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Opinion: Is the focus of Budget 2017-18 on healthcare adequate?

The honourable Finance Minister deserves applause for increasing the budget allocated for health by 27% to Rs 48,000 crore. However, though laudable, it is hardly adequate when we look at the healthcare needs of India.

Dr Neeraj Nagpal

Focus on increasing PG medical seats is again appreciable but in isolation this is a lopsided approach. Increasing availability of postgraduates without increasing posts for MBBS doctors to work in villages is absurd. India needs at least 70,000 more MBBS doctors to work as general practitioners in Primary Health Centres. It is not clear in the budget what is meant by “health wellness centres”. Will these be manned by MBBS doctors or not? If so, where are these MBBS doctors going to come from in this meagre budget.

Already in Andhra Pradesh there is a problem that all specialists and super-specialists need to be registered in Andhra Pradesh Medical Council to work in Andhra Pradesh. And they will not be registered in Andhra Pradesh Medical Council until they first work in villages for one year irrespective of where they have done their post graduation or super-specialization from. This leaves DM cardiologists scampering to “rural” centres near the city to mark attendances and then work clandestinely in the city. Expecting specialists and super-specialists to work in villages as a concept needs to be called an “oxymoron”. With no infrastructure the specialists and super-specialists twiddle their thumbs, rust their barely acquired skills and feel they are in professional Siberia. Since a cardiologist cannot treat a Myocardial Infarction without adequate infrastructure he is used to give vaccinations and treat TB patients. A photograph of the specialist hung in the Primary Health Centre would do as much good as the cardiologist posted there.

If, however, we are expecting the specialists to fill posts in the civil hospitals and district hospitals then we are ignoring primary healthcare and focusing only on secondary/tertiary healthcare. Even these are poorly equipped for proper professional working except in a few specialities.

There is no incentive given in the budget to healthcare entrepreneurs to set up hospitals and nursing homes in rural areas and semi-urban towns. Presumptive taxation scheme has benefited the businesses and reduced presumptive tax from 8% to 6% but has not touched the medical professionals. Doctors today spend a substantial sum on CAs, Accountants, Tax Attorneys, and agencies to upload TDS and other returns even if the turnover of their small hospital is less than Rs 1 crore. If they could have been included in the presumptive tax scheme for small businesses it would have been a big boon leaving them free to focus on their core work providing medical care to public.

Permitting for-profit medical colleges is confusing. When the government makes a hue and cry about profit making in healthcare (stents et al) will it also decide the profit margins, which would be ethical in medical education. The biggest issue here is the confusion shown in the government’s policy direction. Is healthcare a business or is it not? If it is a business, then profit making in health education is also acceptable. It would be extremely unfair for doctors to pay for the profits to be made by corporate houses which venture into medical education but work as monks with no desire for profits once they graduate.

Starting two AIIMS is good if the six AIIMS started earlier in the previous budgets were performing at a level befitting the “AIIMS” tag. Pronouncements like starting AIIMS, eradicating leprosy, TB etc are simply loud noises to be made from appropriate pedestal only to be brushed under the carpet later. In a country where the Supreme Court has to step in to correct the government’s decades old thrust on alternate day regime for tuberculosis, someone someday needs to audit the lofty pronouncements made by the earlier governments on eradication of diseases like tuberculosis. Such pronouncements carry little substance.

The author, Dr Neeraj Nagpal, is Convenor of Medicos Legal Action Group and Director of Hope Gastrointestinal Diagnostic Clinic, Chandigarh.

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