Despite claims of rural welfare, there are no real benefits for the majority
To assume that the State can regulate private health care is a recipe for disaster
That rural India was to be the focus of budget 2018 was expected indeed needed, urgently. To this end, the finance minister’s budget speech made all the right noises. What is interesting, however, is the narrative of rural development that the government has constructed in this budget. Gone is the focus on jobs, skills, aspirations and empowerment. The rural economy is to be strengthened through greater government welfare intervention.
Improved rural infrastructure, particularly sanitation, housing, roads and the showstopper of this budget — health insurance — are the key focus. Achievements against these schemes are likely to frame the political message that the NDA is going to take to the people in 2019. Important here is a clear admission that the primary political promise of this government — better jobs for an aspirational India — has failed. There is a new promise that is being slowly constructed.
But for all the rhetoric, budget allocations tell a different story. The budget for the Ministry of Rural Development got a mere 4% increase in allocation. Importantly, both Swachh Bharat, the Pradhan Mantri Gram Sadak Yojana (PMGSY) – the rural roads programme and the Pradhan Mantri Awas Yojana (PMAY) — the rural housing programme, saw no real change in allocation. In fact, allocations for Swachh Bharat and PMAY have fallen by 9% compared to revised estimates of the previous year. Importantly MGNREGA allocations did not increase, despite growing pending liabilities. How then will the promise of reviving the rural economy be met?
And now to this budget’s showstopper – the National Health Protection Scheme to cover 100 million poor and vulnerable families with a coverage of up to ₹5 lakh per family. The focus on health care in this budget is very welcome. For the last three years, the National Democratic Alliance’s health policy has been floundering and in need of urgent attention. But I fear that this current approach runs the risk of creating the world’s largest, unregulated public private partnership with limited impact on health outcomes. This is because key preconditions for an effective health insurance — a strong primary health system that can prevent minor illnesses from reaching hospitals and to ensure efficient referral for those who genuinely need hospital care and an effective regulatory system are not in place. The push for an insurance based public private partnership is premised on the assumption that a state that has failed to get basic provision right can perform the far more complex task of regulation. To assume that a low capability state like ours can perform a task as complex as regulating private health care –which includes addressing pricing, quality control, especially when existing legislation is weak – is a recipe for disaster. The first step to improving health care is reforms in primary care and in particular getting doctors to work. Health insurance programmes that are not embedded in a health systems reform effort are unlikely to achieve this.
So in the final analysis what can be said of this budget? An important political statement but one that is unlikely to improve Indian’s “ease of living”.
What this means for election 2019, only time will tell.