Healthcare an ailing issue in Indian elections
It is indeed ironical that in a country like India, which is a major destination for affordable health tourism from within and overseas, a large number of its own people continue to suffer due to state apathy and lack of proper medical attention. The reasons are many. But at the core is the want of of proper planning and resources to match the needs of the masses.
It is an equal a matter of concern that despite healthcare crying for the attention of policy-makers and political parties, it has never really been a major election issue in the country. Election time merely sees politicians make lofty promises with scant attention to delivery - at least on the scale this issue needs to be addressed. The politicians are seldom questioned.
In the US, for example, healthcare was a major election plank during the 2012 presidential fight between Democratic Party's Barack Obama and the Republican Party's Mitt Romney. There were hot debates on the subject as well, involving the two.
Analysts believe the American people saw more merit in the healthcare plan of Obama than Romney's and that was also a major decisive factor in ensuring a second term for the latter.
India presents a contrasting picture.
A look at the manifestos of the two major political parties - the Indian National Congress and the Bharatiya Janata Party (BJP) - before the 2009 general elections is revealing.
The Congress took credit for launching the National Rural Health Mission, said it had vastly stepped up government spending on healthcare and promised health security for all. But what it will do, when and how remained unspecified. To address an issue as important as healthcare, the delivery lies in detail and resources, an aspect that was missing.
The Congress manifesto presented earlier this week for the upcoming elections is no different. The grand old party has promised to make this issue a national priority and enact a right to health law. But the promised spending of 3 percent of gross domestic product (GDP) is hardly sufficient.
It amounts to around Rs.38,500 crore given the projections made for the current fiscal. If universal healthcare was woefully underprovided with a spending of Rs.36,000 crore, which the Congress claims to have ensured as central government spending, what will Rs.38,500 crore achive. More on this later.
The Bharatiya Janata Party also made some tall promises ahead of the last elections. This included health insurance for all families below the poverty line with access to cashless treatments at both government and private hospitals. It also promised a massive health-for-all programme under public-private partnership. Specifics were missing again.
The two major principal parties also did not deem it fit to elaborate how they proposed to raise revenues for their programmes - but for stating that they will dovetail the private sector into the initiative. They also did not spell out how they intended to implement most of the ideas and promises.
The actual figures on expenditure on healthcare that successive governments have been projecting are also revealing. The numbers are far from transparent. The sub-text is often confusing and the figures given in tables are replete with footnotes.
Against this backdrop, the self-praise which governments project themselves to over hikes in outlays for the health sector should also be taken with a pinch of salt - and the political parties questioned on that.
The government often quotes official statistics to say that India spends around 2.5 percent of its gross domestic product (GDP) on healthcare. But during the 11th Five Year Plan, the central government's spending was a mere 0.35 percent on what is termed as core health by the Planning Commission.
The government often quotes a figure of 1.03 percent of GDP spent on healthcare. But that is the result of adding the 0.68 percent contribution made by the state governments. Accordingly, the figure of 2.5 percent of GDP is comes after one includes what the private sector, as also you and I, spend on health.
Taken in total, the increase in healthcare spending since the 10th Five Year Plan has merely been 0.10 percentage points.
Hidden behind the numbers is another fact. The enhanced government spending also includes what is termed as broad health. This includes the central and state governments' expenditure on additional areas like drinking water, sanitation, the mid-day meal scheme and the Integrated Child Development Services (ICDS) programme.
It is not that such spending is not important. They demand attention, all right. But the fact is by including these as well to highlight the total government expenditure on healthcare, the actual spending on the ground - that is on "core health" - emerges far lesser.
More so, when one considers the fact that the expenditure is on both the plan and non-plan side. This means the salaries, wages and similar recurring expenditure paid to staff also stands included.
There is no doubt people covered by health insurance has grown significantly in the past decade. But independent analyses reveal a startling fact, clearly showing that the benefits have not percolated down.
A study by industry body Ficci, for example, says a whopping 65 percent of Indians get into debt and 3 percent even fall below the poverty line again due to health-related reasons. Not just that, as mentioned earlier, 61 percent of the medical expenses incurred by people is accounted for out-of-pocket -- that is, without any form of insurance cover.
In this backdrop, a 3 percent spending on healthcare is far from sufficient and people must make political parties come out with a comprehensive plan. Their representatives in parliament must be selected accordingly and what better time than elections!
(Arvind Padmanabhan is Executive Edtior-Business at IANS. The views expressed are personal. He can be contacted at firstname.lastname@example.org)
(Posted on 28-03-2014)