Tuesday, March 1, 2016

Budget 2016: Three steps to cut household medical bills


The budget has proposed initiatives to provide Rs 1 lakh health cover per family, lower dialysis costs and add 3,000 shops selling inexpensive medicines in an effort to lower out-of-pocket healthcare expenses of households.

But health policy analysts have cautioned that the impact of these initiatives would depend on the details.

The budget has also pledged to increase allocation for health by 19 per cent to about Rs 37,000 crore from Rs 31,000 crore. But analysts tracking government spending on health say the hike appears more like a restoration of funds denied in the previous two years.

Finance minister Arun Jaitley cited "catastrophic health events" as the prime cause of unforeseen out-of-pocket expenditure in households and pledged a scheme that would provide cover up to Rs 1 lakh per family. Households with senior citizens would get an additional amount of up to Rs 30,000.

"The costs of out-patient services, diagnosis and medicines make up nearly 70 per cent of out-of-pocket expenses in India," said K. Srinath Reddy, the president of the New Delhi-based Public Health Foundation of India, a research and education institution.

"We need to wait and see whether this scheme will cover the costs of medicines and out-patient services."

Several public-funded health protection schemes -either paid by the Centre or state governments - at present cover only hospitalisation, and have had limited impact on reducing personal expenses of households where patients require long-term treatment for chronic illnesses.

The plan to add 3,000 jan aushadhi shops that sell relatively inexpensive generic medicines is expected to reduce households' bills for drugs. About 137 jan aushadi shops are functional across 20 states, offering medicines at prices three to 15 times lower than the market cost of the same medicines.

Jaitley has also announced a national dialysis services programme that will provide government funds to expand services to all district hospitals and use customs duty and excise incentives to lower the cost of dialysis equipment.

Doctors estimate that over 200,000 people develop end-stage kidney failure - a condition that can be treated only through dialysis or transplantation - every year. Only half of these patients can afford or access regular dialysis services.

Each dialysis session costs about Rs 2,000, and patients typically require dialysis up to three times a week, implying an annual expenditure of about Rs 300,000.

"A government-supported dialysis programme will help many patients who're unable to access or afford dialysis," said Devinder Rana, a consultant nephrologist at the Sir Ganga Ram Hospital, New Delhi, and secretary general of the Indian Society for Haemodialysis.

But Vivekanand Jha, a professor of nephrology at the Post-Graduate Institute Medical Education and Research, Chandigarh, and executive director of The George Institute for Global Health, India, said the impact of the dialysis scheme would lie in its details.

"Provision of dialysis has long been a benchmark for the willingness of governments to provide healthcare to their populations," Jha said.

"The government should also pay attention to peritoneal dialysis (an alternative dialysis technique that can be done at home suitable only for some patients) which can be provided to large numbers at lower price, does not require setting up expensive infrastructure such as dialysis units and water treatment systems."

A senior official in a corporate hospital said the health protection scheme would help even if it covers only hospitalisation.

"It is up to healthcare institutions and doctors to work towards low-cost protocols and pathways to enable critical services to be covered within the amount," said Suneeta Reddy, the managing director of Apollo Hospitals, Chennai. Despite the proposed 19 per cent increase in the outlay for health and family welfare, concerns about under-funding of the health sector persist.

"This increase (this year) is insufficient to offset the 54 per cent decline in the allocations by the central government between 2013-14 and 2015-16," said Poonam Muttreja, the executive director of the New Delhi-based Population Foundation of India, a non-government agency.