The biggest takeaway for healthcare from the budget was a signal of the government’s continued commitment to providing health insurance. This should put at rest speculation on the direction the National Health Mission (NHM) would take. Budgetary allocation to health insurance has increased sharply.
Allocation for health insurance in the 2016-17 budget was Rs.1,500 crore. A revised estimate for the current financial year shows expenditure of Rs.595 crore. This is an increase of 152% within one year for the Rashtriya Swasthya Suraksha Yojana, or National Health Protection Scheme (NHPS), a new nomenclature for the Rashtriya Swasthya Bima Yojana (RSBY). Under the NHPS, the finance minister announced a cover of Rs.1 lakh per family. An additional cover of Rs.30,000 was announced for senior citizens.
“It looks like insurance is the direction that universal health coverage and NHM are taking. There is clear emphasis on insurance,” said K. Srinath Reddy, president of the non-profit Public Health Foundation of India.
After the report of the high-level expert group on universal health coverage (UHC) of the erstwhile Planning Commission came out in 2011, the debate on UHC revolved around two possibilities—insurance cover to patients or provision of free medicines and diagnostics.
The debate was carried forward with the announcement of the NHM two years ago. With an increase in the insurance coverage without any mention of provision of free medicines in its latest budget, the government has indicated that it will follow the health insurance model in the coming years.
On medicines, finance minister Arun Jaitley said the centre planned to open 3,000 Jan Aushadhi stores offering affordable generic medicines. Currently, India has a total of 137 such stores in 19 states.
The overall budget allocation for fiscal 2016-17 for health, including AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy) is Rs.39,532.55 crore.
The revised estimate for 2015-16 is Rs.34,956.6 crore. The allocation for the next year means an increase of nearly Rs.5,000 crore, or 13%. NHM saw an increase of only 2% (from Rs.19,135.37 crore in the current fiscal year to Rs.19,437 crore in the next).
Another sector that has emerged as the focus area is so-called super specialty (or tertiary care) facilities under the Pradhan Mantri Swasthya Suraksha Yojana (PMSSY), which is responsible for establishing new All India Institutes of Medical Sciences and upgrading state hospitals.
The budgetary allocation for this increased from Rs.1,215.85 crore to Rs.2,500 crore this year.
“In this budget, spending on institutes managed by central government has increased substantially. Success of NHM will depend on how states decide about their priorities,” said Padmapriya Janakiraman, senior research associate at research group Accountability Initiative.
In a major initiative, the finance minister announced that dialysis units will be installed at all district hospitals for renal patients under the National Dialysis Service Programme. Jaitley proposed to raise funds for the initiative through public-private partnerships and urged private entities to step in.
He proposed exemptions from customs and excise duty for dialysis equipment.
The increase in allocation has been welcomed by experts in the health sector. However, they say that it lacks an integrated approach.
“Insurance, Jan Aushadhi scheme and dialysis programme are individual components, which are useful gestures in their own way. But we still cannot see an overall picture. For example, dialysis facilities are much needed. But we do not know what is the government doing to address hypertension and diabetes, which lead to renal disorders in the first place,” said Reddy.
“These are some of the incremental but positive steps announced by the finance minister in the area of public health,” said Kenneth Thorpe, chairperson of NGO Partnership to Fight Chronic Disease.
“However, in the broader framework, these measures are not adequate enough to help address the larger issue of access to healthcare, particularly when it comes to addressing the growing burden of non-communicable diseases (NCDs),” he said.
Recent data from the Registrar General of India showed that nearly half of all deaths in the country occur due to NCDs, with cardiovascular diseases responsible for 23% of them.