Impact of budget 2017 on healthcare sector: High on ambition, low on vision

The healthcare community would also have loved to see a larger long-term vision to reform or revolutionise Indian healthcare system, including greater emphasis on stemming the rise of non-communicable diseases, which is unfortunately missing from the budget. 

However, let us take a look at the positive aspects first:

Focus on primary healthcare: In many ways the prime focus of this year’s budget has been on rural India. Rural India faces a huge shortage of general physicians as well as specialists. Some primary health centres and rural hospitals cater to disproportionately large populations and availability of hospital beds remains heavily skewed in favor of urban areas. In this light, the government’s announcement that 150,000 health subcentres will be transformed into health and wellness centres is a welcome initiative for strengthening primary health care. The increase in allocation for schemes related to women and child welfare across all ministries to the tune of Rs 24,000 crore is also a positive measure that will strengthen an underfinanced public healthcare.

Strengthening secondary and tertiary healthcare: Creating 5,000 new post graduate seats per annum and rolling out new medical courses in major district hospitals will help churn out more specialists as well as allied healthcare professionals. Given the paucity of well-trained emergency medicine personnel, we hope the government would pay special attention to starting dedicated EMT courses in several hospitals. Another notable announcement has been that of setting up two news AIIMS in Gujarat and Jharkhand. Given the need to expand availability of healthcare, strengthen the medical education system and improving the doctor-patient ratio, we need at least one AIIMS in every state. Fortunately, over the past 15 years, the government has taken note of this need and has initiated measures to start a series of AIIMS across the country. 

Ambitious targets on disease elimination: For the first time, Indian government has stated that it has laid out concrete plans to eliminate tuberculosis from India by 2025.  India has the highest burden of tuberculosis, a disease which has been successfully eliminated from a large part of the world. Other notable targets of elimination include kala-azar and filariasis by 2017, leprosy by 2018, and measles by 2020. Though they seem ambitious targets, it is highly imperative that all resources are spent towards achieving them to reduce the burden of communicable diseases. We have also heard a new pledge by the government to bring down the Maternal Mortality Rate (MMR) to 100 till 2020. 

Move towards cheaper drugs: The cost of drugs and medical devices is a major factor that increases the cost of treatment and makes it difficult for a large number of poor people to avail medical services. Our observation over the years has suggested that in many cases patients from poor families have to discontinue important treatments mid-way because of lack of resources for affording drugs. In patients undergoing long term treatments, high medical bills due to high cost of drugs and devices such as pacemakers is a major deterrent. Amending the Drugs and Cosmetics Rules, which has been announced by the government, will help cut down prices of crucial drugs and boost supply of cheaper generic drugs. 

Change in income tax rates: Most people would believe that the reduction of tax rates for the lowest rung of income earners would hardly have any impact on the healthcare sector. However, a closer look at the patterns of spending show it would. Our observation tells us that when people have more money in their hands, they tend to pay greater attention to their health parameters. People with greater disposable income are less likely to postpone or forego their annual health screenings or preventive diagnostic tests. In this respect the notable step of decreasing the tax component of the people earning between Rs 2.5- Rs 5 lacs is a welcome measure. 

Now, let’s take a look at some of the disappointments:

No attention to rapidly rising non-communicable diseases: India is witnessing a rapid shift in disease incidence with non-communicable diseases overtaking communicable diseases as major killers. In fact, cardiovascular disease is today the leading cause of death of Indians. While the budget talks about setting detailed action plans to get rid of tuberculosis, kala azar and three other diseases, it is unfortunately silent on prevention, control and management of diseases such as cancer, heart disease, hypertension and diabetes. The incidence of these diseases is no longer limited to urban areas; rural India, which has a paucity of specialists, is also witnessing a major surge in these illnesses. We need not just increased budgetary allocation to deal with increasing burden of non-communicable diseases, but also innovative ideas to stem their rise.

No word on the health protection scheme: The Finance Minister won many a heart last year by announcing an ambitious insurance scheme, which promised a health cover of Rs 1 lakh per family for 40 crore people. However, one year later neither has any movement been made on its implementation, nor has the Finance Minister announced any follow up measures. We request the government to take immediate steps towards its early roll out. 

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Dr Dharminder Nagar is the managing director and CEO of Paras Healthcare