Closing the Health Gap

Context: While the Budget 2021-22 proposed a huge increase in healthcare spending, it still neglected core issues in the health sector.

Health sector-related provisions in the Budget 2021-22: (Pre-COVID, the health budget was Rs 69,000 crore)

• Inclusive Healthcare funding: 137% increase in the health allocation which included funds for 
  • Drinking water, sanitation, nutrition, AYUSH, health research, vaccination 
  • Grants assigned by the 15th Finance Commission (FFC).
  • Strengthening the National Centre for Disease Control (NCDC).
• PM Aatmanirbhar Swasthya Bharat Yojana: a centrally sponsored scheme which - 
  • Funds over 18,000 rural and over 11,000 urban health and wellness centres,
  • Provides support for public health laboratories, 
  • Establishes critical care hospitals together with five regional branches and 20 metropolitan health surveillance units linked to NCDC.

Associated challenges of the health sector: missed in the budget 2021-22

• Continuation of Out-Of-Pocket expenditure for poor: Since outpatient treatment costs are not included under Ayushman Bharat.
• Low insurance coverage: Some 30 crore Indians are without any state-supported medical insurance (after excluding 50 crore beneficiaries under Ayushman Bharat and 10% workers in Formal sector).
• Lack of consumer protection: 
  • Poor implementation of the model Clinical Establishments Act 2010 by states.
  • The Consumer Protection Act of 1986 was never mandated to address the complexities of medical negligence or malpractice. 

Way forward:

• Set up a corpus fund to aid medical personnel: facing unforeseen risks and challenges while confronting health emergencies.
• Enlarge Ayushman Bharat's scope: to protect poor from doctor hunting, receiving irrational treatment from unqualified medical practitioners, provide drugs and address the inability to pay.
• Provide comprehensive universal health insurance: 
  • Beneficiary identification: Aadhar and laws like the Shops and Establishments Act, 1948 can be used for identification of beneficiaries in the unorganized sector.
  • Go beyond blue-collar workers to cover white-collar employees in the unorganized sector: by amending The Employees State Insurance Corporation scheme, 1948.
  • Learning from other countries: 
    • Canadian system pays for all services based on need rather than the ability to pay. 
    • Germany and France fund health care through contributions mandated by law and shared by the employer and employee.
• Ensure quality medical regulation: to protect consumer rights.
  • Health policy 2017: grading of clinical establishments would give protection to patient rights.
  • Public health in concurrent list: As recommended by the 15th Finance Commission.
  • Establish a separate Empowered Medical Tribunal (as recommended by the Health Policy 2017) -  on the lines of the State and Central Regulatory Commissions, like for electricity.