India’s healthcare landscape is changing. We are swiftly moving towards the realization that health is crucial for sustainable development, both as an undeniable human right and an essential contributor to our economic growth. While the government has taken several comprehensive initiatives over the past few years, right from the Swachh Bharat Abhiyan to Digital India and Make in India, the launch of Ayushman Bharat has impressively demonstrated the government’s commitment to enhance the health outcomes of the country.
However, providing accessible and affordable quality healthcare to 1.3 billion people is still a mammoth task, which cannot be attained with the current Rs 64,500 crore allocated for the sector in the Budget for 2019-20. The government needs to increase the public health spend to at least 2.5% of GDP as envisaged in the National Health Policy 2017, and preferably 3%, at the earliest.
As per the FICCI estimates, Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) would require about 6.4 lakh additional beds with an investment of Rs 3 trillion (USD 44 billion) over next 10 years. Government, too, has estimated that additional 2,500 hospitals will be needed for smoother execution of AB-PMJAY. Government’s intention of investing Rs 100 lakh crore in infrastructure in next 5 years is indeed a welcome step for the overall economic growth of the country. In view of substantial investment needed for healthcare infrastructure, it is crucial that specific focus is provided for construction of healthcare facilities.
Private sector has played a critical role in providing nearly 60% of in-patient care and has contributed to 70% of bed capacity expansion in the last decade and will continue to do so albeit appropriate incentives and financial mechanism are put in place. The government has proposed reforms in the long-term financing sector, which has been a long-standing FICCI demand for healthcare sector. The recommendations that will be developed by the Development Finance Committee should have specific focus on healthcare sector and the expert committee should have appropriate representation of experts from the private sector.
Healthcare sector needs to be accorded a National Priority Status with creation of Special Healthcare Zones with provision of benefits like infrastructure support and manufacturing incentives. To address the issue of capital-intensiveness, with high upfront investment and long gestation period, it is recommended that an interest subsidy should be made available to the sector to help make investments attractive. Additionally, capital subsidy for acquisition of land and construction of hospitals would reduce the upfront investment and help breaking even faster, making the sector more viable for investments. Such benefits can be announced for investments in targeted areas specifically in tier II and III cities and rural areas. Taxation benefits like extension of 150% weighted deduction scheme under section 35AD of the IT Act for an additional 10 years are required for hospital projects. Tax incentives for promoting specific developmental activities like implementation of EHR, securing accreditation for healthcare facilities and use of advanced digital remote care technologies, will further help in enhancing the quality and access to care.
Ayushman Bharat also envisions operationalisation of 1.5 lakh Health and Wellness Centres (HWC) by 2022. Considering about Rs 17 lakhs is required to upgrade a Sub-centre/PHC to HWC, it must be ensured that sufficient additional funds are allocated to other initiatives and programs under National Health Mission (NHM). Overall increase in allocation to NHM is only about 7.5%, which may not be adequate.
The most important prerequisite for delivering quality healthcare to all the citizens is provisioning of skilled and qualified healthcare workforce in adequate numbers in the country. We need workable solutions to add 1 million MBBS doctors, 0.1 million specialists, 2 million nurses and 3 million paramedics and healthcare technicians by 2022. Although the government has announced its focus on skill development in the country and in the recent past made provisions for additional medical seats, it is extremely important to take immediate steps like fast-tracking the upgradation of our district hospitals to medical colleges and encouraging the private sector to invest resources in skill development and medical education. Healthcare facilities (hospitals and diagnostic centres) can be incentivised by extending deductions under Income Tax Act- Section 80JJAA on stipend paid to professionals undergoing vocational training and DNB program and Section 35CCD on expenses incurred on skill development projects.
The government has shown its intent to boost entrepreneurship in the country through various benefits for Startups and refocus on Stand-up India campaign. These will help to promote low-cost, indigenous, innovative models for healthcare delivery as well as an impetus to medical technology and health IT sectors. However, specific funds like Healthcare Infrastructure Fund and Healthcare Innovation Fund should be launched to encourage entrepreneurship, innovative start-ups and newer business models that are replicable and scalable.
Government’s announcement of launch of “Pradhan Mantri Gramin Digital Saksharta Abhiyan” for enhancing digital awareness and creating facilities will help in the growth of telemedicine thereby augmenting the provision of remote medical care in the country. It will also provide an overall impetus to preventive healthcare through various apps, which is crucial to tackle the increasing burden of non-communicable diseases in urban as well as rural population. National Research Foundation announced in the budget to promote overall research will certainly provide the needed fillip to overall medical/clinical research in the country in the long term.
(The author is Chair, FICCI Health Services Committee and CMD, Dr Lal PathLabs)