Smaller health budget may stymie targets

The Planning Commission proposes to substantially reduce the country’s health budget over the next five years, raising serious doubts about whether the governments will have adequate resources to meet public health targets and lower out-of-pocket expenditure on health.

A 79-page draft of the health chapter in the Planning Commission’s final document -- available with Deccan Herald - envisages pegging total public funding for health at 1.58 per cent of GDP.

This runs contrary to recommendations of the Planning Commission’s High Level Expert Group (HLEG) on health for allocating 2.5 per cent of GDP by the end of 12th Plan and subsequently 3 per cent of GDP in the 13th Plan.

The promise in the 12th Plan document is lower than that made during the 11th Plan, under which it was proposed to hike health budget to 2.5 per cent of GDP but finally pegged at around one per cent of GDP.

“The proposed allocation is not sufficient to meet our public health requirements. It is in contradiction to our recommendations. We will meet the Planning Commission members on Thursday to convey our views,” a source in the HLEG, which was disbanded after it submitted its report a few months back, told Deccan Herald.

The Central Government’s share in the additional health expenditure would be less than half of states’ contribution. “This means 60 per cent of the budget will come from the state governments, which have fewer sources for generating additional revenue,” said Abhay Shukla of CEHAT, a non-governmental public health organisation in Pune.

The Planning Commission’s proposal to rope in private hospitals and clinics in providing public health care and suggesting corporatisation of government hospitals triggered alarm among public health specialists.

“Though it is proposed to be in the form of a few pilot projects in the states, even the mere suggestion of corporatising public health has raised a red flag,” said the HLEG source.

Ideally public health system should be strengthened to boost primary and secondary care, which in turn minimises the need for tertiary care because a strong public health sector acts as a gatekeeper.

“But the Planning Commission draft seems to suggest roping in private sector without adequate monitoring  and regulatory mechanism in place as a result of which there may be unnecessary but expensive diagnostics and surgeries,” he said.

Skewed insurance plan

For instance, under the existing government health insurance scheme, there is no coverage for out patients while a five-day stay in hospital entitles one for insurance claim. As a consequence, there is no money to manage diabetes clinically at the OPD, but there will be insurance coverage if diabetes – left untreated – led to amputation of limb, said Yogesh Jain from Jan Swasthya Sahyog in Bilaspur, a member of the HLEG.