The
challenge posed by the rising cost of health care in India, is accepted at all
levels. Non other than the Prime
Minister Dr.Manmohan Sigh said the impact of high medical costs placed an
unconscionable burden on the poor.
Speaking at a health summit, he said : “We are therefore, focusing our
attention on social security of the poor with regard to their health care.”
It
does not require mention that the health status of India’s people is poor. There
are economic social and regional differences but the larger picture is
one of high mortality(of infants, children and mothers), low life expectancy
and high morbidity. The limited volume and quality of public
services has been driving people to private health services. These are booming, but the large out of
pocket expenses on health care and drugs are imposing a heavy burden on
patients. Such expenditure is estimated
to push 30 million people a year into poverty.
Dr.
B Ekbal public health activist, author and former Vice Chancellor of Kerala University says : “Cost of treatment
has been increasing alarmingly as a result of the entry of super and multi-specialty hospitals. Lack of
government intervention has led many
private hospitals to do anything to make profits in the name of check ups or
supply of medicines.”
In
the context of neoliberal policies, the growth of the private medical sector in
India has not been based on any planned attempt to address health needs. Being ‘private’ by definition the sector has
to function in accordance with the logic of the market. The market(for all goods and services)does
not, in the long term, allow the survival of the ‘inefficient’
entrepreneur. In the medical sector the
efficient entrepreneur is not necessarily one who provides the best service,
but often the one whose profit margins are the healthiest.
The
logic of the market, in the medical care sector has produced a situation where
now huge corporate chains are replacing smaller players. It has brought in its
wake more centralization of services and
a higher degree of pooling of
skills and expertise in a few centers. This
goes against the established tenets of public health and primary health care,
where it is understood that better health outcome is a function of a wide
spread of facilities and care providers,
across the entire population.
While
the services of specialists and even super-specialists are underutilized in
urban areas, the deficit of specialists is as high as 80 per cent or more in
the public health system, especially in rural areas. On the other hand, we
subsidise the medical care needs of countries in Europe and North America by
exporting trained physicians, most of whom are trained at public cost.
The
rapidly growing industry of medical tourism in India, now harness highly
trained Indian medical professionals to treat rich medical tourist from
developed nations. While our public
health system remains grossly understaffed, we do not train an adequate number
of other health workers.
In
this context, experts who analysed the social sector components of the Union
Budget 2012-13 concluded that “the budget has failed to provide a vision or a
clear direction on the policy front as far as the social sector is concerned.”(
Business Standard 19.03.2012). On
the healthcare, Finance Minister Pranab Mukheerji announced only an
incremental increase of about Rs.2700
crores in the allocation for the National Rural Health Mission.
The
12th Five Year Plan envisages that the government’s health care
spend will from 1.90 per cent to 2.50 per cent of GDP. A large part of this would be under
public-private partnerships(PPP). The High Level Expert Group of the Planning
Commission on Universal Health Coverage for India has laid out a clear road
map. The expert group chaired by Dr.K.Srinath Reddy proposed a far-going reform
in several areas. On funding, it put the
onus on the government to mobilize the resources necessary from taxation. The recommendations of the
expert group, including the emphasis on making essential medicines available
free to patients through state funding,
is timely.
A
book titled “Morbid System—Health Under Capitalism” edited by Leo Panitch and
Collin Leys, convey the message that mindless privatization of the health care
delivery system in various countries, which is the result of neoliberal globalization is
counter-productive to achieving a reasonable level of health.
Consistently
low levels of public health expenditure explain the slow progress in addressing
the challenges of Infant Mortality Rate(IMR), Maternal Mortality Rate(MMR) and
other key health indicators. The Out of
Pocket(OOP) expense on health care at 75 per cent is one of the highest in the
world and it is imperative for the State sending in health care to rise in
order to alleviate the burden on the economically weaker sections of the
society.
The
Rashtriya Swasthya Bima Yojana(RSBY) the health care scheme meant for the Below
Poverty Line(BPL), now being extended to the above poverty line section,
provides Rs.30000 per family to cover treatment charges. Several States have evolved their own
distinctive health insurance schemes. Though RSBY received no mention in this
year’s budget, it has seen a 45 per cent increase in allocation. On the whole,
the Budget provides a marginal boost to the health sector.
