Budget 2018: Need paradigm shift in access, goals, funding of healthcare

In Union Budget 2018-19, FM Jaitley should look at raising public health expenditure to 2.5% of GDP in a time bound manner, besides health policy 'sick-care to wellness'

Finance Minister Arun Jaitley’s Budget 2018 needs to bring a paradigm shift in healthcare services in the country in terms of access, goals, financing and modality. It should focus on a comprehensive look at the health policy ‘sick-care to wellness’, prevention and health promotion, financial protection, stronger partnership with the private sector and raising public health expenditure to 2.5 per cent of the GDP in a time bound manner. There has to be a concrete proposal of Universal Health Coverage (UHC) that guarantees free, cashless health services to all citizens. This is what was completely missing before in terms of healthcare as a fundamental right.

UHC, in which people receive healthcare without suffering financial hardship, is an ideal that many countries in the world are successfully moving towards. Thailand has already shown the rest of the world that even with poor resources, UHC is achievable. India has agreed to achieve Sustainable Development Goal (SDG) by 2030 -- a promise made by the UPA government. It's the new minimum in global health, without which no policy or Budget makes sense.

The Budget should also make the right proposals in identifying the pitfalls of India's healthcare situation. It should acknowledge poor state spending (1% of the GDP), catastrophic expenses people suffer because 70% of their needs are met by the private sector, and how poor access to healthcare pulls down the country's development goals. It should acknowledge the need for UHC in primary, secondary as well as tertiary care because all three sectors are equally important. It should promise improved access and affordability of services through a combination of public hospitals and strategic purchasing of services from the private health sector.

Budget 2018 should also seek to strengthen the infrastructure, capacity, financing and human resources, and envisage a complete overhaul of primary care. The idea of primary care should include important elements that had been part of secondary or even tertiary care earlier. It should seek to harness the complementary results of the initiatives by other sectors - such as cleanliness drive, reduction of train and road accidents, and action against gender-based violence - into the new Budget for greater synergy.

The Budget should speak about a single purchaser or payer for health, which essentially means that the government would buy the healthcare services for its people, who need not worry about paying for them. The policy should promise that it would buy services mostly from public hospitals; but should also use the private players to fill in the gaps.  The most crucial element this year is a strong public health infrastructure. The Budget should strive to strengthen NRHM (National Rural Health Mission), train thousands of people through it, and improve infrastructure.

The author is CEO of Bhatia Hospital, Mumbai