Twelfth Five Year Plan (India)

The Twelfth Five Year plan for health services in India covering 2012-2017 was formulated based on the recommendation of a High Level Experts Group (HLEG) and other stakeholder consultations. The long term objective of this strategy is to establish a system of Universal Health Coverage (UHC) in the country. Key points include:
Criticism.
The High Level Expert Group report recommends an increase in public expenditure on health from 1.58 per cent of GDP currently to 2.1 per cent of GDP by the end of the 12th five-year plan. However, even this is far lower than the global median of 5 per cent. The lack of extensive and adequately funded public health services pushes large numbers of people to incur heavy out of pocket expenditures on services purchased from the private sector. Out of pocket expenditures arise even in public sector hospitals, since lack of medicines means that patients have to buy them. This results in a very high financial burden on families in case of severe illness. Though, the 12th plan document express concern over high out-of-pocket (OOP) expenditure, it does not give any target or time frame for reducing this expense . OOP can be reduced only by increasing public expenditure on health and by setting up widespread public health service providers. But the planning commission is planning to do this by regulating private health care providers. It takes solace from the HLEG report which admits that, "the transformation of India’s health system to become an effective platform for UHC is an evolutionary process that will span several years".
Instead of developing a better public health system with enhanced health budget, 12th five-year plan document plans to hand over health care system to private institutions. The 12th plan document causes concern over Rashtriya Swasthya Bhima Yojana being used as a medium to hand over public funds to the private sector through an insurance route. This has also incentivised unnecessary treatment which in due course will increase costs and premiums. There have been complaints about high transaction cost for this scheme due to insurance intermediaries. RSBY does not take into consideration state specific variation in disease profiles and health needs. Even though these things are acknowledged in the report, no alternative remedy is given. There is no reference to nutrition as key component of health and for universal Public Distribution System (PDS) in the plan document or HLEG recommendation. In the section of National Rural Health Mission (NRHM) in the document, the commitment to provide 30- to 50-bed Community Health Centres (CHC) per 100 000 population is missing from the main text. It was easy for the government to recruit poor women as ASHA (Accredited Social Health Activist) workers but it has failed to bring doctors, nurses and specialist in this area. The ASHA workers who are coming from a poor background are given incentive based on performance. These people lose many days job undertaking their task as ASHA worker which is not incentivised properly. Even the 12th plan doesn't give any solace. To summarize, successive administrative and political reforms have conveniently bypassed training citizens and local bodies to actively participate in healthcare. In a situation where people are not enabled to identify poor quality, speak up and debate. There is dire need for the health system to fill that role on behalf of the people and can be easily done by decentralization of healthcare governance.
A recent study pointed out that access to advanced medical facilities under a single roof was the main reason for the choice of private hospitals in both rural and urban areas. The second major reason for private healthcare preference was proximity of the facility in the rural area and approachability and friendly conduct of doctors and staff in the urban centers.