Budget disappoints on healthcare

Posted on February 5, 2022

Shailaja Chandra writes: Many expectations for the health sector remain unfulfilled

Written by Shailaja Chandra | Updated: February 5, 2022 9:39:12 am

There were many expectations of the Union budget for the health sector. The big-ticket items — the digitally managed health ecosystem and provisions for mental health — veer away from the prevalent systems. They rely on the power of technology to bypass the need to undertake physical visits to doctors, carry prescriptions and wait in queues. The digital experience could be a game-changer, but only if the facility, doctors, patients, and systems work in tandem.

When it comes to Covid vaccinations, the digital platform has been a runaway success, primarily because the COWIN platform was simple and slick, and the citizen could choose between public and private facilities. Online medical consultations have started in metros and people are setting up appointments with doctors easily. But the management of hospital beds across the country is a different story. Of the 19 lakh beds in India, 62 per cent are in the private sector. Nearly 95 per cent of them are operated by small hospitals or nursing homes — the first port of call for most citizens seeking medical care. The setting up of a National Digital Ecosystem which “will maintain digital registries of health providers and health facilities,” is welcome, but one must be clear whether it will encompass both the public and private health sector and include smaller hospitals and nursing homes. And, what about consent, compliance and cost?

The other big-ticket announcement relates to the mental health sector. It serves one purpose straightaway- making society aware that such conditions can afflict anyone, but the disease can be treated, and patients should not be stigmatized. With IIT Bangalore and the National institute of Mental Health and Neurosciences (NIMHANS) in the driver’s seat, we can expect professionalism and results

The other big-ticket announcement relates to the mental health sector. It serves one purpose straightaway — making society aware that such conditions can afflict anyone, but the disease can be treated, and patients should not be stigmatised. With IIT Bangalore and the National Institute of Mental Health and Neurosciences (NIMHANS) in the driver’s seat, we can expect professionalism and results. But the budget speech did not mention if the mental health strategy will focus on all psychological problems or only those that have arisen in the wake of Covid. Many mental health conditions encompass disorders that are not amenable to teleconsultation.

While the budget has provided some financial leg up to the National Health Mission and more to the Pradhan Mantri Swasthya Suraksha Yojana (under which AIIMS-type of hospitals and government medical colleges are being established or upgraded) these are programmes that have been in progress since 2005. Four announcements were expected but did not come.

First, the need to substantially raise the overall budgetary contribution to the health sector. It is currently pegged at 1.8 per cent of the GDP and the push in the budget appears very small.

Second, during the pandemic the unorganised middle class was caught without adequate (or even any) health insurance. After excluding insurance coverage for the organised sector (both government and private), and those covered by Ayushman Bharat and state-level health security schemes, a whopping 26 crore people had no health insurance when the pandemic started. They found hospitalisation costs staggering. One of the biggest expectations from the budget was that the lower end of the “missing middle” would get some handholding.

Third, there was an expectation that Ayushman Bharat would be expanded to cover the outpatient costs faced by the poor. The Economic Survey has recognised that such expenditure is huge.

Fourth, there was a need to address the crisis of non-communicable diseases — hypertension, diabetes, and cardiovascular diseases largely caused by unhealthy lifestyles. During Covid, people with comorbidities constituted the largest segment that succumbed. Fiscal measures, incentives, and disincentives have reduced the incidences related to lethal consequences of smoking. A repetition of the prevention of smoking story was called for.

The health sector outlay leaves many expectations unfulfilled. People I spoke to said “not everything needs to be announced in the budget.” We live in hope.

This column first appeared in the print edition on February 5, 2022 under the title ‘Not so healthy’. The writer is a former secretary in the Ministry of Health.