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Budget or ‘fudge’it, only time will tell


Even if FM Jaitley has rectified the mistakes of Obamacare, will this government have the time to implement Modicare?

new-viveka-100x100Finance Minister Arun Jaitley’s last full budget before the 2019 general elections seems to be a first step towards universal health coverage for Indian citizens. This is clearly a precursor to Prime Minister Modi’s version of Obamacare.

Kicking off the health section of the Union Budget 2018-19, the FM said, “Only Swasth (healthy) Bharat can be a Samriddha (prosperous) Bharat. India cannot realize its demographic dividend without its citizens being healthy.” There is criticism that with recent electoral set backs due to farmer distress in the rural areas and a restless jobless urban youth, most Budget announcements this year favoured Bharat rather than India. The sub text to most announcements is the creation of jobs as an additional spin off benefit. There is also an effort to distance itself from the Opposition’s criticism of being overtly corporate friendly (‘suit-boot ki sarkar’) at the cost of the common citizen. For instance, the FM prefaces his allocation for an additional Rs.600 crore for nutritional support to TB patients at the rate of Rs 500 per month during their treatment, with the statement that TB ”affects mainly poor and malnourished people.”

There is no fault with this rationale. In fact, a focus on bettering health outcomes at the grassroots, including both rural and urban poor, is long overdue. Centers of excellence in healthcare, both in public and corporate, tend to be located in major metros. Most urban Indians tend to have more resources, hence better access to nutrition and preventive health check ups. Most of the salaried population can afford self purchased as well as corporate sponsored/subsidised insurance cover.

Thus the FM’s announcement to upgrade existing district hospitals in the country and create 24 new Government Medical Colleges and Hospitals is a good move to strengthen the health ecosystem in India’s villages and district towns, reducing the need to travel to cities for healthcare, except for the very serious cases. It will also address the dearth of doctors and paramedical staff in India, which often hampers healthcare delivery. The FM has also increased the limit of deduction for senior citizen health insurance under Section 80D, from Rs. 30,000 to Rs. 50,000 which will enable senor citizens to access more healthcare facilities.

But the centrepeice of the budget’s proposals for health is the a flagship National Health Protection Scheme, as part of the Ayushman Bharat scheme. Pegged as the ”world’s largest government funded national health programme”, it aims to provide insurance cover to over 10 crore poor and vulnerable families, (benefiting approximately 50 crore family members), providing coverage upto Rs 5 lakh per family per year for secondary and tertiary care hospitalisation programme. While major hospitals, diagnostic players and insurance companies have hailed these announcements, as more business could come their way, they are cautiously awaiting details of its implementation. Many PPPs have gone south as private players allege that payments from government tend to get mired in red tape, are disputed, delayed and often have to be written off.

On the primary healthcare side, the FM committed Rs1200 crore to the existing 1.5 lakh Health and Wellness Centres and expanded their coverage to include non-communicable diseases and maternal and child health services, with free essential drugs and diagnostic services. He also intends to harness the mandatory CSR funds of corporates by inviting them to adopt these centres.

As industry scrutinises the finer details, there is criticism that fund allocation to healthcare hasn’t really increased that much, with the government merely repackaging old wine in a new bottle and topping it off a bit. For instance, there are indications that Ayushman Bharat will be a consolidation of existing schemes under the Jan Suraksha framework, with existing schemes like the Rashtriya Swasthya Bima Yojana (RSBY) as well as schemes launched by individual state governments under a common umbrella.

Funds allocated by the centre for state run health schemes often do not get spent, hence this could be a good way to monitor and re-distribute funds to states and schemes which have a history of using health funding efficiently with maximum proven outcomes. With the traditional animosity between centre and state governments, especially those not of the same political colour as the centre, this could well turn out to be a prolonged turf war.

Even if FM Jaitley has rectified the mistakes of Obamacare, will this government have the time to implement Modicare?

Viveka Roychowdhury
[email protected]

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