Guru Prasad Mohanta
The budget session of Parliament has just ended. If the interim budget is anything to go by, healthcare has been given a fair deal. The overall allocation for health has risen by 13 per cent increasing the outlay to Rs 61,398 crore for 2019-20 compared with Rs 54,667 crore in 2018-19 revised estimate. The two flagship schemes: Ayushman Bharat and Ayushman Bharat Health and Wellness Centres received sizeable raise in the budget. Allocation raised to Rs 6,400 crore for Health Protection Scheme and Rs 1,600 crore for Health and Wellness Centres. It is a sizeable investment in health.
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Ayushman Bharat – Health Protection Scheme, also known as Pradhan Mantri Jan Arogya Yojana (PMJAY) aims to benefit 10 crore poor and vulnerable families accounting for about 50 crore population empowering them to go for treatment to higher centres which are usually located in cities. It provides health insurance cover of up to Rs 5 lakh per family per year. In this cashless and paperless access to healthcare insurance covers 1,350 medical packages covering surgery, medical and daycare treatments. This is viewed as the game changer in life of vulnerable population.
In a federal country like ours, the Centre and states should work together to optimise the use of resources and build a healthy India
The healthcare expenditures are known to be catastrophic and spending on health pushed more than 50 million people to below poverty line in 2017. More than 10 lakh people have already benefited from the scheme within just four months. Health insurance is not very popular in the country and a very small percentage of people opt for it.
General health insurance does not cover day care and one needs to be hospitalised for at least a day to claim insurance. This implies needless expenditure of being hospitalised without valid medical reason. There is concern for people who are just above the border line of people identified as eligible for the insurance. These groups should be encouraged and perhaps with support to have health insurance, failing which they would be pushed to back by a decade.
Primary healthcare centres have been the foundation of India’s health system. The Alma Ata Declaration in 1978 adopted “Health for All by 2000 AD” ensuring primary healthcare. Even after 40 years, health for all could not be achieved.
In 2018, again in Astana Declaration, the leaders of all countries reaffirmed that Health for all can be achieved through strengthening primary care. India, now, proposes to establish 1.5 lakh health and wellness centres upgrading the existing primary health centres. These centres should be established on priority to provide healthcare to the vicinity of the population. More people availing the service at these centres would reduce the burden of secondary and tertiary care. The upgradation does not look feasible without the cooperation of states.
Owing to increasing awareness of PMJAY, the people would directly go to higher centres for healthcare and this is likely to increase the influx even in private hospitals making a beeline. This impact may encourage establishing more hospitals for secondary and tertiary care centres. If this does not happen, the higher centres of healthcare would become overcrowded and ill maintained centres as we see in public facilities.
The two bold decisions in the last two years: launching of National Health Policy 2017 and National Health Protection Scheme could be seen as sincere efforts to bring a transformation in healthcare and promotion of health in the country. It has never been attempted earlier and allocated resources to achieve the target. But health is a state subject.
In a federal country like ours, the Centre and states should work together to optimise the use of resources and build a healthy India. Investment in health is perhaps a priority area as healthy India would bring more productive opportunities and employability besides increasing longevity.
The writer is professor, department of pharmacy, Annamalai University. e-Mail: gpmohanta@hotmail.com.
