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New Delhi, : Weeks before the Lok Sabha polls, a section of doctors and health activists on Thursday asked political parties to promise a Right to Healthcare legislation in their manifesto as Narendra Modi government’s multiple health schemes including the flagship PMJAY were unable to alleviate people’s distress arising from high medical cost.
A legislation to ensure a guaranteed availability of free and quality treatment is among 12 proposals that Jan Swasthya Abhiyan shared with all major parties including the ruling BJP. Others include reducing out-of-pocket expenditure, filling up of vacant posts in hospitals and health centres, taking care of the grass root health workers and making top quality medicines affordable.
“Studies have shown that over 80% beneficiaries of PMJAY spend around Rs 13,700 on an average out of pocket, even though it is supposed to be a cashless scheme,” said Abhay Shukla, a Pune-based physician and convenor of JSA.
The release of the People’s Health Manifesto comes a few weeks after the Supreme Court took strong objection to the Union government’s failure to specify a range of rates within which private hospitals and clinical establishments can charge for their treatment services. Although a rule was framed twelve years ago, it has not been enforced yet.
With $ 25 per capita spending on health by the government, India’s public spending on health is one of the lowest when compared to neighbouring countries like Bhutan ($ 69), Vietnam ($ 74), Sri Lanka ($ 77), Indonesia ($ 95), Thailand ($ 256) and Malaysia ($ 274).
India is also the poorest among the BRICS nations with Brazil ($ 347), South Africa ($ 352) and China ($ 363). Consequently, the out of pocket expenditure is very high pushing lakhs below the poverty line.
A legislation on healthcare along with an increased budgetary allocation, according to the JSA, will help remove the ills of the country’s healthcare landscape driven predominantly by the private sector.
Despite having a coverage of Rs 5 lakh under the Pradhan Mantri Jan Arogya Yojna (PMJAY), the poor have to pay a part of their treatment from their pocket, because of the treatment packages private hospitals offer.
“The packages are made in such a way that something always remains outside the PMJAY package,” said Narendra Gupta, a community health physician and founder of Prayas in Chittorgarh, who had petitioned the apex court flagging the loopholes in the scheme. “To make the matter worse, more than 80% medicines are outside the price control.”
The rate of hospitalisation fell from 37 per 1000 in 2014 to 28 per 1000 in 2018 as per the latest government survey that came in 2018. “This means a large section of people avoid hospitals, fearing the cost. Unfortunately, we don’t have data after 2018 but in states like Kerala and Tamil Nadu with better healthcare, the corresponding figure is 111 per 1000,” said Shukla.