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Industry Voice
Budget 2008: Did it Provide Enough Incentives?
The voice of the needy in healthcare is not loud enough to
make political sense
Brig Joe Curian |
It was music to the ears for those concerned with healthcare,
hearing the Finance Minister say "healthcare was one of the pillars of
social sector reforms". Now that the 'sound' has somewhat settled, let
us search for some 'light' in the healthcare budget.
An increase of public spending by approximately 15 per cent has been declared
taking the same to Rs 16,543 crore. The move is in the right direction, but
is it adequate? Fifteen per cent over the existing GDP percentage of less than
1 per cent will not make the desired impact within the desired time frame. For
a developing country this falls way below even 30 per cent of what WHO recommends.
Considering the fact that in many key parameters of health, we are below even
Bangladesh or Sri Lanka, a much bigger allocation was necessary. Perhaps, the
voice of the needy in healthcare is not loud enough to make political sense,
as of now.
A five-year tax holiday under Section 80-1B has been declared for new hospitals.
This perhaps is the boldest of all initiatives for healthcare in the new budget.
This will certainly spur more investments, especially in tier II and III cities
as also in rural India. This tax holiday will give real benefit to new hospitals
only after approximately three years of starting, because it takes about that
much time for any new hospitals to break even. This benefit would be enjoyed
for about two years thereafter by the new hospitals. Undoubtedly, this incentive
would increase 'supply' and accessibility. But what about affordability, when
most people still pay for healthcare out-of-pocket is the question.
 The
budget allocates Rs 12,050 crore for the National Rural Health Mission. Again,
this is a significant improvement over the previous allocations. Upgradation
of over 320 hospitals at district level planned under the scheme will help many
people by improving access to good, high-tech healthcare.
Another Rs 993 crore has been allocated towards battle against AIDs. Against
the background of the expected increase of AIDS-affected patients to 1.75 lakh
in the next three years, this allocation should make a significant impact both
in preventing and treating such patients.
Similarly, the drive against polio will be supported by Rs 1,042 crore. Against
864 cases already reported in 2007 and almost 12 per cent of the said figure
is further reported in 2008 already, this initiative is indeed welcome. But
what about Hepatatis 'B' and Hepatatis 'C'? There is an urgent need to address
both of these on war footing. Hepatitis B&C immunisation programmes could
have been planned in areas/districts where drinking water and sanitation facilities
are lacking.
Another welcome initiative is the insurance plan called 'Rastriya
Swasthiya Bheema Yojana' starting with New Delhi, Harayana and Rajasthan for
the unorganised work force for Rs 30,000 per head. Allocation of Rs 205 crore
for this purpose is encouraging. Should we start all our programme with Delhi
and relatively more developed states? If equity is a criterion, then this programme
should have started with the most backward states or most backward districts
rather than Delhi and other places where the accessibility and quality of healthcare
is relatively better. The 'have-nots' should be the first in queue for such
benefits.
The National Programme for the elderly with an allocation of Rs 400 crore is
good news for those above 65 (Rs 24 crore) as also above 80 (Rs 5 crores). The
two national institutes of ageing and eight regional centers and one geriatric
department each in at least one tertiary care hospital in every state would
give focused healthcare to the elderly. Similarly, an increase in outlay by
almost one fourth for women and child development is another initiative which
will make positive impact on their healthcare. The well-focused initiative to
provide clean drinking water in schools, in water-deficient areas with the allocation
of Rs 200 crore and special allocation of Rs 1,200 crore for various sanitation
programmes must receive kudos.
Let us now look on the over all impact on healthcare that these initiatives
would have. One needs to understand that the ultimate healthcare outcome would
depend on the efficiency with which allocated resources would get utilised besides
the proportion of allocations. From the industry perspective, it is a moot point
if the budget has addressed both demand and supply. But when will this sector
receive infrastructure status?
It may not be quite logical to categorise medical equipment and drugs as 'life
saving' and 'non life saving' and give benefits accordingly, as if to suggest,
we will help you if you are about to die! Why no incentives have been given
for maintaining health and rewarding a 'stitch in time' approach? Present thought,
perhaps, needs to be turned on its head. Should we give scholarships only to
kids who are about to fail? Nobody pops medicine for fun!!
One also wishes that health insurance could have been made available to large
groups like the whole 'panchayat' in backward areas in the light of expected
new hospitals coming up with tax benefits declared now.
The writer is President, Global Hospitals
Email: joecurian@globalhospitals.net
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