Funding modern, low-cost Indian healthcare infrastructure
KV Prasad Jun 13, 2022, 06:35 AM IST (Published)
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Summary
Much of our economic slowdown and the impact on the public morale due to Covid is a hard reality. We need to get the economy into revival mode and also as a conscientious nation, we must spend in building health care infrastructure with a vengeance.
The Indian Healthcare sector has challenges of inadequate distribution of healthcare service providers and the need for low-cost (and yet impactful) healthcare solutions for increasing diseases (especially chronic ones).
India has a doctor-to-patient ratio of 1:10,189—much lower than the 1:1,000 recommended by the World Health Organization (WHO). India also has a huge shortage of doctors, nurses and paramedics. Estimates indicate that we need 10 lakh new doctors to relieve the burden in the medical fraternity. Obviously, this challenge cannot be addressed in one year. An increase in the number of seats in the existing medical colleges can help meet the demands of skilled doctors, but parallelly, we need to prepare a pool of qualified teaching staff for running the new medical colleges and providing quality medical education.
India’s hospital bed density is less than half the global average of three hospital beds per 1,000 people — implying that an estimated 2.2 million beds will be required over the next 15 years. Average Life expectancy is also expected to exceed 70 years by 2022 and hence more healthcare services required. Enough public data and research studies are available to showcase the dangers that nearly 1/3rd of the Indian population could be prone to Obesity & Diabetes (O&D) in the years to come.
Non-Communicable Diseases (NCDs) have emerged as one of the largest contributors of death in India, accounting for 15 percent of the global NCD deaths and 60 percent of total deaths in India. NCD prevention is most effective when it works at the origin of the problem and if the intervention starts right at its beginning. Taking timely action is important to reduce premature mortality related to NCDs by a third by 2030—which is a sustainable development goal (SDG) that India has signed up for!
To solve all these, we need to create high-quality health centres and hospitals in rural areas. That’s the only way to decongest Urban medical centres. Having quality healthcare infrastructure would encourage doctors to practice outside the big cities. After all, the rural population accounts for more than 63 percent of the total population.
How to fund this growth?
In a COVID-19 world where every nation has been impacted, global corporate majors and investors would want to look at future opportunities. So the private sector investment would come in, where there is a promise of the safety of investments and opening up of the sector to private business management.
As India starts rebuilding its economy post-coronavirus, it would need a massive outlay of capital for long-term infrastructure projects. However, health care would also need governmental spending to go along with those private investments.
The current fiscal situation would not permit us that luxury. In the same breath, we need to be prudent about global borrowing programs. Where would India generate that from? After all, we cannot create a larger debt pile for our future generations.
Let’s take a leaf from the suggestion for an “Elephant bond” recommended by a High-Level Advisory Group (HLAG) set up by the Minister of Commerce in 2019, and tweak it for better outcomes for all stakeholders.
“Healthy India 2034 fund”
- Idea: Open an amnesty scheme to declare undisclosed income/wealth. Open a window for 3 months for Indians to declare any undisclosed income/wealth (currently lying in any securities form, anywhere globally) without fear of prosecution.
- Collect 20 percent of the declared amount as tax to be deducted at source (or call it “amnesty-tax”)
- Allow the declarer to hold 30 percent as legal tender with themselves.
- The declarer has to compulsorily deposit the balance 50 percent with GoI into a “Healthy India 2034 fund” with a 12-year lock-in. (In today’s covid-hit fragile human sentiments, having seen deaths in families and societies, longer tenure lock-in of investments will not act as an incentive!).
- The interest rate on the investment bond can be a “reverse-repo” rate. The interest earned on such bonds can be credited (post TDS) to the depositors’ account annually or once every 3 years. It also increases the income-tax revenues on this base for the subsequent 12 years.
At present, the Indian Government faces a weighted average borrowing cost of close to 8 percent. Such an amnesty scheme, if successfully done, could bring down the cost of government borrowings to reduce the overall interest burden.
In a black swan event like the COVID-19 pandemic, we need to be open to all ideas to ensure the ability to develop the national infrastructure and to fund it self-sufficiently! After all, we cannot have our healthcare development goal as a sine-die situation.
This is not the time to worry if such an “amnesty” scheme will upset the optics of the “politics & morality” in the run-up to 2024 national elections. Use the perceived “sinned” funds for developing the global-best grassroots healthcare system by 2034. Healthcare funding could well be Hobson’s choice!
—Srinath Sridharan is an independent markets commentator, startup mentor and CEO coach. The views expressed are personal
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