Affordable healthcare for everyone needs an all out push

CRITICAL healthcare is not only becoming unaffordable for the public at large but also prone to malpractices, especially by some corporate hospitals. In spite of medical insurance, the Central Government Health Scheme (CGHS) and the Ayushman Bharat scheme, out-of-pocket expenditure in our country is around 60 per cent of the total health expenditure. The official figure is about 50 per cent, but this does not consider medical insurance premium and unreported treatment in the form of doctors’ fees collected in private OPDs and medicines sold by unauthorised pharmacists. The government claims that the out-of-pocket expenditure dropped from 64.2 per cent to 48.2 per cent in five years (2014-19), while the share of government health expenditure increased from 28.6 per cent to 40.6 per cent during the same period. Worldwide, the out-of-pocket expenses on health are just 18 per cent.

Getting payments for health insurance claims is an onerous task. Usually, insurance companies find reasons or pretexts for not paying claims. The patient, once admitted, is at the mercy of hospitals and doctors. Most patients in a critical condition receive treatment in corporate/private hospitals as many government hospitals lack adequate facilities for them.

Amrinder Bajaj, an obstetrician and a gynaecologist who was working in a corporate hospital in Delhi-NCR, was forced to leave as she could not meet its ‘targets’. In an article published in 2020, she aired her grievances: “l know very well that the corporate has no feelings. They understand but one language, in fact just one word, ‘revenue’, and my revenue graph was not to their liking — as of that day. Expertise, experience, loyalty matter not a whit. I belong to a generation that set great store by such things, but the younger generation plays its game. From the sidelines, I observed the bright new ‘revenue-generating machines’ they recruited, who jumped the fence with no compunction when a more lucrative offer came their way. The corporate got what it gave and though I understood the game, I could never bring myself to play it.”

As a Rajya Sabha member, I took up the matter in December 2022 as a special mention on the need to provide affordable healthcare in hospitals. I highlighted that people were dying due to non-affordability of healthcare. In corporate hospitals and institutions run by so-called charitable trusts, the forbiddingly high cost makes treatment out of bounds for most. We need to cap as many medical charges as possible, especially for IPD (in-patient department) patients. We also need to ensure that the cost of medical facilities is close to the CGHS rates, if not the same. Especially, we need to make sure that institutions/hospitals getting income tax exemption from the government do not charge fees which are extortionate even for the upper middle class, forget about the working classes.

In December 2023, I pointed out shortcomings in the Ayushman scheme and gave suggestions for course correction. The average amount spent under this scheme on every patient is Rs 12,000, whereas the approved amount for every family is capped at Rs 5 lakh per year.

As the hospitalisation cost approved under the scheme is low, private and corporate hospitals usually do not want to get empanelled. That is why many patients do not get the best possible care under this government initiative.

The average bed strength of hospitals empanelled under the scheme is 48. It means that mostly smaller hospitals are empanelled and the bigger ones, which can treat critical illnesses, are generally not. The government should make it compulsory for bigger hospitals to get empanelled; at the very least, the hospitals that get government benefits, have medical colleges and enjoy income tax exemption must join the scheme.

The government should also increase the approved cost of treatment under the scheme so that the poor people are covered for treatment for critical illnesses.

Since Independence, India has progressed a lot in medical care. As compared to many other countries, we did quite well during the Covid-19 pandemic. We are on course to become a tuberculosis-mukt country. These are good signs, but without affordable healthcare, our population will always struggle to get quality treatment.

Around 7.5 crore families are pushed into poverty by health expenses each year. This is one-third of the global number. We also need to rethink fast to increase the health expenditure as a percentage of the GDP. It is less than 2 per cent, far lower than in developed countries (as high as 16.5 per cent). The 15th Finance Commission had recommended that public health expenditure of the Union and the states together should be increased in a progressive manner to reach 2.5 per cent of the GDP by 2025. Our country is not even among the first 50 nations in terms of health spend as a share of the GDP.

Well-off people and organisations should do their bit for poor patients requiring critical care. We need to take various steps towards achieving the goal of affordable healthcare for all.