Unhealthy Signs In Health Sector Cry For Action

By G. Srinivasan

If health is wealth, are we spending sufficiently to maintain the basic health needs of millions of our citizens in the world’s fifth biggest economy as our politicos make braggadocio with little qualms? In his Independence day speech delivered with fervent zest Prime Minister Narendra Modi declared the world’s humongous government-funded healthcare programme designed to provide insurance coverage of five lakh of rupees per family annually to benefit more than 100 million poor families in a country of one billion plus population. The indefatigable Prime Minister inaugurated the first healthcare and wellness centre under Ayushman Bharat Yojana in Chhattisgarh’s Bijapur on August 14, a day prior to his unveiling of the big scheme, billed as the Modicare, from the ramparts of the Red Fort

Essentially, Ayushman Bharat, also hailed as the National Health Protection scheme —has twin tasks—first, fostering a network of health and wellness centres across the vast country of continental size, supplanting the well-nigh moribund primary health centres and second, extending insurance cover to 40 per cent of India’s population by degrees, i.e., the most deprived, for secondary and tertiary care, including hospitalization costs. Even as several states have their own state health insurance schemes, how far the new scheme would subsume the extant ones or help those who have been left untouched by it has not been adequately amplified, with the resources for such a daunting operation pan-India by way of state premium having not been identified or bruited for the broader understanding of the biggest ambitious programme in the annals of the nation.

Be that as it may, the 2017-18 Economic Survey said the total expenditure by the government (central and States combined) on health as a percentage to gross domestic product (GDP) has increased from 1.2 per cent in 2013-14 to 1.4 per cent in 2017-18 (i.e., from the last year of the UPA government to the first four years of the NDA government). The National Health Policy 2017 of the NDA government foresees raising government health spending by 1.1 per cent to 2.5 per cent by 2025 in a time-bound manner, while aiming at augmenting state sector health spend to more than 8 per cent of their budget by 2020. With states not getting overly worried over addressing basic issues like primary health and primary education as the cost of electioneering and winning elections becoming too big a task on hand to tackle, it would be too much to expect them to set apart enhanced outlays on health, particularly the medical institutions run by them are in parlous state, making even poor patients to seek private hospitals and physicians.

Though the healthcare in the country comprises both public and private sectors, the private sector provides nearly 80 per cent of outpatient care and about 60 per cent of inpatient care, according to the latest report on assessment of entities engaged in health and allied sector by the Public Accounts Committee (PAC). Interestingly, the PAC, which studied an earlier report of the Comptroller and Auditor General of India (CAG) on the issue, found that although there was expansion of the private healthcare expenditure by more than 35,000 crore of rupees and 39,000 crore of rupees during 2012-13 and 2013-14 respectively, the number of corporate assesses in the categories viz., medical professionals, nursing homes, specialty hospitals had actually declined in 2012-13 and then increased marginally in 2013-14, revealing the extent of suppression of income and non-filing of returns, making abundant use of available exemptions and loopholes in the statute.

The PAC report also took cognizance of the referral fees disbursed to doctors by private hospitals, nursing homes, diagnostics centres for referring patients and payments made on account of advertisement expenses by the medical practitioners; but such expenditure has been held as “disallowed and unethical as per the directives of the Central Board of Direct Taxes (CBDT) and the Indian Medical Council (Professional conduct, etiquettes and ethics) Regulations, 2002 read with Homeopathic Practitioners (Professional Conduct, Etiquette & Code of Ethics) Regulations respectively. Despite the directives in place explicitly, such benefits are still being distributed though in other forms, the committee said wryly. Hence the committee pertinently suggests that such expenses being pertained to promotion of business, be allowed to be incurred from the profits after tax of the hospitals /pharmaceuticals and allied industries and by practicing doctors themselves and these should be made taxable in the hands of the beneficiaries.

A cognate issue flagged off by the PAC is that the fees charged by health professionals, private hospitals, nursing homes, medical clinics, medical colleges, diagnostic centres, pathological labs and medical supply stores for their services are mostly received in cash, which is a high-risk area with potential for evasion of tax. If demonetization of high denominational notes had not brought the best result in making these categories of service providers to desist from taking cash, digitalization of the economy would be ill-served if the authorities do not crack the whip to nip these nefarious practices from persisting any further. This way they would provide immense relief to legions of patients who find paying their medical expenses a gargantuan task.

Yet another CAG report, tabled in Parliament in the monsoon session, on Pradhan Mantri Swashtya Suraksha Yojana, designed to rectify the imbalances in the availability of tertiary healthcare services and improving the quality of medical education in the country by establishing institutions of eminence after the pattern of AIIMS, found inadequacies in the entire scheme from planning to financial management, setting up of new AIIMs and upgradation of existing state Government Medical Colleges and Institutions (GMCIs).

Illustrating financial management problems, the CAG report cited that six new AIIMs in Bhopal, Bhubaneswar, Jodhpur, Patna, Raipur and Rishikesh were holding an unutilized balance of funds of Rs 1,264.71 crore, with Rs 393.53 crore for civil works and Rs 437.28 crore for procurement of equipment lying unspent with the executing agencies. Four GMCIs (BJMC-Ahmadabad, BMCRI- Bangalore, NIMS-Hyderabad and RIMS-Ranchi) diverted Rs 26.71 crore for other purposes.

Together the PAC report and the latest CAG report touch only the tiny specks of the welter of problems plaguing the healthcare industry in the country. They are unfortunately compounded by the apathy of the authorities, who could not fathom the depth of the health crisis the nation would be facing if bitter medicines are not prescribed forthwith. There is no magic wand or silver bullet to cure many a malady but all promises to deliver health for the under-served would be utterly wasted and defeated if the best reports being with the government are not taken serious note of and action initiated with no further loss of precious time. (IPA Service)