The National issues that the Nation is not talking about!!


This election should set a benchmark

and transform the landscape of healthcare in India,

no matter who comes to power.


Compiled by: Dr.M.Arulpitchai Narayanan


VINOD PAUL and K.SRINATH REDDY state in their article: "For an all-party manifesto on health" as :

Current Health Scenario in India

By Health it is meant both Physical and Mental Health of both the individual and the society in a country.

As the countdown to the next general election begins, political parties are making multiple promises to pull in votes. All the party leaders are committing to transforming the lives of people. But health, ironically, does not feature high on their priority list, even though it is the central pillar of a nation’s development and productivity and the key to happiness for individuals, families and societies. Perhaps it is time to remind all parties that are seeking to govern the country that India’s health challenges are perhaps the greatest for any single nation in the world.

Nothing short of a massive transformation of the health system can address these challenges and meet the needs of citizens. People expect much more than a handful of select services under the limited ambit of the existing national programmes.

Each year, more than 40 million people, mostly in rural areas, are impoverished and run into massive debts to access healthcare. The devastating contribution of out-of-pocket medical expenses to poverty is often not fully appreciated by the media and policy-makers.

Mr.Nitin Desai in his article India’s right to health in Business Standard

The impact of such an intervention on poverty levels could be substantial. Catastrophic health expenditures (CHE) that exceed 40 per cent of non-subsistence consumption or 10 per cent of total consumption expenditure are a major - possibly the principal - source of vulnerability for families near or below the poverty line. According to a recent World Health Organisation (WHO) survey, out-of-pocket health expenditures amounted to an average of 10 per cent of total household expenditure and 22 per cent of non-subsistence spending in India. Almost 24 per cent of households spent either equal to or more than their capacity to pay (non-subsistence spending) on health care services; consequently, they had to forego their basic subsistence consumption. This proportion is 35 per cent among poor households. These numbers do not include the cost of travelling to urban areas for health care or the loss of earnings. If one looks at the composition of expenditure, 60 to 70 per cent is spent on medicines and a little over 20 per cent on in-patient or out-patient services.

The stress on a family's standard of living is most acute when a major illness strikes a family member. A survey in Kerala of heart-attack patients showed that 84 per cent faced catastrophic health expenditures. The coping strategies included loans and dipping into savings. But, according to the study, in order to cope, children discontinued their education, got transferred from private schools to free government schools and families moved out of expensive rental accommodation to cheaper ones - or even moved in with willing relatives to cut expenditure.

“”The entire spectrum of political leadership should take a pledge to transform the healthcare system of India”” 

Suggested points for overall Better Health Care for India as Affordable and Accessible:

1. Social Infrastructure status for Health Care.

Reduction of Health Care Cost:

2. Rural Service and Income Tax

a] Tax incentive for the Individual Medical Practitioner who practices at Rural and semi Urban areas and special incentives for the receivables and professional service charges of specialists and super specialists for on-site service of health care at Rural and tier III and II towns.

Tax incentives means either no tax for the income earned for the Health Care Service in the rural area, or increased tax slab for the amount earned for the service rendered in the rural area and for the population below poverty line [BPL]

and specially designed financial packages for Infrastructure capital expenses/ investments for Hospitals and Health Care facilities at Rural and Tier III and II towns.

3. Encouraging manufacturing Medical equipment at India with possible incentives so that Capital burden is   reduced since the equipments manufactured in India shall become less costly.

Local manufactures of high tech medical equipment such as Ultrasound , CT&MRI scans , cardiac cathlabs, diagnostic equipment like auto analysers to be encouraged intensively and immediately so that the Heath Care Cost shall comedown by 40% 

4. Consumers of Health Care and Income Tax:

CURRENT TAX PRACTICE

Income Tax and Health Insurance :

Buy health insurance for the family: Given that it’s a necessity, the earlier you buy a medical insurance, the better. If you buy it only for yourself, you can save up to Rs 15,000 a year. But if you buy a policy for your parent, you can get an additional deduction of Rs 20,000 a year per parent under Section 80D.

“Benefit under Section 80D can be claimed for payment of premium towards health insurance for self, spouse, children and parents. You can claim deductions of up to Rs 15,000 for premium payment for self, spouse and kids and up to Rs 20,000 for senior citizen parent(s),” explains Amarpal Chadha, tax partner at EY.

If your parents are not senior citizens, you can claim up to Rs 15,000 for premium payments for their health cover. This deduction is available irrespective of whether the parents are financially dependent or not. In case of a married couple, the husband can claim for premium payment for his parents and the wife can claim for her own parents.

DEMAND:

a] Increase in the Tax exemption limits to Rs.100,000 on the premium paid for Health Insurance [Husband, wife, Children, Parents of Both The Spouses]

b] And parents of both the spouses must be considered as dependents of any one of the spouses and medical insurance premium paid by one of the spouses must be exempted for income tax.

c] Restoring that the higher exemption limit for woman, which prevailed a few years ago should be restored.

d] Insurance including health insurance is not available for aged except for renewal, but at a very heavy premium. There is need for rationalizing the same.

e] Deduction for medical treatment and health insurance should not be subjected to ceiling with reference to premium, but with reference to benefits for which a ceiling of Rs.10 lakhs may be placed subject to revision every year proportionate to increase in the premium and inflation.

5. Man Power:

Creation of more specialists and super specialist, paramedical and supportive staff by creating more seats in existing institutions. Increase the allied health care professionals by creating more seats in the existing institutions and newly creating more institutions. 

6. Health Care Specific Acts for Entire India:

Labour law, acts and rules, more specific to healthcare delivery and General Labour Law cannot be applied to health care segment.

7. Reducing the Real Estate Cost of Hospitals facilitating to get located inside the Towns:

More FSI for hospitals in the Urban Areas so that cost per square feet of building becomes less, thereby   capital cost of the hospital building is reduced.

8. Mental Health: Society and Individual

Regular audit of Mental Health of the individual and the society. Review of social violence has to be correlated with mental health. Community oriented lifestyle practices more pertaining to Geographical and Ethnical Culture must be encouraged for better mental and physical Heath.

9. Public Health Audit

Public Health Audit must be made mandatory along with financial audit for any project in Government or Private. There must be a public health reference in the preliminary report of any project.

10. Coordination between Human, Veterinary, Agri and Marine for better Health Care.

11. Drugs:

Pharmaceuticals and drugs, medical devices, disposables are subjected for better pricing with quality.

With view of the ongoing tussle by the pharmaceutical industries in India, there must be a separate and exclusive ministry for pharmaceuticals at the government of India level. Forming such a separate, exclusive ministry shall facilitate lower cost of medicine for the patients / citizens of India. As an industry it will improve economic scenario of the country and facilitate better regulations, increasing the export income of the country.

Article by Yogima Seth Sharma in Economic times titled Patented Drugs cheaper by 46% bur less affordable here states that

Patented drugs are much less affordable in India than China, Mexico, Brazil, Indonesia and South Africa despite selling at 46 per cent of the prices prevailing in developing countries on an average partially because of poor health insurance coverage and the government picking up less of the tab, according to a study for the PlanningCommission by IMS Health, a pharmaceutical market research firm.

More than 78 per cent of the total expenditure on healthcare that Indians incur is out of pocket while in most other countries a share of this cost is either borne by the government or covered by insurers. However, when it comes to generic drugs, Indians are better off than the Chinese, Mexicans and South Africans as these are available at 14-17 per cent of the price at which they are marketed in other developing countries




Relative affordability has been measured by taking into account factors such as cost of medicines and per capita GDP of the respective countries. When compared with rates in developed countries, patented drugs are available in India at 27 per cent of the average price there. “”

12. Medical Research

Medical Research is to be encouraged. Coordinated Data collection and analysis must be improved and periodical review is to be done. We are far below in Medical Research and there is criminal waste of our clinical materials losing financials from these sources.

13. A separate tribunal for medical negligence

A separate tribunal for medical negligence to be established and to be taken out of ambit of the consumer forum.

Medical Negligence can not be pin pointed only on the Treating Doctor or the Hospital. ‘

The patient treatment depends on the quality of the Diagnosis before, During and After the treatments. But we do not have any regulation or guarantee assuring the quality of Diagnostic equipments, the reagents and personal involved in diagnostics and the treatment of the patient by the Doctor is on this unregulated Diagnostic results.

Opinion by the supportive doctors and the allied Heath Care workers as team members have role in the patient management.

Similarly, the cure of the patient solely depends on the Medicines and the devices such as stents. But, there is no regulation on the quality of the Medicines and devices such as stents.

Ultimately, the Doctor and the Hospital lands up with law suits of Medical Negligence.

Ref: US Doctors uneasy after Indian drugs come under FDA scanner.

http://www.financialexpress.com/news/us-doctors-uneasy-after-indian-drugs-come-under-fda-scanner/1234001

If the Doctors are made to practice defensive medicine or under threat of litigation, it shall be loss to the consumer of the health care.

14. Protocol:

Medicine is an imperfect science. And highly dynamic.

An initiative to be established or formalized the treatment protocol specific to Indians on the lines of international practice as in developed countries.

15. The concept and recognition of the healthcare delivery under the leadership of the physician by the allied healthcare and supportive staffs as HEALTH CARE TEAM to be promoted. ""....insight on the seismic changes hitting the healthcare workforce in the coming years. The discussion will focus on how organizational structures and personal career paths will be impacted by reform laws, a focus on team-based care, the expansion of roles for supporting practitioners and a growing emphasis on providing care in ambulatory settings.""

16. Special focus on health care information technology. 

The entire spectrum of political leadership should take a pledge to transform the healthcare system of India 

India must learn a lesson that in the on going healthcare issue which has shattered, shacked and tremor the so called leader of the world The United States of America. The recent revelation says that the present Obamacare has been originally proposed by Mrs.Hilary Clinton in 1993 and the proposal was stalled by a few vested interested group through lobbying.

India , is a country known for its unity inDiversity, and we must arrive at a unique model for India by studying the healthcare delivery models of USA , UK, Canada , Germany , Australia with insurance and not.

It is by India’s experience that a socially independent country nationalizes the private banks in 70s and claimed by nationalization the population will be served better., But the same nationalize banks get privatized and their motive is only profit and not profiting or developing the society.. Government owned public enterprises privatize and they become an business entity to look at only the profit.

Similary the biggest threat in Indian healthcare scenario is the so called health insurance companies looking only at their profits rather than looking at the over all healthcare delivery as affordable and accessible of the population . Hence , a unique model with indianised approach to each citizen of this country for better health must be arrived at by long debate with various stake holders.


The main priority

To begin with, parties must make healthcare a core priority for the next decade, to enable transformation of the healthcare system, while promoting pro-health policies in other sectors. We believe that the following five principles form the core national agenda on health and should be embraced by all the parties.

First, we call upon all the political parties to commit to the goal of achieving UHC in the country by the year 2025, and develop a clear roadmap thereof by mid-2015.

Second, public spending on health should be raised from a meagre 1.04 per cent of the GDP in the Eleventh Plan Plan to 3 per cent by 2020, and 4 per cent by 2025.

Third, all essential drugs, including anti-cancer agents, should be made available free to all citizens in 3-4 years.

Fourth, standards of care including clinical guidelines, applicable to both the public and the private sectors, should be developed and enforced in the next five years.

Fifth, equity must be ensured in the provision of health services across districts, communities and gender.

The next government, irrespective of its party composition, should within the first 100 days of coming to power create an enabling mechanism to plan, mentor and implement the above promises. A National Health Regulatory and Development Authority would help to effectively advance this agenda.

This election should set a benchmark and transform the landscape of healthcare in India, no matter who comes to power.

(Vinod Paul is Head, Department of Pediatrics and WHO Collaborating Centre for Training and Research in Newborn Care, AIIMS, and K. Srinath Reddy is President, Public Health Foundation of India.)
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