Considering skewed public and private healthcare spending in India taking its toll on underprivileged section of the society, the government needs to increase public healthcare spending and create vigorous healthcare delivery system having infrastructure and human resources to ensure quality care for people, said Alok Kumar, Adviser, Niti Aayog.
The country spends 4 per cent of GDP on health which is similar to the healthcare spending of countries like Sri Lanka, Thailand but the outcome of the spending is not satisfactory. We need to strengthen the mechanism ensuring accountability to deliver outcomes. Due to less public spending coupled with lack of pool financing mechanism, people are left vulnerable in the hands of private healthcare providers, he added.
Government spending accounts for roughly 25 per cent of total health expenditure in India as compared to an average of over 50 per cent across the countries in the world. Share between public and private healthcare spending is skewed which needs to be corrected. Once the public spending increases, hopefully private out of pocket spending will be displaced, said Adviser, Niti Aayog.
Putting in place a national framework determining the role of public and private sectors, creating prescreening system and decentralised healthcare data collection system, also need to be considered to improve healthcare of people.
Considering competitive demand of financing amongst various developmental priorities, there is hardly any room for an increase in healthcare allocation in the budget as it stands today but there is a possibility of organizing out of pocket spending to ensure more efficient procurement of healthcare services while maintaining the resource envelope as a constant. Kumar further hoped that a portion of the additional revenue generated post implementation of GST could be used to supplement government spending on healthcare.
In a bid to ensure that the government raises healthcare allocation, there is a need to bring health to the political centre stage, create awareness regarding the importance of public health among policy makers and other stakeholders including people, healthcare providers, NGOs etc.
Talking about tax financing to improve healthcare spending, he said in India out of pocket health spending dominates which is more regressive, it costs poor people heavily. Poor spend a higher proportion of their incomes on healthcare as compared to the rich. Concept like cross subsidization need to be pushed to ensure that the burden of health care spending is shared more equitably. Progressive taxation is another option where taxes can be imposed on people belonging to higher income group to leverage financing for strengthening public health system.
There are other mechanisms of financing where government can pool in better and effective way to cater to healthcare. Preventive healthcare is the cheapest and most equitable way of financing public health. The government has taken slew of initiatives towards this with introduction of National Health Mission, maternal and child healthcare programme but this is not sufficient. There should be an overall comprehensive healthcare programme.
Besides this, there is urgent need of decentralised data collection system which needs to be published annually as against population health data published by National Family Health Survey once a decade. It will shed light on penetration of diseases in different geographical locations, population risk factors equiping the government to take measures to prevent ailments.
India also lacks disease registry system. For instance, in case of TB case notification, rates vary from 1 in 5 to 1 in 10 depending on the state of health systems prevalent. This inhibits proper planning of an adequate response mechanism.
Performance based reward system needs to be put in place to encourage district performance in healthcare. Prescreeing system and disease response and surveillance system are part of measures need to be adopted to improve health outcome in India.
In states public spending on healthcare is not same. 80 per cent of patients in Assam go to public health facility while in Maharashtra less than 20 per cent of patients visit government hospitals. There should be uniformity in health policy of states. Considering diversity in the country, we need to delegate powers to states to draft policy catering to local healthcare needs, he concluded.