PHA-Exch> Financing health

[Gopal Dabade]

THE HINDU
Date:06/04/2009
URL: http://www.thehindu.com/2009/04/06/stories/2009040650760800.htm
Opinion - Editorials

Financing health
The United Progressive Alliance government has lost a valuable
opportunity to expand and improve healthcare access across the land
and across all social sections during its five-year term. The Common
Minimum Programme promised a public expenditure on health of between
two and three per cent of the GDP. The actual spending (a statistic
inflated by including spending on social determinants such as drinking
water and nutrition) was a dismal 1.39 per cent in 2007-08. It may be
argued that primary health care has improved in the better-performing
States, and the National Rural Health Mission has extended services to
far-flung populations. These measures do not, however, address the
unaffordable cost of managing chronic ailments arising out of
longevity or social circumstances, and of emergency medical care. An
expanded, free, healthcare system and improved publicly funded health
infrastructure could have benefited millions of people who did not
seek care because of high costs, more so during an economic slowdown.
Empirical studies show that most Indians incur impoverishing
expenditures on health — because they must pay out-of-pocket. The
National Commission on Macroeconomics and Health, using new
methodologies, estimated in 2005 that households were obliged to use
their own resources for 68.8 per cent of the aggregate national
spending on health, while the share of the central and State
governments together was 21.6 per cent (the rest was accounted for by
public sector, private, and charitable sources).
Government investment in health has positive externalities in the form
of reduced social costs of morbidity and removal of inequality. Price
subsidies or direct public provision of health facilities will
encourage more people to seek medical care. The case for massive
public investment in health is strong, because this vital area cannot
be left to market forces that cater to the better-off sections. Even
in the United States, that recognition has led to proposals from
Democratic lawmakers for a competition-stirring, government-funded
health insurance plan that seeks to achieve the Obama administration’s
goal of universal healthcare. It is imperative that India launch a
comprehensive plan to reduce out-of-pocket expenditure for all
citizens, build first-class primary health care, and widen access to
tertiary care through public facilities. A special funding mechanism
to create access to and underwrite treatment costs for chronic
ailments, such as cardiovascular conditions, diabetes, kidney disease,
cancer, and emergencies of all kinds must be the first step.
Preventing millions from descending into poverty on account of
catastrophic health expenditure must become a national priority.
Election season is a good time to reinforce this message.

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Dr Gopal Dabade,
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