The budget has promoted private healthcare at the cost of public sector

Dr Arun Bal

Though this is the first time that the budget has declared some sops to the healthcare sector, it needs to be seen who is the beneficiary. The beneficiary is the urban middle class populace who has capacity to go the private hospitals. The budget has completely neglected seventy per cent of the Indian populace who live in rural area and avail the public healthcare facility.

In developed countries, the public healthcare system is in the hands of the government. But in India this budget has handed over the public healthcare system to the private sector. The extension of tax benefits to financial institutions that provide long term capital to private hospitals with more than 100 beds would give a boost to the private sector interested in building more hospitals. But the question is do we need more hospitals? No, we don’t. Building more hospitals in the city is only to give a boost to medical tourism. What we really need is to better the infrastructure of the public hospitals. But the budget has given no allocation of increase of funds for the public sector. The outlay for public sector needs to be increased. In real term when one takes in to account the inflation this has remained static. The budget has tried to promote the private healthcare at the cost of the public sector.

While the WHO standard states a country needs to invest five per cent of its GDP in healthcare, we still invest 1.2 per cent, as against 14.4 per cent of US and seven per cent of UK. The boost to private hospitals is also an emphasis on the curative aspect of healthcare of the government, which is a flawed perspective. What about the preventive aspect? The prevalence of communicable infective diseases related to poor availability of potable water and environmental pollution is an alarming sixty per cent. But no policy has been devised for promoting preventive healthcare.

At present though the government has vast infrastructure in healthcare in rural India in the form of Primary Health Centres, the common man still to a large extent, depends on the private sector. However private sector is mainly involved in curative services and therefore, the root cause of healthcare inequalities remains uncorrected. The government should have thought about the menace of diabetes for which a patient needs to have life-long support. Even the community based health insurance as proposed in the budget will end up strengthening the curative approach to the healthcare problems of the common man than trying to attack the main reason. Secondly, the community based health insurance per se can not correct the healthcare inequalities.

In short term, this scheme is unlikely to benefit the consumers. The budget does not specify as to from where the funds for below poverty population will be provided. Also the details of this scheme needs to be looked into. The implementation will be crucial. A number of government schemes remain only on the paper. In the long term, this scheme may benefit the consumers for curative treatment to some extent only if the health bureaucracy is kept away from it.

If such a scheme is to be effectively implemented even for a curative approach, it should be kept away from the health sector bureaucracy. The government should form a co-operative and take the help of NGOs as the Karnataka government has recently done. It is necessary that the people are involved at panchayat level in formulating and implementing the scheme. Only people’s participation will give some success to this scheme. The implementation of such a scheme needs to take into account the prevalence of the diseases in the country. The schemes need to be designed to correct the inequalities in the accessibility, availability and affordability of the healthcare. Also, good monitoring of the private sector in the country is needed which is at present lacking. In the absence of good infrastructure other than government health bureaucracy implantation is likely to be unsatisfactory.

(The author is founder member of Association for Consumer Actions’ on Safety and Health)