Comments on Health Budget

Dear Sundar,    Why don';t you draft it? Let us send out a JSA critique as most papers have not reported this cut in health budget. I have copy-pasted below the key budget figures  As per budget paper 2015-16 :  Expenditure on Health in Rs. crores Actual 2013-14 Budget 2014-15 Budget 2015-16 reduction AYUSH 642 1272 1214 Pharmaceuticals 107 248 259 AIDS control 1473 1785 1395 Health research 874 1017 1018 NHM 18633 24490 18295 6195 (25.3%) Page 168 27145 35163 29653 5510 (15.7%) Page 169 vol II Plan outlay 22476 30645 24549 6096 (19.9%) Page 169 vol II SY Anant  On 1 March 2015 at 07:45, Sundar <sundararaman.t@gmail.com> wrote: There are two important things about health sector in the 2014-15 budget speech. The first is the almost complete absence of mention of it- not even one full paragraph on it. Just a bland budget allocation line in one para, and then in another para as part of setting up different central institutions in all states a mention of AIIMS in a few states, then in another paragraph a proposal to give persons a choice to shift over from ESI to private insurance  and finally in the tax proposals mention of increased limit for tax exemption for health insurance. All in different sites as part of different agendas- where health is very incidental Secondly - there is a reduction in health expenditure even in nominal terms- let alone adjusting for inflation in budget allocation. The  overall budget allocation reduces from 39237  crores to a  33152 crores.  As related to expenditure of the last year- it stagnates in nominal terms but declines in real terms.  Within this  budget the decrease of NHM budget is much more. Also the addition of CGHS into this budget amount which was earlier placed elsewhere means that the decrease may be even more steep. Thus the central govt employees would have care at Rs 7000 per capita and the rest of the population at only about 900 per capita- about one tenth of the same, of which the central govt share is in the range of Rs 270 !! One argument that is  raised is that the health expenditure is being transferred to states through the 14th finance commission recommendations that have been accepted as part of moving away from centrally sponsored schemes. This claim has to be examined further. But even if it were so, the central committment both in line with 12th Plan and the govt';s own draft national health policy is to raise the central share also and this was urgently required in many areas of health systems strengthening. The complete disconnect with the National Health Policy 2015 draft is total- where specific central committment is stated  as "this policy proposes a potentially achievable target of raising public health expenditure to 2.5% of the GDP. It also notes that 40% of this would need to come from Central expenditures. At current prices, a target of 2.5% of GDP translates to Rs. 3800 per capita," In other words though states would have to increase their expenditure, the central expenditure on health has to increase also to reach Rs 1520 per capita in three years ( at current prices). This budget puts the central expenditure at about Rs 276 per capita, which is less than one fifth of the target. The direction also is not of increase. Clearly the draft policy and all its proposal are  reduced to just empty words. The provision for AIIMS hospitals is also insubstantial and in 5 years only buildings will come up- and anyway it is not really the solution at all. None of the new AIIMS are operating at the level of AIIMS- they have just about begun outpatient care and a few admissions and have less services than the usual state medical college. It took them all of ten years to reach this stage. And a series of AIIMS are anyway  no answer to the dismal situation in health.  Another aspect of the exemption in tax for those paying for medical insurance. The limit has been raised to Rs 25,000 per year. That is costly even by private medical insurance standards. And obviously this is trying to get the upper middle class and the rich to buy even costlier insurance. It has nothing to do with publicly financed insurance where the premium is only Rs 750 per year. By mentioning only insurance for the rich, yet another signal is being sent.  Nothing in nutrition or education or any other social sector.  All in all a terrible day for public health.  Equally dangerous was the way the TV media went on about the budget with no space for any views except that for industry representatives and their view point.  I think the contributions of Ravi Duggal, Anant, Amit etc have been useful and I only reiterate much of what is already stated.  We must work on a quick statement - perhaps within the next couple of days. is that possible? Would be willing to help.  Greetings Sundararaman T. Sundararaman