IASbaba's Flagship Course: Integrated Learning Programme (ILP) - 2024 Read Details
Search 12th February, 2019 Spotlight here: http://www.newsonair.com/Main_Audio_Bulletins_Search.aspx
TOPIC: General Studies 2
- Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources
- Government policies and interventions for development in various sectors and issues arising out of their design and implementation.
In News: There is an increase of more than Rs 7,000 crore in nominal terms from last year’s expenditure on health in this year’s budget — the outlay has increased from Rs 56,045 crore to Rs 63,298 crore. Accounting for inflation, this amounts to a 9.2 per cent increase in real terms.
Pradhan Mantri Jan Arogya Yojana (PMJAY) Scheme
Aim: To make path-breaking interventions to address health holistically, in primary, secondary and tertiary care systems
Objective: Prevention + Promotion (Health & Wellness)
Two major initiatives:
The Concern: The National Sample Survey’s (NSS) health data of 2014 shows that in an estimated total 24.85 crore families in India, there were 5.72 crore cases of hospitalisation. By that calculation, out of the 10-crore families, there would be roughly 2.3 crore hospitalisations in a year. This means that from the Rs 6,556 crore government funds, health insurance agencies on average have only Rs 2,850 to pay per hospitalisation (assuming there are no administrative costs or insurance overheads).
The average out-of-pocket expenditure (OOPE) per hospitalisation is much higher — around Rs 15,244 as per NSS 2014 data, which amounts to Rs 19,500 in 2019-20 assuming a 5 per cent annual inflation. The PMJAY’s budgetary provisions for insurance agencies will barely cover 15 per cent of this expenditure.
Ayushmaan Bharat can be a Game Changer only if:
Some concerns and Way Ahead
Poor public health spending: Government aims to increase public health spending to 5% of GDP. However, current health spending is only 1.15-1.5% of GDP. To reach its target, the government should increase funding for health by 20-25% every year for the next five years or more.
Poor allocation in Interim Budget: The total allocation to healthcare is ₹61,398 crore (an increase of ₹7,000 crore from the previous Budget). However, there is no net increase since the total amount is 2.2% of the Budget, the same as the previous Budget. The increase roughly equates the ₹6,400 crore allocated for implementation of the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PMJAY). The modest increase in budgetary allocations in health should have been prioritised towards improving the worn-out public sector district hospitals, community health centres, primary health centres and sub-centres in under-served areas.
Per capita spending on health: Public per capita expenditure on health increased from ₹621 in 2009-10 to ₹1,112 in 2015-16. Per capita spending on health for 2018 is approx. ₹1,500. Therefore, despite the doubling of per capita expenditure on health over six years, the public spending figure is still abysmal.
Strengthening of the country’s primary healthcare system taken a backseat: Allocation under the National Rural Health Mission (NRHM) — which provides funds for rural primary healthcare — has been reduced in real terms (accounting for inflation). Its share in the health component of the budget has declined steeply over the past four years — from 52 per cent in 2015-16 to 41 per cent this year. Within the NRHM, there have been budget cuts for reproductive and child healthcare projects and maintenance of rural healthcare infrastructure.
Ranking on the basis of Per capita Budget expenditure on health: It is among the lowest in the world. It is important to note that U.S.’s health expenditure is 18% of GDP, while India’s is still under 1.5%. In U.S. allocation for healthcare is 23.5% of the budget and per capita spending on health in the Budget is $3,150. In India, allocation for healthcare is merely 2.2% of the Budget and per capita spending on health in the budget in India is approx $30. There is $4,000-$5,000 per capita spending in OECD countries.
High out-of-pocket expenditure: Out-of-pocket expenditure in India is at a massive 67%. Although, the ₹6,400 crore allocation to Ayushman Bharat-PMJAY in the Interim Budget will help reduce out-of-pocket expenditure on health.
Note:
PM-JAY app: The app has been introduced within just four months since the launch of the scheme and is aimed at helping users get easy access to information on the scheme, check eligibility, find hospitals nearby and get assisted help.
National Health Authority (NHA): Aims to effectively implement PM-JAY. The National Health Authority with a stronger mandate would be able to prevent, detect and control frauds, abuse and redress grievances, thus resulting in the reduction of leakages.
National Health Stack (NHS): A national electronic registry usable by both the Centre and the States across public and private sectors.
The new Digital Information Security in HealthCare Act (DISHA):
₹250 crore has been allocated for setting up health and wellness centres under the National Urban Health Mission. Under the National Rural Health Mission, ₹1,350 crore has been allocated for the same.
Nearly 1.5 lakh health and wellness centres would be set up under Ayushman Bharat.
The non-communicable diseases programme of the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Strokehas been allocated ₹175 crore, from ₹275 crore.
Allocation to the National Tobacco Control Programme and Drug De-addiction Programme is only ₹65 crore, a decrease of ₹2 crore.
Must Read:
Connecting the Dots: