• India spends a total of 4 per cent of its GDP on health, which in itself is a significant amount. However, it is high  out-of pocket expenditure that cause problem 
  • Total Spending on Health = 4% of GDP
  • Public Sector = 1.15% of GDP
  • Rest : Out of Pocket
• Global Burden of Disease Report (2018) by LANCET  Rank =  145 
• Research suggests that $1 spent on nutritional interventions in India could generate $34 in public economic returns.

• (Economic Survey) Prominence of Private Sector : Out of 4% expenditure on healthcare in India, Public Sector accounts for just 1.15%
• (Economic Survey) High Out of Pocket Expenditure (OoPE) : OoPE is as high as 62% (2014-15) 
• Number of hospital beds per 1000 people – WHO average = 3.5  || India = 0.7.
• Planning commission => health problem pushes 39 million people every year under poverty line. 
• Doctors unwilling to serve in Rural Areas .
• Dominance of Medical Council of India hindered development of nurses and other health cadres

• Health is under State list
  • Debate going on – Should it be moved to Concurrent List given that even after 70 years of independence, state of health in India is still poor
  • Centre can only make model laws to which states can voluntarily subscribe

• Article 47 of Indian Constitution (Directive Principle of State Policy) : State shall regard the raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties

• Article 21 – Right to Life

1 . Universal Immunization Program (UIP)

• Universal Immunization Program started by India in 1985
• Under Indian Immunisation Program, Vaccine is given for 12 life threatening diseases

Side Note : Pentavalent

Protects against 5 infections — diphtheria, tetanus, pertussis, hepatitis B, and Haemophilus influenzae Type B (Hib) in one shot.

2. Mission Indradhanush

Side Topic : Why People resist Vaccination ?

• Herd Immunity : When a critical number of children are vaccinated, it protects the “herd”, so that even non-vaccinated children are safe. Some parents  begin to think that vaccinations are not needed. 

• Misleading Comments : misleading comments on social media derail  vaccine programme.  Statements like the vaccine is introduced to induce impotence in children belonging to certain communities .
  • Muslim Community is very much vulnerable to this.
  • 2018 Punjab : Similar rumours regarding Measles – Rubella

Previous Policy was given in 2002. There was need for new policy because

• 15 years have passed => new challenges have come up in health sector.
  1. At that time, Polio was major Problem. Now , WHO has declared India to be Polio Free
  2. That policy was keeping in view of Millennium Development Goals (MDG) . Now, we are in era of Sustainable Development Goals (SDG) . 
  3. At that time , Communicable Diseases were major problem. Now Non Communicable Diseases have come into scene.

Main provisions of Public Health Policy, 2017

Criticism of the policy

• Abandoned idea to make  health a right proposed under Draft Health Policy. NHP speaks of “assurance-based approach”.
• Raising Government Expenditure to 2.5% of GDP till 2025 is too far fetched given problem India facing is serious. Along with that no yearwise plan of yearly incrementation is given . There is lesser hope that even this will be attained given the past experience that health policy of 2002 had promised health expenditure of 2% of its GDP on health by 2010
• Governance issues are ignored : Silent on whether Health should be moved to Concurrent list
• Professional issues are ignored eg MCI issue , Private practice by Government doctors.

• This topic has been frequently discussed in previous Economic Surveys. Hence, it is important topic.
• Data
  • 5.5 Crore Indians fell into serious poverty-trap  per year due to high health expenditure
  • India’s  out-of-pocket expenditure for health is one of the highest in the world, at 62 percent.(Global Average = 18%)
  • Current expenditure on health is 4% of GDP out of which government spending is 1.15% and rest is private spending.

Why Out of Pocket Expenditure is high ?

• Low Public Health Expenditure by Government : Government spends just 1.15% of GDP on health

• No Insurance Cover (80% of  population not covered under any insurance) 
• Underfunded Drug Provisions :  India allocates  0.1 % of GDP on publicly funded drugs 
• Provider Induced Demand 
• Changing Nature of Diseases  to non-communicable diseases  which isn’t covered by any public health system 

Impact of high Out of Pocket Expenditure

• Large number of people are pushed into poverty because of this
• Increasing Inequalities in the society (according to Economic Survey of 2018)
• Causing feeling of relative deprivation in poor sections of society which can cause social unrest.
• Sizable amount of population doesn’t  go for any treatment because of financial constraints
• Creates vicious cycle of poverty (Poverty Trap)

Steps Already Taken

• National Health Policy : Increase Health expenditure to 2.5% of GDP
• Ayushman Bharat
• Jan-Aushadi Stores
• National Free Diagnostic  Initiative : to provide essential diagnostic services
• National Free Drug Initiative :   expanding the availability of free drug in all public health facilities
• All the registered Medical practitioners directed by MCI to prescribe generic drugs & write name of salt instead of brand name

Way forward / How to control

• Pass Clinical Establishment Registration Act : To stop Provider Induced demands by doctors

• Increase health expenditures from their current level to at least 3 percent of the GDP
• Improve working of Jan Aushadhi stores  
• Ensure a standard pricing system to bring parity on service cost