Need a 20 Percent Y-o-Y Increase for Swastha Bharat

The Union Budget 2018–2019 announced by the finance minister on February 1, 2018 certainly seems ambitious. Ayushman Bharat, promises to bring over 100 million families under a health insurance scheme with a cover upto Rs. 5 lakh. This would require an allocation of Rs. 5000 crore in year 1, and Rs. 10,000 crore in year 2. Also, the creation of 150,000 health and wellness centers will provide free essential drugs and diagnostic services. An amount of Rs. 1200 crore has been allocated for this.

How will this translate into reality is the big question? How can Rs. 1200 crore be sufficient for 150,000 centers, when the cost of operationalizing one health and wellness center is Rs. 1.7 lakh? The allocation for the National Health Mission is down by 2.1 percent, from Rs. 31,292 crore to Rs. 30,634 crore; is the Rs. 1200 crore being taken from this reduced NHM outlay?

On a similar note, setting up of 24 new government medical colleges and hospitals has been announced. However, the budget allocation for this has been slashed from Rs. 3300 crore in 2017–2018 to Rs. 2888 crore in 2018–2019, a 12.5 percent decline. Allocation for the Pradhan Mantri Swasthya Suraksha Yojana, which includes setting up AIIMS-like institutions and upgrading existing medical colleges, has also been slashed from Rs. 3975 crore in the budget estimates for 2017–2018 to Rs. 3825 crore in 2018–2019, a 4 percent decline.

It is estimated that to meet the objectives of the policy, the governments – both central and state – together would need to increase their total allocation toward health to Rs. 800,000 crore, up from the current Rs. 200,000 crore by year 2025. To achieve that, the central government health budget alone should increase at least 20 percent year-on-year for the next seven–eight years. However the budgetary allocation of Rs. 52,800 crore in 2018–2019 is 11.5 percent higher than last year’s allocation of Rs. 47,352 crore, half of what is needed. And a mere 5 percent higher than the revised estimate of Rs. 50,079.6 crore, in 2017–2018!