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Across the aisle: For healthcare, Budget gifts a jumla

It is an insult to the people’s intelligence to announce a grand scheme without forethought or preparation or money in the last year of the term of the government.

Written by P Chidambaram | Updated: February 11, 2018 4:37 am
For healthcare, Budget gifts a jumla Union Finance Minister Arun Jaitley holds the bag containing the papers for the Union Budget as he comes to present the Budget at the Parliament on Monday. (Express Photo by Neeraj Priyadarshi)

So many questions have been asked about the Union Budget for 2018-19. Let me ask one on the Central government’s expenditure.

What does the government spend and on what? In 2017-18, the government estimated that it will spen Rs 21,46,735 crore, but it will end up spending Rs 22,17,750 crore — an increase of Rs 71,015 crore How will it get the additional money? It will get it entirely from additional borrowing (Rs 48,309 crore that the government will borrow directly, and about Rs 37,000 crore from ONGC, which will borrow as a proxy of the government).

Borrow and Spend

On what head will the additional borrowing be spent? Rs 1,07, 371 crore will be the increase in revenue expenditure. Consequently, capital expenditure will be cut by Rs 36,356 crore.

That is a double whammy. The government is borrowing heavily to spend on the revenue account and, in order to find the money needed, it is cutting back on the capital account. Did a large share of the additional revenue expenditure go to ‘Health’ in 2017-18? Hardly (see table).

As can be seen, the increase in expenditure, on account of health, over the Budget estimates was only Rs 4,320 crore, a small fraction of the total additional expenditure of Rs 71,015 crore and an even smaller fraction of the additional revenue expenditure of Rs 1,07,371 crore.

Child Health Indicators

Let’s look at one part of healthcare: the state of child health and child nutrition in the country. I have looked at the data for 2005-06 to 2015-16.

* Sex ratio at birth, that is females per 1,000 male children, has improved marginally from 914 to 919. At the current rate of improvement it may take many decades to achieve full gender parity.

* Infant mortality rate has declined from 57 to 41. The world’s average is 30.5 and the world’s best is 2.

* Under-five mortality rate has declined from 74 to 50. The world’s average is 41 and the world’s best is 2.1.

* In 2015-16, only 62 per cent of children had been fully immunised.

* Among children below the age of five years, one out of two is anaemic; one out of three is underweight and stunted; and one out of five is wasted.

Because we have neglected child nutrition and child health, the quality of our human resources is poor. From economic growth to national security to technological progress to social harmony, everything depends upon the quality of human capital. Doctors have a great responsibility to nurture our human resources, especially our children, but doctors are so few. India has one doctor for 1,681 persons (2016 data) and one government doctor for 11,528 persons, against the World Health Organization’s norm of one doctor for 1,000 persons. We produce only 55,000 graduate doctors and 25,000 post-graduate doctors every year. Each doctor carries the burden of at least two doctors.

Our healthcare system is broadly divided into three categories: public/government hospitals, private for-profit hospitals and private not-for-profit hospitals. Because of lackadaisical administration, public hospitals (with notable exceptions like AIIMS-New Delhi, JIPMER-Puducherry and a few others) are seen as inefficient, turning away patients and refusing to take normal risks while treating a patient. Many taluk- and district-level hospitals have become just referral hospitals.

On the other hand, private for-profit hospitals (with notable exceptions) are seen as purely profit-driven that prescribe redundant tests, procedures and treatment and turn away poor patients.

Scheme without Money

Notwithstanding free public hospitals and availability of health insurance, nearly every patient bears, out of his/her pocket, a substantial cost of medical care. The rural population spent (2014 data), on an average, Rs 5,636 for hospitalised treatment in a public hospital and Rs 21,726 in a private hospital. In the case of urban population, the corresponding amounts were Rs 7,670 and Rs 32,375. This and other data give rise to the question whether India’s healthcare system is becoming more and more unequal?

It is in this background one must critically view the National Health Protection Scheme announced with great fanfare. It is not ‘the world’s largest government-funded health scheme’, it is the world’s largest unfunded government health jumla. A National Health Scheme was announced in the Budget for 2016-17 to cover, through insurance, about six crore families up to Rs 100,000. No scheme was approved or implemented, or money allocated, and it was given a quiet burial. Now, a larger scheme to cover 10 crore families upto Rs 500,000 has been announced, but not one rupee has been provided. Insurers have hinted that the premium at 1-3 per cent will amount to Rs 50,000-1,50,000 crore a year and they were not consulted before the Budget announcement. There is talk of states sharing 40 per cent of the cost, but states were not consulted before the announcement. Besides, many states have their own schemes with their own branding, and there is no reason to assume they will come on board the new scheme.

It is an insult to the people’s intelligence to announce a grand scheme without forethought or preparation or money in the last year of the term of the government. Having made the announcement, the government will spend its time and energies and human resources to breathe life into a dead-on-arrival idea. Meanwhile, the neglect of the health sector will continue.

Website: pchidambaram.in; Twitter: @Pchidambaram_IN

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P Chidambaram
  1. J
    Jawanar RMP
    Feb 15, 2018 at 3:59 pm
    Without doubt you had deconstructed the Budget bit by bit and expose what a great Jumla it is. BJP is cheating the people. They have cheated people announcing Rs 1 lakh health insurance scheme and did nothing. Now what they will do is do nothing in Rs 10 lakh scheme. Wait for 2 to 3 years and announce another Rs 10 lakh scheme. This is what you had beautifully exposed. Without your brave efforts in spite so much false raids on near and dear in exposing the budget burglary to the people, India would have got cheated en mass by BJP.
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    1. R
      Raja
      Feb 14, 2018 at 6:44 am
      It is indeed a pleasure to read the Sunday express for the quality of columns, be they by Ms Tavleen Singh or Mr Chidambaram. Any person visiting any Primary Health center, Government Clinic or Hospital will be troubled at the least to see how public money is being wasted. Forget the politics of it, the poor and tax paying ( and that is a huge number, as even poor are paying GST! ) deserve better and targeted health and other basic services. God will bless the next government that delivers on these issues.
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      1. D
        durgesh
        Feb 12, 2018 at 5:06 pm
        Neglect of health education is going on for last 5 decades. Be it major part with Congress or some with BJP- Janata Party or whatever. announcing Nirbhaya fund and utilizing nothing, or providing for One Rank One Pension nominally in every budget was also done earlier The question raised here is correct. No doubts. But it is something like continuing old practice. Congress must announce their positive idea's on taking India to next level. Criticizing what is done by someone else is common that we have seen for years. If you are in opposition, oppose for everything. That's what others did and now Congress is doing.... so how are you diffe ?
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        1. V
          vish
          Feb 12, 2018 at 8:10 am
          Chidambaram is a big Jumla , has done nothing except cheating and looting .Doesn't deserve to be in Indian Politics.
          (0)(3)
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