Good news for India’s healthcare system

#### GS Paper 2

Syllabus: Government Policies and Interventions

Source: IE

Context: India’s healthcare system is witnessing positive developments, with significant increases in government health expenditure (GHE) as a proportion of GDP and per capita expenditure.

Findings of the recent National Health Accounts (NHA):

• Increasing Government Investment in Healthcare: Government health expenditure (GHE) as a percentage of GDP rose from 1.13% to 1.84% between 2014-15 and 2021-22.

• Per capita government spending on health almost tripled during the same period. The National Health Policy (NHP) aims to increase public health expenditure to 2.5% of GDP by 2025.

• The National Health Policy (NHP) aims to increase public health expenditure to 2.5% of GDP by 2025.

• Government-Funded Insurance Schemes: Investment in government health insurance schemes like Ayushman Bharat PMJAY increased significantly (4.4-fold rise since 2013-14).

• Decreasing Out-of-Pocket Expenditure (OOPE): OOPE decreased from over 62% to about 39% between 2014-15 and 2021-22.

• Factors Contributing to Lower OOPE: Increased utilization of government facilities, free ambulance services, and other initiatives contribute to reduced OOPE. The availability of free medicines and diagnostics at Ayushman Arogya Kendras (AAMs) further lowers healthcare costs.

• Focus on Essential Drugs and Price Regulation: Jan Aushadhi Kendras provide affordable generic medicines and surgical items, resulting in substantial savings since 2014.

• Strengthening Social Determinants of Health: Increased government spending includes investments in water supply and sanitation through various missions.

• Investing in Healthcare Infrastructure: Schemes like Pradhan Mantri Swasthya Suraksha Yojana and Ayushman Bharat Infrastructure Mission are bolstering medical infrastructure.

Challenges in the healthcare sector in India:

Challenges | Description

Inequitable Access to Health Insurance | Lowest health insurance coverage among households under the underprivileged sections.

NFHS-5 results show only about 36% coverage among lowest lowest-wealth households.

Poor Finance | India’s current health expenditure (both Government + Private) stands at approximately 3.2% of its GDP, significantly lower than the average of over 5% observed among Lower- and Middle-Income Countries (LMIC).

Inclusion and Exclusion Errors | Government Schemes are prone to inclusion and exclusion errors, potentially including ineligible households and excluding eligible ones.

Inadequate Availability of Services | 56% of PMJAY empanelled hospitals in the public sector, and 40% in the private for-profit sector, indicating unequal service availability

Inadequate Infrastructure | Lack of proper infrastructure, including health facilities, equipment, and medical supplies, hinders UHC

The shortfall of over 79% specialists at Community Health Centers compared to the requirement.

Lower bed density: (number of hospital beds per 1000 population) in India is 1.0 while in low-income countries it is 1.2, in middle-income countries it is 2.4 while in the world it is 2.7. 72 per cent of hospital beds in India are available in urban areas, while 28 per cent are in rural areas.

Poor Health Education | Lack of education and awareness about healthy lifestyles and preventive measures contributes to preventable illnesses and conditions.

72 per cent of hospital beds in India are available in urban areas, while 28 per cent are in rural areas.

Way forward:

• Investing in Rural Healthcare Infrastructure: Build affordable hospitals, and clinics, and provide incentives for healthcare professionals.

• Monitoring and Regulation: Ensure efficient fund utilization and prevent leakages through robust monitoring systems and stricter regulations.

• Preventative Healthcare: Promote healthy lifestyles, early disease detection, and regular checkups to reduce future healthcare costs.

• Infrastructure and Human Resource Improvement: Invest in new healthcare facilities, and medical research, and expand medical education.

• Accessibility of Quality Healthcare: Implement targeted programs for marginalized communities, enforce regulations, and ensure transparency.

• Improving Mental Health Services: Increase funding, train healthcare workers, and reduce social stigma around mental illness.

• Addressing Health Inequities: Collaborate with other sectors to address social determinants of health and reduce health inequities.

• Sustainable Health Governance: Strengthen management systems, regulatory bodies, and cybersecurity measures for critical medical infrastructure.

• Tax Reductions: Incentivize R&D with tax deductions and reduce GST on life-saving drugs.

• One Health Approach: Recognize the interconnectedness of human, animal, and environmental health, promoting collective health initiatives.

About National Health Account (NHA) estimates:

Its estimates, prepared by the National Health Systems Resource Centre (NHSRC), serve as a vital tool for health financing analysis. Established in 2006-07 under the National Rural Health Mission (NRHM), NHSRC aids policy development and capacity building for the Ministry of Health and Family Welfare (MoHFW). Using the System of Health Accounts framework by WHO, NHA provides internationally comparable data, aiding policymakers in monitoring health financing indicators.

Mains Link:

“Besides being a moral imperative of a Welfare State, primary health structure is a necessary precondition for sustainable development.” Analyse. (UPSC 2021)

Prelims Link:

Which of the following are the objectives of ‘National Nutrition Mission’? (UPSC 2017)

• To create awareness relating to malnutrition among pregnant women and lactating mothers.

• To reduce the incidence of anaemia among young children, adolescent girls and women.

• To promote the consumption of millets, coarse cereals and unpolished rice.

• To promote the consumption of poultry eggs.

Select the correct answer using the code given below:

(a) 1 and 2 only

(b) 1, 2 and 3 only

(d) 3 and 4 only

Ans: A