policy that aims at reducing personal financial burden related to healthcare should focus on brining down the direct payments by the individual. This means a change in who pays for healthcare, now borne overwhelmingly by individuals in countries that have weak government-paid health-care system.
The Alma Ata Declaration(1978), the outcome of a joint initiative by the WHO and the UNICEF, proclaimed that "the main social target of governments, international organisations and the whole world community in the coming decades should be the attainment by all peoples of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life."
Now, three decades and more after the solemn declaration and ten years after the the target date, the world is nowhere near the goal of "Health for All."
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