Health Sector Budget 2019: What after Ayushman Bharat?

After the Interim budget, India is looking up to Nirmala Sitharaman, the newly appointed Finance Minister for the upcoming Union Budget 2019-20 on 5th July. Health sector is one of the most important sectors besides other significant sectors like Agriculture, Education, Defence in the Union Budget. It plays a major role in the economy of the country, as it is the fastest-growing sector.   

Health sector was allocated with Rs. 61,398 crore, highest in the last two years. Increment of 16 percent over the 2018-19 interim budget in health has been noticed. This years’ health budget primarily focuses on Government schemes. Maximum share of the allocated budget is being invested in the center’s Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana (AP-PMJAY) health insurance scheme. Prime Minister Narendra Modi launched AP- PMJAY on 23rd September 2018. The scheme targets over 50 crore beneficiaries and also known to be the “world’s largest government-funded healthcare” program. It will provide affordable and accessible healthcare facilities. This health insurance scheme is believed to be a complete game-changer in the health scenario of the country. Other schemes with increased allocation include the National Health Mission (NHM) and National AIDS and STD Control Programme. The allocation also included Rs 250 crore and Rs 1,350 crore for setting up Health and Wellness Centres focusing on issues like diabetes, cancer, blood pressure and old age-related illness, under the National Urban and Rural Health Mission respectively.  

The latest interim budget made it very evident that they have prioritized the needs of medical officials especially nursing services and decided to invest mainly in medical and paramedical institutions to fulfill the increased demand of health officials in government and private hospitals. To upgrade nursing services, Rs 64 crore has been granted and that for district hospitals and post-graduation seats in state government medical colleges received a grant of Rs. 800 crore. Rs 2,000 crore and Rs 20 crore is allocated for establishing new medical colleges and Paramedical institutes, individually. Thereafter, Ram Manohar Lohia (RML) Hospital, New Delhi is deciding to initiate the MBBS course, according to a recent story covered by an English daily. This will be the 10th medical college in the capital with 100 seats as they have received the approval of the Medical Council of India. Another medical institute and research center, AIIMS, operated autonomously under the Ministry of Health and Family Welfare has been allocated with an increased grant of Rs 3,599.65 crore.  

There are some health programs that will be feeling weakened from the government’s end due to cut back in the grants this year. Almost ignored the issue in India, mental health has taken a back seat in the priority list of the Government and is being allocated with a 20 per cent reduction from 2018-19 Union budget that is from Rs 50 crore to Rs 40 crore. Ischemic heart disease leading to heart attack is the biggest cause of death in the country followed by stroke and COPD (Chronic Obstructive Pulmonary Disease) claimed by the Institute of Health Metrics and Evaluation yet National Programme for prevention and control of Cancer, Diabetes, Cardiovascular Disease, and Stroke suffered the reduction from Rs 295 crore to Rs 175 crore in 2019-20.   

Though NHM saw an increment but Rashtriya Swasthya Bima Yojana (RSBY), which is featured under NHM, observed a reduction of Rs. 1,844 crore.   

Prakriti Poddar, Psychotherapist and Managing Trustee of Poddar Foundation said, “I find it imperative that the Government is sensitive towards the needs of its citizens and takes the first step by allocating sufficient funds for mental health and be at the forefront of aiding the various other stakeholders in the field to bridge the care gap. With the policy framework in place, the appropriate budget allocation will aid in effective implementation and changing the ground root reality.”  

Narendra Modi led NDA government is always shoving to bring change in the country from the past five years. In the 2014-15 budget, the health sector shared 1.8 per cent of the total budget whereas it was highest in the financial year 2017-18, 2.4 per cent. It again witnessed a decline of 0.3 per cent last year. During the last tenure of the Modi Government, Ayushman Bharat scheme was launched to represent all the healthcare initiatives. This year, they made the AB-PMJAY scheme their prime focus and increased the highest, up to 166 per cent that is Rs 6,400.   

Interim budget 2019-20 ignored non-communicative diseases (NCDs) like cardiovascular disease, diabetes, stroke, etc. And the forgotten part was, these are the largest causes of death in India. According to a recent state-level disease study report by the Indian Council of Medical Research (ICMR), ‘India: Health of the Nation’s States’, stated, all deaths due to NCDs has increased to 61.8 per cent in 2016 from 37.09 per cent in 1990. They did not consider certain major issues like immunization, nutrition, reproductive health, etc.   

Dr. Alok Roy, Chairman of Medica Super specialty Hospital said, “The main expectation from this year’s budget is that the healthcare industry must be made attractive from an investment point of view. We have seen private healthcare players have slowed down their expansion plans. Keeping in mind the role played by the private healthcare sector, the government must increase its intent to collaborate with the private sector.  The ambitious PMJAY scheme (Ayushman Bharat) holds a lot of promise and has the right intent, but I do hope the government authorities take the right partnership approach to more inclusive participation.”  

Introducing a new National health insurance scheme will be a helping hand for more than 30,000 individuals. Spending on health schemes still has a scope of betterment as it continues to fall short with approximately 1.4 per cent of the GDP which is less than the GDP of countries like Bhutan with 2.5 per cent and Sri Lanka with 1.6 per cent, who are economically weaker than India, according to the latest annual report of Central Bureau of Health Intelligence 2017-18.