Enhancing Public Health Expenditure – UPSC

Enhancing public health expenditure is a critical endeavor with far-reaching implications for societal well-being and economic prosperity. By allocating resources towards preventive measures, healthcare infrastructure, and research initiatives, governments can mitigate the burden of disease, improve access to quality healthcare services, and foster innovation in medical science. Increased investment in public health not only safeguards individual health but also strengthens the resilience of communities against emerging health threats and pandemics. Furthermore, it serves as a cornerstone for promoting equity in healthcare delivery, ensuring that vulnerable populations receive the care they need. In essence, bolstering public health expenditure is an investment in the present and future health of nations, offering a pathway towards healthier, more prosperous societies.

Tags:GS Paper- 2, Health– Government Policies & Interventions, GS Paper – 3– Government Budgeting– Planning 

For Prelims: National Health Profile, Indian Journal of Public Health, National Health Mission, Ayushman Bharat, National Health Profile, Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), National Medical Commission, One Health Approach. 

For Mains: Potential of India’s Healthcare Sector, Issues Associated with India’s Healthcare Sector, Recent Government Initiatives Related to Healthcare. 

Context:  

•  India’s health sector witnesses promising progress with rising government expenditure and declining out-of-pocket expenses, paving the way for Universal Health Coverage. 
• According to the 2023-24 Budget document, the total central government budget allocated for health (excluding research) is approximately Rs 86,175 crore ($10 billion). This translates to roughly Rs 615 per citizen. 

Government Health Expenditure (GHE): 

• India currently allocates approximately Rs 8 lakh crore ($100 billion) or around 3.2 percent of its GDP towards healthcare. 
• This percentage is notably lower than the average healthcare expenditure as a percentage of GDP among Lower and Middle Income Countries (LMIC), which stands at approximately 5.2 percent. 
• Of this total expenditure, the combined government spending (from both the Centre and states) amounts to about Rs 2.8 lakh crore (approximately $35 billion), roughly equivalent to 1.1 percent of the GDP. 
• Comparatively, the government health expenditure in countries such as China (3 percent), Thailand (2.7 percent), Vietnam (2.7 percent), and Sri Lanka (1.4 percent) demonstrates variations in commitment to healthcare funding. 
• India has among the highest out-of-pocket (OOP) expenditures of all countries in the world- 62% of the total health expenditure in India is OOP. 

Decline in Out-of-Pocket Expenditure (OOPE): 

1. Improving Infrastructure and Human Resources: Investment in constructing new healthcare facilities currently standing at 2.1% of GDP. Addressing the shortage of healthcare workers is crucial, necessitating an increase in medical schools and training programs, and attracting professionals to underserved areas. 
2. Accessibility of Quality Healthcare: Time-bound implementation of targeted programs is essential to enhance access to healthcare for marginalised communities, including those living in poverty, lower castes, and women, alongside providing education and information about healthcare. 
3. Addressing the Root Causes of Health Inequities: Collaboration between the healthcare system and other sectors such as education, housing, and sanitation is crucial to tackle the social determinants of health and reduce health inequities. 
4. Sustainable Health Governance: Implementation of robust management systems, strengthening healthcare regulatory bodies, and establishing independent oversight mechanisms are essential for ensuring effective and efficient healthcare services. 
5. Tax Reductions: Providing additional tax deductions to incentivize Research and Development (R&D) for greater investments in new drug developments and reducing GST on life-saving and essential drugs can facilitate improved healthcare affordability and innovation. 
6. Towards One Health Approach: Recognizing the interconnectedness of human, animal, and environmental health, collective health initiatives covering a holistic approach to health—encompassing a healthy atmosphere, healthy animals, and healthy humans—are imperative for comprehensive healthcare outcomes. 

Challenges associated with India’s healthcare sector: 

1. Low Budget Spending: Despite healthcare being a crucial aspect, India’s public expenditure on it remains low, accounting for only 2.1% of GDP in 2021-22. In comparison, countries like Japan, Canada, and France allocate approximately 10% of their GDP to public healthcare. 
2. Unequal Distribution: The healthcare infrastructure in India is disproportionately concentrated in urban areas, leaving rural regions underserved despite being home to the majority of the population. 
3. Lack of Medical Research: India’s focus on research and development (R&D) and the adoption of cutting-edge technologies in healthcare are notably lacking compared to other nations. 
4. Low Doctor-Patient Ratio: India faces a significant shortage of doctors, with a doctor-patient ratio of approximately 1:1500, much higher than the WHO’s recommended norm of one doctor for every 1,000 people. 
5. Lack of Affordability: The private sector dominates healthcare expenditure in India, contributing around 80% of the total expenditure, while the public sector’s contribution is only 20%. Additionally, 58% of hospitals and 81% of doctors are provided by the private sector. 

Government of India Initiatives to improve healthcare sector in the country: 

1. Pradhan Mantri-Ayushman Bharat Health Infrastructure Mission (PM-ABHIM): This initiative is aimed at fortifying India’s healthcare infrastructure and enhancing primary, secondary, and tertiary care services across the nation. 
2. Ayushman Bharat: This initiative follows a dual approach, involving the establishment of health and wellness centres to bring healthcare services closer to homes, along with the implementation of Pradhan Mantri Jan Arogya Yojana (PMJAY) to provide financial protection to poor and vulnerable families during health crises. 
3. Ayushman Bharat Digital Mission: With the goal of connecting digital health solutions of hospitals nationwide, this mission ensures that every citizen receives a digital health ID and their health records are securely stored digitally. 
4. National Ayush Mission: This centrally sponsored scheme focuses on the development of traditional medicines to integrate them into the mainstream healthcare system. 
5. Pradhan Mantri Swasthya Suraksha Yojana (PMSSY): This initiative aims to address regional disparities in the availability of affordable and reliable tertiary healthcare services, while also bolstering facilities for quality medical education across the country. 

Conclusion:  

Thus, India’s positive strides in public health expenditure and efforts towards declining Out-of-Pocket Expenditure (OOPE), reflects strides towards a more inclusive health system, fostering hope for Universal Health Coverage. As India progresses, ongoing health system reforms hold promise in ensuring comprehensive healthcare for all, marking a transformative milestone in public health. 

UPSC Civil Services Examination, Previous Year Questions (PYQs) 

Prelims 

Q: 1 Which of the following are the objectives of ‘National Nutrition Mission’? (2017) 

1. To create awareness relating to malnutrition among pregnant women and lactating mothers. 
2. To reduce the incidence of anaemia among young children, adolescent girls and women. 
3. To promote the consumption of millets, coarse cereals and unpolished rice. 
4. To promote the consumption of poultry eggs. 

Select the correct answer using the code given below: 

(a) 1 and 2 only 

(b) 1, 2 and 3 only 

(c) 1, 2 and 4 only  

(d) 3 and 4 only 

Ans: (a) 

Q: 1) Consider the following: 

1. Aarogya Setu 
2. COWIN 
3. DigiLocker 
4. DIKSHA 

Which of the above are built on top of open-source digital platforms? (2022) 

1. 1 and 2 only 
2. 2, 3 and 4 only 
3. 1, 3 and 4 only 
4. 1, 2, 3 and 4 

Answer: D 

Q:3 ) With reference to recent developments regarding ‘Recombinant vector Vaccines’, consider the following statements: 

1. Genetic engineering is applied in the development of these vaccines. 
2. Bacteria and viruses are used as vectors. 

Which of the statements given above is/are correct? (2021) 

1. 1 only 
2. 2 only 
3. Both 1 and 2 
4. Neither 1 nor 2 

Answer:   C  

Mains 

Q: 1“Besides being a moral imperative of a Welfare State, primary health structure is a necessary precondition for sustainable development.” Analyse. (2021) 

Source: (IE) 

FAQs

1. Why is enhancing public health expenditure crucial?

• Enhancing public health expenditure is crucial because it improves healthcare accessibility and quality for all citizens. It enables the government to invest in preventive measures, disease management, and infrastructure, ultimately leading to better health outcomes for communities.

2. How does increased public health expenditure benefit society?

• Increased public health expenditure benefits society by reducing the burden of disease, lowering healthcare costs in the long run, increasing life expectancy, and enhancing overall quality of life. It also promotes economic productivity by keeping the workforce healthy and reducing absenteeism due to illness.

3. What areas can increased public health expenditure address?

• Increased public health expenditure can address various areas, including but not limited to:
  • Improving healthcare infrastructure.
  • Strengthening disease surveillance and response systems.
  • Expanding access to essential medicines and vaccines.
  • Promoting health education and awareness programs.
  • Supporting research and development in healthcare innovations.
  • Enhancing mental health services and support.

4. How can enhanced public health expenditure contribute to pandemic preparedness?

• Enhanced public health expenditure can contribute significantly to pandemic preparedness by enabling governments to:
  • Invest in early detection and response mechanisms.
  • Stockpile essential medical supplies and equipment.
  • Strengthen healthcare systems to handle surges in patient volumes.
  • Conduct research on emerging infectious diseases and develop vaccines.
  • Implement public awareness campaigns to educate and prepare the population for pandemics.

5. What are the potential challenges in increasing public health expenditure?

• Some potential challenges in increasing public health expenditure include:
  • Budget constraints and competing priorities.
  • Ensuring efficient utilization of funds and avoiding wastage.
  • Addressing disparities in healthcare access and outcomes.
  • Garnering political support and public buy-in for increased spending.
  • Implementing effective monitoring and evaluation mechanisms to track the impact of investments.
  • Overcoming resistance from vested interests or stakeholders benefiting from the status quo.

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