THE HEALTH NUDGE IS MERELY A MIRAGE

Context: While the Budget 2021-22 allocates more than 1.5% of the Gross Domestic Product (GDP), implying a 137% increase in the outlay to the health sector, the allocation may not be sufficient.

   

Reservations about the budget allocation for the health sector:

• Inclusion of water, sanitation and covid-19 vaccination under the health: After removing these from health allocation, it is left with Rs 92,794 crore (about 0.6% of GDP).
• No increase in allocation for insurance schemes: either in Ayushman Bharat or the Rashtriya Swasthya Bima Yojana (RSBY) will see a 97% decline.
  • Two-third of the country has no health insurance of any kind; Insurance coverage is below target of 500 million under RSBY and other state-run insurance schemes.
• Low allocation to the National Digital Health Mission (stuck at Rs 30 crores): Despite the Economic Survey promoting telemedicine by investing in internet connectivity and online platforms.
• Decline in Health research: which saw a 34% decrease in the budget 2021.
• Health infrastructure: India is ranked 155 of 167 on its bed density (0.5 per 1000 residents), behind most developing economies.
  • Marginal budget allocation (just Rs 64,000 crore): for creating new public health infrastructure.
  • Issues with healthcare professionals:
    • Skewed distribution: More than 50% of India’s doctors are located in just five states.
    • Vacancies: Government scheme of providing bridge courses to fill the gap have not seen to materialize on the ground.
• Reduced allocation to important schemes: like the allocation on anganwadis, on the Poshan Abhiyan, and all Mahila Kendras has been slashed.
  • Saksham scheme: a new name for Anganwadis plus creches plus Poshan, faces a cut compared to the ongoing fiscal year.
  • The Matru Vandana Yojana’s outlay, which includes the erstwhile Beti Bachao and Mahila Shakti Kendras, has been reduced.
• Redundant Schemes: Creation of 1.5 lakhs HWCs is already an aim of the Ayushman Bharat, on which no information was provided in the budget.

Way forward:

• Reducing the Out-Of-Pocket (OOP) expenses on health: through health allocation of 3% of GDP in the budget-the long-term government target.
  • Insurance cover was considered necessary by the Economic Survey to reduce OPP.
  • Standalone health insurance companies saw their gross premium underwritten spike by nearly 10% year-on-year between April and December 2020 as per Irdai figures
• Larger outlays for infrastructure: including vaccine research, testing, cold storage facilities, hiring of staff, and maintaining a high-quality tracking and tracing mechanism for all diseases.

Conclusion: The government should exploit the pandemic opportunity and transform the health sector by creating a robust physical and human resource health infrastructure in the country.