Who will pay for health care? (Guest Editorial 2)

For Morung Express newspaper Editorial

About 78% of all health care expenditures in India are paid from the patients’ pocket. It is estimated that about 2% of households fall into poverty every year because of paying medical bills. Government spends only about 1.2 % of its GDP on Health which is among the lowest in the world (less than Afghanistan and Sierra Leon). Union Budget for 2015-16 shows that there isn’t going to be any change in the coming year too, much to the disappointment of many health activists.

On the other hand, there has been constant talk about Health for All, MDGs, accessible and affordable health care, comprehensive primary health care, and so on. But anyone who has visited any health institution for consultation knows that medical care is not cheap. So, how do we make sense of all this high sounding words and phrases when contrasted with ground reality?

In the midst of discussion about fund leakage and mismanagement, it is true without a doubt that health care is grossly underfunded in India. There is simply not enough money for delivering decent health care to the people. A lot of packaging and repackaging are being done but the central government in the recent years have not committed to increasing investment in health care. The justification for increasing only 2% on health in the union budget this year is that the Centre wants the States to bear more responsibility for health care. This may spell more misery for a State like Nagaland. For all the centrally sponsored programs which now form the main bulk of the medical department, the State is supposed to give 10% of the year’s approved budget. But the State has failed to do its part every year. Health is not a priority according to the government of Nagaland. The allocation to Health has been decreasing with each passing year. This was not because of the National Rural Health Mission (NRHM, now NHM). When the NRHM decreased its budget, the same year, State government continued to decrease its allocation to health. Also the move to empower the State backfired last year when Centre decided to route the NHM fund through the State treasuries. The money got stuck in the Finance Department and the Health service delivery has been severely affected. 

There is no sign of commitment either from the Centre or the State to increase investment in health care. So, who will pay for health care? Where will the people turn to? It is an alarming and depressing situation we are in. With increase in the cost of health care, catastrophic health expenditures are bound to increase. Health care cost of a household exceeding 10% of its total monthly consumption expenditures or 40% of its non-food consumption expenditure is called catastrophic health expenditures. 

To prevent families falling into this catastrophe, it is imperative that the State government prioritize Health in its budget allocation during the upcoming State budget session. For the poor, there is little or no alternative to public funded health care. Despite all the shortcomings, government health institutions and programs remain the backbone of health care in most of the villages and districts in Nagaland. Private medical care and Health Insurance are neither affordable nor accessible for the majority of the people who lives in rural areas. Charitable health institutions/initiatives are too few. The church is fond of setting up educational institutions, but few venture into health care. I hope our churches understand this precarious health care scenario and take the plunge. 

   ‘Health and happiness is not only a driver of economic growth, it is its very purpose’.

- National Health Policy 2015 (Draft)