Healthcare: Focus on higher spending, universal coverage

India’s health expenditure has stayed at the same level for the past 7 years while it has made little progress in achieving universal health coverage


The new government has expressed its commitment to universally accessible, affordable and effective, holistic healthcare.
The new government has expressed its commitment to universally accessible, affordable and effective, holistic healthcare.

New Delhi: The budget is expected to spur higher spending on public health, focus more on primary healthcare and make essential medicines more easily available, healthcare experts said.

India spent 4.1% of its gross domestic product (GDP) on health services in 2012; indeed, the country’s health expenditure has stayed at the same level for the past seven years. It was 3.9% in 2007.

In contrast, the US spends 17.9% of its GDP on healthcare. Nepal does 5.5%.

The last three years have seen little increase in health spending, according to Sakthivel Selvaraj, senior health economist at the Public Health Foundation of India, a not-for-profit organization. In real terms (considering high inflation), there was a decline, he said. Both Union and state governments should increase spending on public health, Selvaraj added.

India has made little progress in achieving universal health coverage—despite several ambitions programmes designed to do so. The new government has expressed its commitment to universally accessible, affordable and effective, holistic healthcare.

Addressing Parliament on the opening day of the 16th Lok Sabha, President Pranab Mukherjee said the government would formulate a new health policy and a national health assurance mission to achieve universal health coverage.

“The Bharatiya Janata Party’s manifesto talks about universal health coverage, reaching out to the minorities and population stabilization. There is a large focus on mission mode,” said Sona Sharma, joint director (advocacy and communications) at Population Foundation of India, a think tank on population issues. “What we would like to see is a rights-based approach, looking at non-coercive methods.”

Tax-funded universal health coverage is the only way to go for India, since health insurance may be unreliable or impossible, Selvaraj said. This is because 93% of the country’s workers are in the informal or unorganized sector, where it won’t be easy to collect premia.

Even as India continues to cope with communicable diseases such as tuberculosis, dengue, malaria and AIDS, the threat of non-communicable diseases continues to grow, accounting for 53% of deaths. Experts assess that treatment costs for the latter are nearly double that of other conditions and illnesses. Evidence suggests that cardiovascular diseases (24%), chronic respiratory diseases (11%), cancer (6%) and diabetes (2%) are the leading causes of mortality in India.

Shortage of healthcare professionals is one reason for the high mortality. As of 2011, India had only 0.7 physicians per 1,000 people, much less than the OECD (Organisation for Economic Co-operation and Development) countries’ average of 3.2. India also had less than one nurse per 1,000 in 2010, much below the OECD average of 8.7.

India’s healthcare workforce is not only smaller, but also less evenly distributed, according to Selvaraj. Apart from creating more health professionals and ensuring an even distribution, the country would do well to focus on building a corps of paramedics rather than just focusing on doctors, he said.

The National Democratic Alliance government has promised to transform health education and training, and set up medical colleges and attached hospitals modelled on the All India Institute of Medical Sciences in every state.

“Primary care expenditure should take precedence, because if you look around the country, in the last few years, publicly funded health insurance schemes have actually tended to distort public funding in favour of tertiary care at the cost of primary care,” Selvaraj said.

There are drug shortages due to inefficient procurement processes, he said, and added: “A model based on centralized procurement and decentralized distribution must be replicated by states.”

The government can provide free essential medicines in public heath institutions, Selvaraj said. “Currently, the government—both the Centre and the states together—just spends around 0.1% of GDP on medicines. That is way too low,” he added.

Vanshika Agarwal contributed to this story.

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