The proposed enhancement of public health expenditure in India as a percentage of GDP during the Twelfth Plan will deploy massive tax funds in a sector that is poorly regulated. If the government accepts the recommendation of the High Level Expert Group of the Planning Commission on Universal Health Coverage to increase government expenditure on health to 2.5 per cent of GDP from 1.2 per cent today, there will be an estimated five-fold increase in per capita public spending. It is inevitable that private health infrastructure is tapped to provide UHC, at least in the short term, while the government-run system is improved qualitatively and quantitatively. Such a massive increase in public spending requires a review of regulation of the entire sector, covering all categories of hospitals and clinical establishments. The Clinical Establishment Act, 2010 makes a beginning in this regard but it has a long way to go as it requires ratification by States to be applicable, except in Arunachal Pradesh, Himachal Pradesh, Mizoram, Sikkim and Union Territories which are already covered. It is essential that State governments move quickly to ratify the Central Act, considering that they are committing huge public funds for health insurance schemes to purchase care from private hospitals.
Benchmarking care is a standard requirement for hospitals and clinical facilities in the developed world. India's efforts in this regard remain fragmented, with the National Accreditation Board for Hospitals and Healthcare Providers, the Indian Public Health Standards, and the Clinical Establishment Act attempting to define standards. What the country needs is one integrated standards and regulatory system, requiring compulsory registration and regulation. The decision of the NABH to make surprise visits to hospitals to verify uniform adherence to its standards is certainly welcome, but incremental approaches will not do. A single empowered national standards body is needed, and the Planning Commission group has a worthwhile recommendation on forming a national regulatory body, State units and subsidiary agencies to evolve protocols, accreditation and evaluation norms. Somewhat disappointingly, a section of medical professionals has opposed such measures on the ground that it would unleash an inspector raj. Such a prospect can be avoided by building a transparent system that mandates pro-active disclosure for all stakeholders. As things stand, the medical community does have a genuine demand for clear rules under the Act. Achieving high standards in healthcare and empowerment of patients is not possible without standard-setting and strong regulation. Laissez faire cannot deliver.
Keywords: UHC, healthcare sector, NABH, Clinical Establishment Act
With the proverbs,"When wealth is lost nothing is lost, when health is lost something is lost but when character is lost everything is lost." recalling from my memory.With this I would like to relate that Minister's who are been administered by the administrator in a very simple manner mainly deals relating to health,education and for better service in centre and state and its very appreiciating hearing the entirely in India the 12th Planning commission since have planned to do expense 2.5 per cent of GDP which has rise to 1.3 per cent for the people of India but here the first problem is to be decided for proper utilization of fund and vigilance with faithful and sincerity should be maintained so that the scandals like 2G Spectrum should not be repeated once again in our Indian history, proper maintaince in the grassroot level should be done not only for report return or data collection to make report to the authority.
if govt. really want to help poor people it should distribute health insurance policies at minimum cost or at free of cost. Instead of spending more money on public health,it should focus on health insurance. This will enhance efficiency of public money and poor- middle class people will have acess to better private medical facilities
The increase in allocation of fund to health care was long overdue. But there are other necessary steps that need to be taken to ensure proper use of fund.
Services of government health care organisation has not been upto the mark in many place and favouritism finds its place in even the most grim situation. We need more accountability on part of administration which can be brought in by involving players. Moresoever, we need to increase funding to R&D as well which are necessary to make available medicines and other facilities at cheaper rate.
Public awareness in availing such facilites and also better attention to hygiene is essential for sustained growth.
Those who have worked in government hospitals, or municipal hospitals, would tell you that lack of funds is not their main problem at all. There are three issues which the Health Departments of State governments or the Municipal Corporations has to tackle. First is to ensure that the funds allotted to the district hospitals or the municipal hospitals as the case may be are properly utilized for the welfare of patients. Secondly, many times the hospital equipment, acquired for hospitals, is not put to use as the consumables are not available or staff has not been trained or some such reasons. It is essentially a management issue. Third, relates to human resource management: motivating the support staff consisting of nurses, ward boys and technicians, to do their best for providing reasonably good service to patients, most of whom are from poorer sections of the society. Thus, the Central government has to take care of these issues before disbursing funds to the hospitals.
Welcoming development in public health care
The increase in Per capita public spending is long over due and the recommendation of the High Level Expert Group of the XII Planning Commission on the increase of UHC is a welcoming development in public health care.The five fold increase in UHC should be implemented giving least scope to corruption in the execution besides the medical professionals to observe the Oath of Hyppocratus in letter and spirit irrespective of the national regulatory body`s role of monitoring over the service done to the patients who are at the receiving end.The proposed National Regulatory Body is warranted in terms of empowerment of the patients and such the medical professionals should not except the evolution of such body.
D.V.R.Surya Rao,
86-4-14/3,Tilak Road,Rajahmundry-533 103.
Dear sir,
It is an extremely laudable effort on the part of the government to enhance public health expenditure.
But I have a query - with so many private institutions in medical field that offer this education at a high rate will this work? There have been several exposes by the media bringing the attention of public and government officials.
When such huge "investments" are made to become a doctor how can health care come cheap? It is natural that you have more private clinics and more unnecessary tests being conducted and more operations performed. All these are required to recover the costs.
The governemnet may also consider investing in higher education and research AND health care. Otherwise this scheme can easily fail.
If as you advise, private players are also roped in, we can easily predict how it will work.
Ravishankar
A very appreciable suggestion by planning commission to invest more in
public health. India is marching towards having young workforce by 2020
where an average age of Indians would be 29 years.It is inevitable to
improve the health of Indians to get the best of the demographic
dividend.Its imperative to implement the proposal of planning commission
with authority and authenticity.I hope the authorities who are to
implement the proposal understand the saying "A healthy body leads to
healthy mind".
The Editorial has highlighted one of the most important requirements of Indian life. Except for some achievements in green revolution & industry and a strong private corporate presence in IT, democratic India's progress goes alongwith least developed countries. Thanks to political leadership these days. India needs a few million more sweepers backed up by automation in order to keep roads,rail and environment neat and clean similar to west which alone will help improve health standards of Aam Admi. On seeing Indian scene, one gets a feeling whether Panchayats and Municipalities abandoned cleaning operations. Burning trash in open air must be banned. Public also must be warned to improve situation. Medical establishment is thriving on the prevalent unhealthy situation with load factor peak at most of the public and private hospitals. Regulation is therefore indispensable so that things are drastically improved. Let's hope good things to come soon for India's development and success..
Laissez Faire will never deliver because majority health market is private owned and privte company bottom line, no matter what field it is working in, is - Profit.This editorial has basis that IF govt accepts Reddy Panel's recommendation then rest of article. This is a BIG IF. We are seeing at Food Security bill, govt even not promising food security to 100% population what evokes author to put faith that govt will make it 2.5% of GDP for Health? Media and civil society has to fight for it. Unfortunately, even middle class wont mind higher medical expences, than long drawn struggle... and voices of poor masses as always are unheard.
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