Doctors' body unhappy with budget; calls it ' a huge disappointment'

The Indian Medical Association (IMA), an influential body of doctors that claims a membership of 3.5 lakh doctors in the country, has called the Union budget “a huge disappointment”. “Health was the only subject which the Union finance minister has preferred to downplay,” the IMA said in a statement released a day after the budget.

The Union health and family welfare ministry has received a small boost in its share—from the budget estimate of Rs 52,800 crore last year, the estimate stands at Rs 62,659 crores this time. The rise in the allocation (Rs 9,859 crore) is not adequate as it merely accounts for inflation, the IMA said.

The government's flagship health insurance scheme, Ayushman Bharat, has received the lion's share of this hike. Last year, after the scheme was announced, its share in the budget stood at Rs 2,400 crore, which has been hiked to Rs 6,400 crore this year—an increase of 4,000 crore. However, the IMA leadership has claimed a "lack of clarity" on the enhancement of investment in the scheme. The doctors' body has also criticised the government for not extending the insurance cover under Ayushman Bharat to primary care. If that was done, “thousands of clinics and small hospitals situated in rural and semi-urban areas” would have participated and benefitted, too. This move would have made both the insurance scheme and the small hospitals viable and sustainable, it pointed out.

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The IMA has also said Ayushman Bharat scheme is threatening the existence of small and medium hospitals (in favour of the bigger, corporate hospitals), and has demanded a review of certain aspects of the scheme.

More importantly, the IMA has pointed out that the second part of the scheme, the plan to develop 1.5 lakh health and wellness centres by 2022, was flawed. "Non-clinicians providing clinical care will actually be part of the problem rather than a solution,” they said, referring to the government's plans of appointing AYUSH professionals at these centres owing to a shortage of doctors. “We are also concerned that the sub-centres, that were created for public health, are now being converted into dispensaries.” Instead, the IMA has said, its members would be willing to partner with the government in providing the services of a doctor. “This would ensure patient care and safety."

The allocation of Rs 2,000 crore for converting district hospitals into new medical colleges, and Rs. 1,361 crore for strengthening government medical colleges (MBBS) was a welcome move, it said. “However, this allocation is highly inadequate considering the fact that the number of district hospitals in the country stands at around 763. An amount of Rs 2-3 crore per district hospital would not be inadequate,” IMA said in a statement on the budget.

The root cause of incidents of violence against healthcare professionals in hospitals, IMA spokespersons said, was inadequate infrastructure and human resources in public sector, leading to rising out-of-pocket expenditure in the private sector. To address that, the government ought to spend more money on building infrastructure. Experts have been demanding a hike in the overall health budget, from the 1.5 per cent of GDP to at least 2.5 per cent. Despite the government's promises, the health budget has only gone up marginally, from 1.2 per cent in 2013-2014, to the current 1.5 per cent. “There is absolutely no indication of any vision towards raising the public health expenditure to 2.5 per cent of the GDP,” the spokespersons said.

“People should exert pressure on their MPs to increase the public spending on health,” they said.