Wednesday, 9 July 2014

Inclusive Growth for Inclusive Health Care

Health Care Services will be a priority area to look for in this budget

India is becoming a preferred destination for medical tourism and super-specialty healthcare. India has tens of thousands of skilled physicians and nurse practitioners. Over the last two decades, the economic boom in India has led to the building of medical facilities & infrastructure that rival the very best that western medical care that the west has to offer. Many of the physicians that practice in these hospitals and clinics have returned (to India) from the U.S. and Europe, leaving behind successful practices. But it still has to go a long way in providing basic healthcare to its own people. Also these success stories are few.

Some sort of institutionalization and collaboration is the need of the hour. Sunil S. Kapur, Director Business of Tertiary Care Hospital, explains the problem. "That the medical tourism industry is growing leaps and bounds is a fact known to all. However, three agencies under the banner of MEA, Tourism and Health are playing a simultaneous role, which is only leading to confusion rather solutions. In order to consolidate the efforts, the government needs to put all concerned agencies under one banner and look to create a conducive environment for the flow of medical tourism to increase. Today, sadly, the cross purposes only ensure that patients are turning away, which not only results in loss of foreign exchange earnings, but also has the cascading effect on all other allied support industries."

The Planning Commission has allocated US$ 55 billion under the 12th Five-Year Plan to the Ministry of Health and Family Welfare, which is about three times the actual expenditure under the 11th Five-Year Plan. The 12th Plan focuses on providing universal healthcare, strengthening healthcare infrastructure, promoting research and development (R&D) and enacting strong regulations for the healthcare sector. But in absolute terms, analysis of healthcare expenditure from Union & State budgets clearly shows that country’s overall expenditure on public health is very low (around 4% of GDP). The public sector hospitals are lacking in infrastructure needs. Till date, people are forced to wait for long hours in long queues for their consultations. The time delay for getting the investigations range from 3-4 months to 6-8 months for a surgery in public hospitals.

Dr D K Baluja, Group President, QRG Medicare substantiates this. "Indian Healthcare is in dilemma and needs serious intervention from the government. The GDP spend on healthcare is amongst the lowest in the world which drastically needs to be increased if we need to see Indian healthcare systems on world map. We have no dearth of skilled manpower which is evident from the medical brain drain from our country to other countries."

Another area of concern is penetration of health insurance. It is estimated that only 3-5% of Indians are covered under any form of health insurance. Initiation of health insurance programs at the urban level as well as rural level could be an important step towards promotion of delivery of affordable and quality health care. The Government ought to look at ways to replicate some of the successful state wise health policies which provides cashless health cover to those below the poverty line. Naresh Kapoor, Director, Finance & Strategy, BLK Hospitals seconds the need of insurance in the sector. “Government should focus on providing healthcare services to every citizen of this country irrespective of its social status by way of a universal health scheme managed by private administrators (TPAs) wherein treatment should be available in the best of hospitals. Government should channelize its resources in providing health insurance to its citizens and hospitals should be set up only for teaching, research and academics.”

However, the abysmal state of public investment and facilities has built a case for private players in Indian healthcare sector. The sector’s share in healthcare delivery is expected to increase from 66 per cent in 2005 to 81 per cent by 2015. The private sector's share in hospitals and hospital beds is estimated at 74 per cent and 40 per cent, respectively. Public-Private Partnerships (PPP) and Public-Private-Collaborations (PPC) are fast picking up to meet the growing needs for health services and fill the gap of demand and supply. The scope of networking with public health institutions that are working in the public sector needs to be expanded within the ambit of the PPP model under the National Rural Health Mission. The government proposed a new National Health Mission which would have under its jurisdiction both the National Rural Health Mission and the proposed NUHM. The NHM was allocated Rs 21,200 crore for this purpose in last year's budget. 

 Not only hospitals, adequate number of human resources are also needed if vast population of the country needs to be catered to. In the words of Dr. Garima Singh, CEO, Saket City Hospital, "Paramedics need more attention in our health industry. The sector is growing very fast in our country and we need more paramedical staff like nurses, OT technicians, pathology technicians and the people to operate with higher equipments like CT, MRI etc. The govt. should open more new centers, nursing colleges, technical training centers and medical colleges to fulfill the requirement in future for doctors, specialists and super specialists."

The FM proposed an increased budget of Rs 4,721 crore for educational medical institutions last year. The recently launched AIIMS-like institutions that started their academic years in September 2012 were given an allocation of Rs 1,670 crore. With the change in government it would be interesting to see how it turns out to be this year around.

Dr. Nikita Trehan, Managing Director, Sunrise Hospital, Delhi vouches for the need for a favorable tax regime in order to ease pressure on the government hospitals. "An ailment like laparoscopy yields to a faster turnover, hence more patients can be looked after by one doctor in the same time and hence the long waiting lists and queues of government hospitals will be managed more effectively. Also since government hospitals are overburdened the taxation levied on private hospitals should be minimized so that private hospitals are in a position to associate (as their costs will be reduced for the patient), in public private partnerships with government hospitals.

In a nut shell, the scope of networking with public health institutions that are working in the public sector needs to be expanded within the ambit of the PPP model under the National Rural Health Mission. Handing over public health sector to private hands gradually may just be the right solution.

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