Policy shift

By unveiling the Ayushman Bharat scheme last September, the Centre signalled a sharp shift towards insurance-led public health. In some measure, this was necessary in view of the role of out-of-pocket health expenditure (OOP) in pushing 55-60 million Indians annually into poverty and debt. OOP, or spending uncovered by insurance, accounts for 67 per cent of total health spending in the country — a huge burden where private services dominate the scene. This share is expected to reduce, once Ayushman gets going. At present, existing Central and State health insurance programmes cover 22 per cent of total health expenditure, while the remaining 11 per cent is met by local bodies and private insurers. Ayushman has shown encouraging results in four months, having received over eight lakh claims exceeding ₹1,000 crore, of which, over 6.2 lakh claims, amounting to over ₹800 crore, were approved. About 15,000 new beneficiaries are enrolled each day across about 14,700 empanelled hospitals, the average claim size being about ₹14,000. In a country where heart disease and cancer cannot any longer be considered ailments of the middle and upper classes, it is heartening that heart patients in particular have benefited from Ayushman packages. A Businessline series, carried last month, observes how existing State schemes have been dovetailed into this programme. A plan to cover 10.7 crore families with an annual insurance cover of ₹5 lakh per family for 1,350 ailments is laudable. But it should not become the sole public health programme.

The Interim Budget’s allocations seem to suggest that Ayushman allocations have come at the expense of existing health schemes ( Businessline , February 7). Ayushman received an allocation of ₹6,400 crore for the forthcoming fiscal, or a tenth of the health budget, whereas outlays for non-communicable diseases and reproductive and child health have been slashed 28-30 per cent. Allocations for the National Health Mission have been reduced from 55 per cent of the Union health budget in 2018-19 to 50 per cent in 2019-20. Worse, there has been an absolute cut in capital expenditure, which includes setting up new medical colleges. This seems to confirm a mistaken notion in policy circles that insurance expenditure can take the place of infrastructure spending.

India’s public health spending, at 1.4 per cent of the GDP (health expenditure as a whole is about 4.5 per cent of GDP), is well below developing country levels. Mexico, Brazil and China spend well over 4 per cent of their GDP, while the US and EU are in the 8 per cent range. The persistent inability of our governments to address this malaise is deeply disturbing. Ayushman should kickstart higher outlays in public health and medical education. Both, the coverage and quality of medical care need to improve, for which the State needs to play a bigger role.