The Government of India’s Department of Personnel and Training (DoPT) has decided to reimburse approved expenditure on treatment abroad, for a defined range of medical conditions, for officers of the Indian Administrative Service (IAS) and Indian Police Service (IPS). In doing so, it is extending to them a benefit available to Members of Parliament and officers of the Indian Foreign Service (IFS) when posted abroad. In addition, the travel and treatment costs for the officer and an attendant will be borne by the government. The order confers benefits over and above the entitlements under the Central Government Health Scheme (CGHS).
At a time when the government is concerned about a high and rising fiscal deficit, and the rupee has steeply depreciated, this additional benefit to government officials appears doubly bizarre. The “fiscal constraint” argument has been repeatedly made by officials who have been critical of ideas pertaining to universal health-care provisioning.
The Plan discussions on universalising health care have required a substantial increase in outlays for health for strengthening public health services. However, the constant refrain of the Planning Commission and the government has been that the required amount could not be allocated due to budgetary constraints. As there have been competing priorities, a balance has had to be maintained. Ministers and bureaucrats have made this case forcefully and silenced academic and activist communities who have demanded increased funding. It is ironic that the same constituency is not worried about using the taxpayer’s money to give itself additional privileges.
Apart from the fiscal ramifications of this bureaucratic generosity, this decision, as indeed the existing privilege enjoyed by MPs, raises several other questions about the political signals such a decision would send about the policy on public health care in India.
Existing rules permit civil servants to secure reimbursement for medical treatment abroad or at a private hospital in India based on what it would cost to secure the same treatment in a private ward at the All India Institute of Medical Sciences (AIIMS), New Delhi. The revised rules entitle all IAS, IPS and IFS officials to seek the same level of reimbursement for treatment abroad that IFS officers are entitled to when on a foreign posting. Not just that. There will be reimbursement of the travel fare.
Impairs health care
Just as MPs have to get such expenditure approved by the Parliamentary Standing Committee of the Ministry of Health and Family Welfare, government officials have to secure the approval of a committee of specialists in government hospitals. Which group of MPs would deny another MP such a benefit? It would be interesting to see if any MP has ever been denied this request. Given the relationship between officers of the IAS and IPS and government doctors at the State and Central levels, how many specialists in government hospitals would have the courage to reject any application from a government official? Professional scrutiny of such applications would then become a mere formality.
This order also raises larger questions about the commitment of the government towards the domestic health-care sector, especially the public sector. The fact is that the decline of government hospitals was in part associated with the decision of ministers and officials to give themselves the benefit of being monetarily compensated for private health care. Ironically, their departure as users from public sector hospitals partly contributed to the decline of the public sector. On the other hand, their usurpation of whatever was being offered by specialised public sector institutions meant marginalisation of ordinary people in these institutions.
Studies have shown that the retreat of governmental leadership from treatment in government hospitals, sometimes justified in the name of the poor, has seriously impaired the quality of health care in the public sector. Would their retreat from even private, superspeciality hospitals at home not have a similar, negative impact? What would the queuing up of political leaders and government officials for treatment abroad do to India’s attempt to establish itself as a destination for what is dubbed “medical tourism”?
Fiscal subsidies and tariff concessions were given to private businesses setting up for-profit health-care facilities in India in the name of the poor and in the name of offering world-class services at home. When government officials lobbied for the inclusion of private for-profit health providers in the CGHS, it was known that there would be an inflation of costs. For the same procedure, corporate hospitals began charging several times the cost that was incurred in public hospitals, and the government began reimbursing this.
Such concessions were also justified on the grounds that this would save the country precious foreign exchange because Indians would secure world-class medical care in the country itself. However, it has now become commonplace for political leaders to go abroad for medical treatment at the taxpayer’s expense. Now, civil servants also want to secure this benefit for themselves.
This constitutes nothing less than a vote of no-confidence on the part of India’s political and administrative leadership in the country’s own health-care system.
At taxpayer’s cost
Economic policymakers have often justified concessions to foreign investors in the fields of health and education on the grounds that this would discourage Indians from spending precious foreign exchange abroad. But this new order will only encourage public officials to seek medical treatment abroad, at the taxpayer’s cost.
The usurpation of privilege at the taxpayer’s cost shows utter callousness in policy thinking and is morally reprehensible and irresponsible. There is enough evidence in the country that a large section of poor and middle classes is impoverished due to the high cost of medical treatment; they are not covered by any insurance. The recently introduced public insurance schemes for the poor are wanting in many respects. Given this, how can anyone morally justify the order passed by the DoPT, or indeed the privilege already being enjoyed by elected representatives?
(Rama V. Baru is professor, Centre for Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi.)