New Delhi: The Economic Survey 2023-24, tabled in parliament on July 22, presented many ‘achievements’ of the Union government and claimed that the Indian health system has been consistently revamped.
But a close analysis of those health initiatives, through which the government sought to assert a ‘revamping’ of the health system reveals that it is not much closer to the reality.
One of the biggest concerns that comes out from the Economic Survey is the stagnant expenditure on health. According to the Economic Survey, the expenditure on health as part of the GDP for the year 2022-23 stood at merely 1.9%. This was not any increase as compared to the preceding year.
It is important to note here that even this 1.9% share includes the budget of not only ‘health and family welfare’ and ‘medical and public health departments’ but also of ‘water and sanitation’. Therefore, the actual expenditure as a percentage of GDP on the health sector is even lower than 1.9%, if we subtract the share of the water and sanitation department.
The National Health Policy 2017 envisages increasing the spending by a minimum of 2.5% of GDP on health by 2025. Earlier this target was to be achieved by 2022.
According to the last Economic Surveys, health expenditure as a percentage of the GDP in 2015-16 was 1.3%.
For 2016-17, 2017-18, 2018-19 and 2019-20 it was stagnant at 1.4%. In the following two years, 2020-21 and 2021-22, it rose to 1.6% and 1.9% respectively. These shares also included the budget of the water and sanitation department.
This trend reveals that such a near-stagnant expenditure on health puts the country off track from reaching the goal of spending 2.5% of the GDP on health even by 2025 unless a dramatic increment happens.
India has one of the lowest expenditures on public healthcare. If the total expenses on healthcare in a household exceed 10% of total income, it is termed as ‘catastrophic’ by the World Health Organisation (WHO).
Also read: What Modi Govt’s Shift in Health Spending – From Infrastructure to Insurance – Shows
According to a Niti Aayog report of 2020, 37% of households surveyed in a national survey experienced catastrophic health expenditure at private hospitals and 10% in public.
The lower expenditure on health is pushing a large proportion of the population into poverty every year. According to another Niti Aayog report, 7% of India’s population — about 10 crore people — are pushed into poverty every year due to the amount of money they spend on healthcare.
While some proportion of this population may recover and come out of poverty, for many it would be difficult to do so completely.
Out-of-pocket expenditure
The Economic survey shows that out-of-pocket expenditure on health (OOPE), or people’s spending on health on their own as a share of total health expenditure of the country has declined to 41% from what used to be 60% 10 years ago.
Even with this decline, according to the World Bank, only 35 countries have an OOPE higher than India. Most of these countries are in the ‘lower income’ group. India belongs to the ‘lower and middle income’ one.
The Household Consumers Expenditure Survey (HCES), which was last released for the year 2022-23 revealed that the Monthly Per Capita Consumer Expenditure (MPCE) on health went up.
HCES measures the expenditure of people on various items in two categories – food and non-food. The health sector lies in the category of non-food items.
It says the MPCE in health in 2011-12 was 3.9% in rural areas. In 2022- 23 it rose to 4.7%. The trend is same in urban areas.
According to HCES, people are spending on health even more than education.
Representational image. Photo: flickr.com/Trinity Care Foundation/CC BY-NC-ND 2.0 DEED
Ayushman Bharat
One of the biggest achievements that this government counts in this field is the launch of the Ayushman Bharat scheme. It is based on an insurance model. The government provides an eligible family a cover of Rs 5 lakh every year to cover all hospitalisation expenses. And the governments at in state and central pay the premium to the insurance companies.
However, one of the major limitations of the scheme is it only caters to inpatient or hospitalisation expenses and not outpatient or non-hospitalisation expenses.
This distinction is important because even the government’s HCES reveals that the expenditure on non-hospitalisation expenses is much higher than the hospitalisation expenses.
In rural areas, the MPCE of a household on hospitalisation is 2.36% while that of non-hospitalisation is 4.77%.
Similarly in urban areas, the households spend 1.9% as part of MPCE on hospitalisation while for non-hospitalisation services it is 4%.
Besides, the scheme is also marred with large-scale corruption as revealed in the last CAG report. The auditor found several irregularities from treating dummy patients to providing purported treatment after the patient had died. The Economic Survey is silent as to how it would deal with these loopholes.
Mental health
A significant part of the health section in the Economic Survey is devoted to mental health. The Survey talks about a lot of initiatives that the government has taken or will take in this area. It refers to various data sets to stress that the problem of mental health has compounded manifold.
“This is definitely welcome,” Indranil Mukopadhyaya, a health economist associated with OP Jindal University said.
“However, the National Mental Health Programs (NMHP) had received a measly allocation of INR 40 crores in the 2023-24 Budget, which continues to be the same since 2019-20. This amounts to spending just 30 paise per person per year, for the NMHP,” he added
Mukopadhyaya said even the allotted funds remain largely underspent.
There also exists a large gap in the availability of mental health services.
The last national mental health survey was done in 2015-16. It revealed that the treatment gap for mental disorders in India ranged between 70 to 92% for different disorders. The second national mental health survey is taking place this year.
The Economic survey also claimed all 1.73 lakh Secondary Health Care Centers (SHCs) and Primary Health Care Centers (PHCs) provide mental health services.
However, an assessment done by the health ministry’s National Health System’s Resource Center reveals that out of surveyed SHCs, only 32% are able to provide mental health services. Only 48% of such SHCs, which have been converted to ‘health and wellness centres’, give these services.
Similarly, only 35% of PHCs or urban PHCs provide mental health services, it said.
