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Allocate 3 per cent of GDP to healthcare, says Indian Medical Association

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Date:Feb 16, 2013

Recommendations for Union Budget 2013-14 include wooing private sector; public health experts sceptical

The Indian Medical Association (IMA) has released its recommendations for the health component of the Union Budget 2013-14. Its key demands include increasing budget allocation for healthcare, increasing the tax rebate for preventive health check-ups, and the promotion of public-private partnership (PPP) programmes.

Quoting the report of the National Commission on Macroeconomics and Health, 2005, compiled by the Union Ministry of Health and Family Welfare, Narendra Saini, secretary general of the IMA, says, "The report estimated that public investment for the provisioning of public goods and primary and secondary services will require Rs 74,000 crore, amounting to 3 per cent of gross domestic product (GDP). IMA is hence demanding an increase from the current 0.9 per cent to 3 per cent of GDP.”

The Finance Bill of 2012 included preventive health check-ups in Section 80D of the Income Tax Act. Under this section, a tax rebate of Rs 10,000 is applicable on expenses related to preventive care such as immunization, diagnostic tests and health insurance. This rebate should be increased to Rs 25,000, says Saini.

IMA has further recommended that PPP models be encouraged, and incentives be provided in the form of income tax rebates and supply of medicines and instruments at a lower cost.

Public health experts are, however, sceptical of the recommendations to provide incentives to the private sector. They claim the government earlier provided interested parties with concessions such as lower land rates, in exchange for promises which were eventually left unmet.

Amit Sengupta, co-convenor of Jan Swasthya Abhiyan, a public health advocacy network, is uncertain whether the private sector can be used to harness the long term goal of development of public healthcare. "There is no evidence that providing incentives to the private sector has benefitted the common people. Smaller clinics and individual private practitioners are facing competition from chain-hospitals, but not suffering a lack of incentives," he adds.

Sengupta believes that the IMA's demand is clearly a position tailored to the interests of private practice. "In fact, the need is to greatly increase public financing as well as provisioning. The evidence – domestic as well as global – shows that best efficiencies are achieved when there is public financing and provisioning. The major gaps are in rural and distant areas. Private players won't go there," he says.

IMA's other demands include promoting indigenous medical products and equipment, and allocation of funds towards research and development so as to bring down prices. The IMA also linked healthcare to the mid-day meal scheme and other projects, demanding proper implementation to decrease the disease burden of India.

The report comes a week ahead of the budget session of Parliament which is to begin on February 21.

 

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As we all have seen in many instances, there is no sacredness or infallibility in government orders in the field of health. They are more or less meant to destruct the free hospital system in India and drive patients away from government hospitals to private institutions. We are yet to see and feel the full impact of the greed of these mammoth private hospitals because the destruction of government hospitals is not yet complete. Once it is finished, we will see and feel it and wish to burn these private institutes down even if we won’t get any treatment when we die. By that time, politicians and bureaucrats would have made small private clinics and doctors’ home consultancies totally extinct. There would only be these giants, gaping their mouths for money, meanwhile doing everything they can for spreading diseases by releasing toxins in wayward researches and installing intricate mechanisms for nosocomial infections, treacherous manipulations we read about in medical thrillers such as those written by our beloved doctor Robin Cook. He was not raising plots from fiction but basing fiction on facts, on real incidents and mathematical probabilities assisted by meticulous research, like Jules Verne and H.G.Wells. When the things we fear happen, health care would have become not a responsibility of state long ago except for parliamentarians and state ministers and top level bureaucrats. Just like those people who reminisce about the time before the Great Change in H.G.Wells’ novel In The Days Of The Comet, people will remember those nostalgic days when state provided free hospital treatment for them when they became sick and treated them to fitness to work again. Lethargy of diseases would make us vaguely reminisce about and trace the sequence of events that led to our fall. We will remember the days when they first bifurcated health services into so many tiny departments such as employees’ insurance, medical education, prevention of food adulteration, etc, etc, so that there were so many directors’ seats for all their sons-in-law to sit. The end result was, no one knew where to go or who to see for each service which was all once obtained under one roof. Then they detached sanitation from the experts’ health services and attached it to local bodies called village councils where the responsibility for sanitation and killing mosquitoes fell into the hands of corrupt local politicians. When materials and money vanished into their pockets and chlorine and DDT reached nowhere near canals, ponds and drains, mosquitoes doubled, tripled and quadrupled and we got dengue and chikungunya. When we went to local government hospitals, we were told there were not facilities for treating these diseases and all doctors had been dismissed for private practice and advised us to go to medical colleges. When we went there, there were not enough places for all of us and so we went to private hospitals where they squeezed 45000 rupees out of each of us for treating dengue and chikungunya. Of this, we knew that 15000 reached those very politicians when elections came. One lakh people affected by dengue each year made them richer by 4500 millions out of which 1500 millions reached politicians and bureaucrats each year. Joining dots in the puzzle, we learned why each government order was devised by them and how they dismantled free hospitals brick by brick. In the haze of the delusion of fever and through the veil of dizziness of diseases we could vaguely see our last hope of saving those small clinics and public doctors’ home practices drifting away to the misty horizon, the last push seaward thrust by the politicians we elected and the bureaucrats we paid, like the last thrust of Longinus’ spear on the dying body of our saviour.

16 February 2013

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