Monday, January 11, 2016

Healthcare or Education - what should the Government prioritize?


If you removed the most basic priorities of the Government of India such as food, the next two most important sectors would probably be healthcare and education. It would be simplistic to assume that one can be prioritised over the other. The argument, "who will you educate if people die of disease?" can be countered with "who will treat the sick if you do not educate?"

India spends only about 4% of GDP on healthcare and only 1.4% is public expenditure. India spends 3.35% of GDP publicly on education. While about 74% of Indians are literate, only about half have access to basic healthcare.

Which side you would gun for largely depends on your personal and professional background. For someone battling a chronic condition, it might seem a no-brainer that the Government must prioritize healthcare spending over education. For someone who has struggled to gather resources for education, education might be more important.

India has extremely poor outcomes when you consider some of the most basic healthcare metrics. While Indians living in large cities have fairly good access, the conditions among the rural population can be abysmal. This inequity in healthcare has to be addressed on an urgent basis.

A paper published in the Lancet authored by Balarajan and others says, "...the infant mortality rate among the poorest and richest wealth quintiles was 82 and 34 per 1000 births...". Interestingly, it added, "...the under-5 mortality rate among mothers with no education compared to those with secondary or higher education was 106 and 49 per 1000 births, respectively."

This shows that both healthcare and education probably go hand in hand.

While we can debate on which sector needs to be prioritised and compelling arguments can be made for both, rather shockingly, the Finance Minister, Arun Jaitley has reduced Government spending as a percentage of GDP on both these sectors in the last Union Budget. India can never hope to be a developed country if Governments do not recognize the urgent need to improve markers pertaining to these two sectors. Acche din, anyone?

Without achieving basic levels of both healthcare and education, progress on many other sectors may be moot. We absolutely need to get our priorities right. While other sectors need not be neglected, we need to understand that it is these two sectors which will determine our long term progress.

Friday, January 8, 2016

Maharashtra shows the way, now the rest of the country must follow

The Maharashtra State Government recently exempted dialysis machines, consumables and drugs used commonly by dialysis patients from all taxes. Speaking to The Hindustan Times, an officer of the state government said:

"The drugs used for dialysis attract 5% VAT in the state, while medical equipment are sold with a VAT ranging between 5-12.5%. Import duty on dialysis equipment (dialyser and tubing) is around 44%, making the procedure very expensive. The decision will bring much relief to patients.”

So true indeed!

Most developed countries fully cover dialysis expenses for their citizens. This is based on the realisation that kidney failure is a chronic disease and the entire life's savings of families can get wiped out in paying for its treatment. In India, we have no such luck. Most patients cannot afford the treatment and simply die. The rest stutter along barely managing to make ends meet.

In these circumstances, the least the government can do is to not burden the patients and their families further. What kind of a state would impose taxes on equipment and drugs for such a condition?

The Government of Maharashtra has shown the way. By abolishing all taxes on equipment, consumables and drugs, they have taken a decision that deserves all the praise and support they can get.

The Government of India and other states should take this initiative to its logical conclusion. These taxes must be abolished with immediate effect in the rest of the country as well.

Another important measure that would go a long way to alleviate the problems faced by dialysis patients would be increasing the exemption on medical expenses from Income Tax. Currently patients must pay tax even on the amount spent on dialysis sessions and associated expenses. This is yet another example of how lopsided some of our policies are. The Government must make a clear distinction between healthcare expenses and expenses on luxuries.

The Right to Live is the most fundamental of all rights. Let us not mess with this at any cost.