Affordable health care: Greater policy focus required to strengthen infra

India is making proactive efforts to improve its health care infrastructure and invest in capacity building. Last week, the Union Cabinet cleared the expansion of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) to provide health coverage to all senior citizens aged 70 years and above, irrespective of their income. Currently income-based, the scheme is the world’s largest publicly funded health scheme, which provides health cover of Rs 5 lakh per family per year for secondary and tertiary care hospitalisation to the bottom 40 per cent of the population. In this regard, the expansion in coverage must be welcomed as a measure to reduce out-of-pocket health care expenses among the poor and the elderly, for whom a health emergency can be a significant setback, often resulting in impoverishment and indebtedness. So far, the scheme has covered 73.7 million hospital admissions, including a large number of women beneficiaries. The utilisation of scheme services by women accounts for approximately 49 per cent of authorised hospital admissions. Government schemes such as AB PM-JAY and the National Health Mission (NHM) are aimed at ensuring access to health care services that are agnostic of economic status and improving India’s health care ecosystem and last-mile access.

However, addressing the problem of affordability is not enough. The government and health regulatory bodies must also ensure that quality standards and minimum patient-safety protocols are enforced, particularly at primary level, which can also help reduce the need for secondary and tertiary care. In this context, the recently released report titled “Health Dynamics of India 2022-23” highlighted the status of infrastructure and human resources in the sector. The report showed that there had been a sharp increase in the number of sub-centres, primary health centres (PHCs), and community health centres (CHCs) between 2005 and 2023. Yet, around 31.4 per cent of sub-centres and 7.4 per cent of PHCs do not have their own building. Rather, they operate from rented buildings or space provided by gram panchayats. At all-India level, there is a 22 per cent shortfall in the number of sub-centres, the most peripheral and first contact point between the primary health care system and the rural community. According to the report, several PHCs across the country lack basic facilities like beds, toilets, clean drinking water facilities, labour rooms, and electricity.

Although public spending on health has increased in recent years, it continues to remain low compared to other countries. The Ministry of Health and Family Welfare received a Budget allocation of Rs 90,958.63 crore in the 2024-25 Union Budget, a 12.9 per cent increase from the previous year’s Revised Estimates. The allocation for the AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homoeopathy) Ministry also registered a 23.7 per cent increase over the Rs 3,000 crore in 2023-24. Additionally, the states’ expenditure on health reached 1.58 per cent of gross domestic product (GDP) in 2023-24. Government (Centre and states combined) expenditure on health has increased at a compound annual growth rate of 15.8 per cent from 2017-18 to reach 1.9 per cent of GDP in 2023-24. Yet it remains below the 2.5 per cent benchmark, as recommended by the National Health Policy in 2017. Clearly, more policy attention is needed to improve the state of health infrastructure to improve outcomes at all levels.