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Last Updated : Aug 17, 2020 08:37 AM IST | Source: Moneycontrol.com
Government needs to play the health card right
Unique ID is welcome, but increased public expenditure is the need of the hour to cure the ills of the country’s ailing health care system
Abhijit Kumar Dutta
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Indians are set to get yet another unique identification number. After Aadhaar, voter ID, PAN and several other identifiers, citizens will now be given a health card, which will have all the information about his or her medical conditions.
While delivering his seventh consecutive Independence Day speech from the ramparts of Red Fort last Saturday, Prime Minister Narendra Modi launched the National Digital Health Mission and said, under this campaign, every citizen will be given a health ID from the government.
“This health ID will work like a health account for every Indian. This account will contain your details of every test, every disease, the doctors you visited, the medicines you took and the diagnosis. When and what was the report, all such information will be incorporated in the health ID,” the Prime Minister said.
“The National Digital Health Mission will eliminate all these difficulties related to appointments with a doctor, depositing money, making a slip in the hospital, etc. We are devising a system which will help each and every citizen to make a better and informed decision,” Modi added.
As apparent from the Prime Minister’s speech, the national health ID will be a repository of all health-related information of a person. Over the last two years, NITI Aayog, the government’s policy think tank, has been trying to create a centralised mechanism to uniquely identify every participating user in the National Health Stack. The creation of the health ID is part of this initiative, which will make available health records of a person digitally.
New Delhi mandarins claim that a unique health ID for an individual will minimise the chances of pilferage and misuse of several health schemes either by patients or doctors, hospitals and medical device manufacturers. Experts feel such an ID should bring in transparency and check multiple frauds plaguing the health care sector.
For the anaemic health care system of the country, the benefits of such a digital initiative can hardly be overemphasised. However, official sources admit that the success of the initiative will depend on the pan India outreach of the scheme. In rural areas, they feel, the lack of penetration of Internet connectivity and erratic electricity supply could pose a serious challenge.
Since the proposed health card involves the sharing of personal ailment records, some experts aver that it may trigger privacy issues. They feel that such an initiative should have been rolled out after the data privacy bill is passed by Parliament.
While these are niggles that administrative and legislative prescriptions can take care of, the bigger question is whether the National Digital Health Mission (NDHM) can be the panacea for ills that beset the country’s health care system.
The way the Covid pandemic has exposed the gangrene in the medical set-up of the county, the answer seems to be in the negative. While the objective of the NDHM is noble, it is a no-brainer that unless infrastructure is there no amount of peripheral initiatives can provide timely and correct treatment to the ailing. Innumerable media reports of Covid patients lying unattended or being turned away from hospitals and overworked doctors and nurses themselves getting infected by the virus have brought to light the inadequacy of our medical facilities.
Though we talk a lot about health and nutrition in the country, our investment in medical facilities is woefully inadequate. According to OECD data, India spent (public and out-of-pocket) 3.6 per cent of its gross domestic product (GDP) on health care in 2017. This was much lower than many other countries — developed nations such as the US spent 16.9 per cent of its GDP in 2018, while Germany and France shelled out 11.2 per cent. Even among the BRICS nations, India’s expenditure in health care is the least — Brazil spends the most (9.2%), followed by South Africa (8.1%), Russia (5.3%), China (5%).
In fact, if we take out the out-of-pocket part, India’s public expenditure in health care is a tad over 1 per cent of GDP. This is even less that what Bhutan spends (2.5 per cent). Moreover, a large part of this expenditure comprises salaries, gross budgetary support to various institutions and hospitals and transfers to states under centrally sponsored schemes such as Ayushman Bharat. So where is the money to create new health infrastructure? According to a Brookings study, the total number of government hospital beds in the country is little above 7 lakhs — which translates to 0.55 beds per 1,000 people. This is abysmally low.
Statistics abound on how India has fallen behind many other countries in providing adequate health facilities to its citizens. As some health experts point out, creating medical infrastructure has two parts. While you need more hospitals, beds and equipment, it is equally important to have more doctors and paramedics. Unless you have “able-beds”, meaning human resources supported by physical infrastructure, proper and effective treatment to the ailing cannot be meted out. This needs massive investment — both public and private.
Given the parlous state of the exchequer, it could be tough for the government to solely rely on its own kitty to develop modern health infrastructure. The administration will have to, therefore, encourage and incentivise private entrepreneurs — who have deep pockets but are more metro- or urban-centric — to participate in a bigger way to extend the reach of modern health care to semi-urban and rural areas. While a health ID is welcome, the Modi government will have to play the card right to take the NDHM to its logical end.

(Write to Abhijit.Dutta@nw18.com with your views about the country's health system)

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