HEALTHCARE IN INDIA is not a political battle field. The historical underinvestment in public health continues and is perhaps getting worse each passing year. In the mid-1980s, India had reached a peak of 1.6 percent of GDP allocated to health with support of the Minimum Needs Program which then saw a massive expansion of public health, especially in rural India. But since then under the structural adjustment impact the trend in budget allocations for health took a U-turn and began its continued descent. Post 2006 under the National Rural Health Mission (now National Health Mission) we did see a brief revival in public health investment with budgetary allocations moving from 0.9 percent of GDP to up to 1.3 percent of GDP until 2015. However,since then we see stagnation at around 1.2 percent of GDP despite the 2017 National Health Policy (‘NHP’) commitment of reaching 2.5 percent of GDP by 2025.
Since the 2017 NHP the trajectory of budget commitment to public health has shifted increasingly towards insurance based financing through programs like Aayushman Bharat Pradhan Mantri Jan Aarogya Yojana (‘PMJAY’), which directly support private hospitals for secondary and tertiary care for the bottom 40 percent of the poor families. Over three-fourths of the PMJAY resources benefit private hospitals and the public hospitals continue to be neglected. Of the remaining 60 percent population, about 10 percent is a privileged class of people who get assured healthcare through schemes like Central Government Health Scheme (‘CGHS’), Employee State Insurance and other similar social insurance schemes. Fifty of India’s citizens (the “missing middle” of current health policy debates) are left to the mercy of markets where the burden is entirely out of pocket or partly paid via insurance for those who can afford to pay insurance premiums.
