Make healthcare budget outcome-oriented

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Even as Prime Minister Narendra Modi has asserted that the country's public health spending will be increased to 2.5 percent of GDP by the year 2025, the fact remains that the problems that confront India's healthcare sector are here and now, and talking about what will happen in seven years' time does not solve today's problems.

As of now, India spends an estimated 1.15 percent of its GDP on health. The kind of increase that the prime minister is talking about would require diversion of funds from other sectors to healthcare. In a situation where the Finance Minister must do a tight-rope walk every budget due to financial constraints, it is difficult to imagine how India will start spending 2.5 percent of its GDP on health.

The National Human Rights Commission recently ordered the Haryana Government to pay compensation of Rs one lakh to a woman who had to deliver her child in the open in the Badshah Khan government hospital premises in Faridabad, after she was refused a bed in the hospital. The Commission held the state vicariously responsible and ordered the payment of the compensation. If the state accepts this responsibility in every case of denial of timely healthcare to every patient that comes to government hospitals, the earmarked funds would get exhausted in paying the compensation alone. After all, it is quite normal for harried patients to run from one government hospital to the other just because basics like a CT Scan machine are not there.

Take the case of the Rajiv Gandhi Super Speciality Hospital in the national capital Delhi. It is after ten years of the establishment of this hospital that the Out Patient Department started in this hospital recently, making headline news due to this shocking delay. If this is the way that the public healthcare sector is operating, one would not be faulted in concluding that the problem does not lie in what percentage of the GDP is spent on healthcare, but rather in how those funds are utilized.

It is quite routine in India for two or three patients to occupy one bed in government hospitals across the country. News has come from a government hospital in Bihar that dogs sleep on beds meant for patients.

There are repeated strikes in government hospitals across the country after doctors are beaten up by relatives of patients. This happens when the attendants are not satisfied with the manner in which the doctors care for the patients, little realizing that the sheer flood of patients makes it impossible for the doctors to give each one of them full attention, especially when the infrastructure in the hospitals is not up to the mark.

In a country where hundreds of millions are suffering from abject poverty, the focus of health policy on treating individuals when they have turned into patients is a very costly approach which amounts to first letting the problem develop and thereafter attempting to solve it. The idea of a Universal Basic Income that has been debated in the country with some vigour in the last three years has the potential to provide some money every month to every poor Indian. Surely, this will ensure food to those who go without food. Adequate nutrition may well mean that millions of people who fall ill every year due to not being properly fed would not fall ill if they had the state providing them a Universal Basic Income of, say, a thousand Rupees a month. This will take a huge load off our hospitals, since it would mean far fewer patients.

Spending money on nutrition in a country where many are indebted and many more are starving would be far better than spending more and more money on building huge hospitals that just refuse to entertain many patients who have no recommendation.

There is an argument being proffered by policy makers against Universal Basic Income that it would turn people into dole receivers and would discourage people from working for a living. It may be said that nobody refuses to work for a living when work is available, if not working means starvation. So, starvation occurs only in a dire situation. It is more cost-effective to provide nutrition through Universal Basic Income and thus save the starving individual from becoming a patient, than to not make an arrangement for nutrition and let him become a patient to be treated in hospitals at great expense under the Ayushman Bharat scheme.

In one sense, the Prime Minister is right. The Ayushman Bharat scheme provides for an estimated fifty crore poor people to get treated for free in various empanelled hospitals. The hospitals would be paid at pre-determined rates by the government through an insurance arrangement, or out of the government's coffers. So, who would finally foot the bill? Yes, the treatment would be free for the fifty crore poor, and the hospitals would be paid from the tax payer's money. The prime minister says that the public health spending is set to go up to 2.5 percent of GDP, which is about Rupees four lakh crore or thereabouts. The taxpayers should be prepared to foot this additional bill. The least that the taxpayers deserve is that this money should be spent in an outcome-oriented fashion.



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