The Hindu : A healthy beginning

Online edition of India's National Newspaper
Wednesday, Mar 05, 2003

Opinion

Opinion - Editorials

A healthy beginning

APART FROM THE schemes outlined in the budget for the health sector, the most encouraging concept this year seems to be the plan to make "India the global health care destination". The capability of Indian medical professionals to provide high quality, low-cost medical care is proven. Besides, the infrastructure available in many cities is admirable. Already, the corporate hospitals in different parts of the country are attracting foreign "medical tourists", making India a `healthcare hub' of the region. The focus must now shift to building them to international standards and linking them with the best health institutions around the world. These hospitals must also be encouraged to extend their expertise to the poor at affordable costs. There are other proposals too in the budget that augur well for the country's population. A community-based universal health insurance scheme for the poor, a slew of measures to reduce duties on life-saving drugs and specified medical equipment to cater to almost all sections, and the Income Tax benefits to boost capital investment in the big hospitals — all of them point to a major exercise in formulating a package to improve the country's health care system. Predictably, the private health care providers (who cater to 80 per cent of out-patient care in the country) are enthused. Leading providers have for long been seeking such fiscal concessions to reduce costs of health care, although it remains to be seen how much of these benefits are to be passed on to the patient-customers. Although, unit costs will come down for drugs and individual medical equipment, some of the health care providers tend to ask patients to repeat procedures and prescriptions which ultimately inflate hospital bills.

The private sector is also elated because hospitals will now be able to get cheaper money to invest in creating new or improving existing infrastructure. But unfortunately the tax exemption is limited to hospitals with 100 beds or more. In India, especially in major metros and towns, 80 per cent of critical care is provided by smaller hospitals. They too require similar tax benefits that can ultimately encourage the private sector to extend its proven capability to the rural areas also. The announcement of a subsidised health insurance scheme for the poor is perhaps the most significant step, as the per capita out-of-the pocket expenses of individual medical care in India is still very high. For a premium of Rs.365 a year, an individual or a family living below the poverty line will now be able to get a reimbursement of up to Rs.30,000 for hospitalisation or Rs.25,000 in case of death. Although, details of the scheme are to be announced, it is doubtful whether the Government will be able to reach its target of covering five million people, given the fact that bureaucrats may seek to push for a scheme that will exclude from its ambit diseases and illnesses that are already covered by national programmes. Many unanswered questions persist on the financing of the scheme and on defining the role of an insurer for providing assured medicare to the insured. The regulatory mechanism for private stakeholders in the health sector is weak. But then countries which initiated health insurance schemes have not waited for answers to all the imponderables. They stumbled and experimented for years to finally set in place a credible system.

But, the larger question of whether these measures will improve the unsatisfactory health indices of the vast millions remains unanswered. The nutritional deficiencies among women and children that have a multiplier effect in the form of low birth-weight babies and serious physical and mental retardations require more sustainable solutions. Increasing the health care budget may be difficult to achieve. But, a prudent health care policy can seek to reduce the actual spending by the poor on combating illnesses.

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