Healthcare in Union Budget 2017-18

The major issues in the healthcare sector in India are low government spending and high out of pocket expenditure on health. There was an expectation of increased budget share of healthcare sector to meet these challenges and the dual challenges posed by communicable and non-communicable diseases. The key budget announcements are as follows:

Increased allocation for Health Ministry

In the latest budget, the allocation for Ministry of Health and Family Welfare increased from Rs.39,688 crore in 2016-17 to Rs.48,853 crore in 2017-18, thus increasing from 1.97% to 2.27% of total budget. At the same time, it is overall a 23.1% increase in allocation for the health sector. This increase is though welcome, but appears to be more lopsided towards human resources (medical education).

Action plan to eliminate diseases and bring down IMR & MMR

The Government has prepared an action plan to eliminate Kala-Azar and Filariasis by 2017, Leprosy by 2018 and Measles by 2020 and Tuberculosis by 2025.  Similarly, action plan has been prepared to reduce IMR from 39 in 2014 to 28 by 2019 and MMR from 167 in 2011-13 to 100 by 2018-2020.

Mahila Shakti Kendras

Rs. 500 Crore have been announced in the budget to set up “Mahila Shakti Kendras” at village level in 14 Lakh ICDS Aangabadi centres. These centres will work as one stop convergent support services for empowering rural women with opportunities for skill development, employment, digital literacy, health and nutrition. We note here that government does not seem to be very clear in what it is going to achieve in Rs.500 crore. They could enhance the already existing Mahila Samakhya scheme rather than leaving that and lunching a new scheme. That programme was run by HRD ministry and last year it was incorporated in NRLM but has now virtually shut down.

Promoting institutional deliveries

This scheme was earlier announced by PM under which Rs.6,000 each will be transferred directly to the bank accounts of pregnant women who undergo institutional delivery and vaccinate their children.

Transformation of Health Sub Centres

As per the budget, the government will transform 1.5 lakh Health Sub Centres into Health and Wellness Centres, which shall also be used to promote generic drugs. But,  how the financial resources for the same will be mobilized is not clear as the government has not given any roadmap for ensuring financial resources for these sub-centres.

Promotion of Diplomate of National Board (DNB) Courses

The government will take steps to roll out DNB courses in big District Hospitals; strengthen PG teaching in select ESI and Municipal Corporation Hospitals; and encourage reputed Private Hospitals to start DNB courses. DNBs are considered equivalent to MD/MS/DM/MCh.

Two new AIIMS

The government has announced two new All India Institutes of Medical Sciences (AIIMS) in Jharkhand and Gujarat. This is welcome step but we note that already announced and opened new AIIMS are not fully functional and are grappling with issues of human resources.

Smart Cards for Older people

The government has announced to introduce Aadhar Based Smart Cards for senior citizens containing their health details. This launch will be through a pilot in 15 districts during 2017-18. One of the important side benefit of health cards is that it helps in consolidating the Electronic Health Record (EHR) in the country.

For Pharma sector

The government announced to bring amendment in D&C Rules to ensure affordable drugs and promote generic medicines. Further, new rules for regulating medical devices will also be formulated to attract investments.

Unaddressed Issues with Healthcare

Despite increased budget and new announcements, there are several problems which still remain unaddressed. Firstly, not much has been done to promote affordable healthcare in private sector which caters to 80% outpatient and 60% of inpatient care in the country. The healthcare in tier-II and tier-III cities is in shambles in both public and private sectors. Secondly, nothing much has been proposed to focus on prevention and preventing healthcare. Currently, the government provides a tax exemption Rs.50000/- on preventive health check up under section 80-D of IT act. There was a need to raise this limit to at least Rs. 20000/- but that has not been done. Thirdly, nothing much has been done to enhance long term financing options for the healthcare industry despite the fact that healthcare was included in infra-structure subsectors in 2012.

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