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Recently, the Parliament passed a law that addresses the issue of sexual harassment in the work place. The Bill, introduced in the Lok Sabha on December 7, 2010, drew on the 1997 judgment of the Supreme Court (known as the Vishaka judgment) to codify measures that employers need to take to address sexual harassment at the work place. (See PRS analysis of the Bill here). The Bill was first passed in the Lok Sabha on September 3, 2011. It incorporated many of the amendments recommended by the Standing Committee on Human Resource Development that examined the Bill. The Rajya Sabha passed it on February 27, 2013 without any new amendments (see Bill as passed by Parliament). We compare the key provisions of the Bill, the Standing Committee recommendations and the Bill that was passed by Parliament (for a detailed comparison, see here).
| Bill as introduced | Standing Committee recommendations | Bill as passed by Parliament |
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Clause 2: Status of domestic workers |
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| Excludes domestic workers from the protection of the Bill. | The definition should include (i) domestic workers; and (ii) situations involving ‘victimization’; | Includes domestic worker. Does not include victimisation. |
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Clause 4: Constitution of Internal Complaints Committee (ICC) |
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| The committee shall include 4 members: a senior woman employee, two or more employees and one member from an NGO committed to the cause of women. | The strength of ICC should be increased from 4 to at least 5 (or an odd number) to facilitate decisions in cases where the bench is divided. | Disqualifies a member if (a) he has been convicted of an offence or an inquiry is pending against him or (b) he is found guilty in disciplinary proceedings or a disciplinary proceeding is pending against him. |
| Members may not engage in any paid employment outside the office. | Barring paid employment outside the office goes against NGO members who may be employed elsewhere. This clause must be edited. | Deletes the provision that disallows NGO members to engage in paid employment outside. NGO members to be paid fees or allowances. |
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Clause 6: Constitution and jurisdiction of Local Complaints Committee (LCC) |
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| An LCC is required to be constituted in every district and additional LLCs at block level. At the block level the additional LCC will address complaints where the complainant does not have recourse to an ICC or where the complaint is against the employer. | The functions of the district level and the block level LCCs are not delineated clearly. It is also unclear whether the block level LCCs are temporary committees constituted for dealing with specific cases. Instead of creating additional LCCs at the block level, the District level LCC may be allowed to handle cases. A local member from the block may be co-opted as a member to aid the LCC in its task. | Accepted. |
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Clause 10: Conciliation |
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| The ICC/ LCC shall provide for conciliation if requested by the complainant. Otherwise, it shall initiate an inquiry. | Distinction should be made between minor and major offences. Conciliation should be allowed only for minor offences. | Adds a proviso that monetary settlement shall not be the basis on which conciliation is made. |
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Clause 11: Inquiry into Complaint |
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| ICC/LCC shall proceed to make inquiry into a complaint in such manner as may be prescribed. | No suggestion. | Inquiries will be conducted in accordance with service rules or in such manner as may be prescribed.For domestic workers, the LCC shall forward the complaint to the police within seven days if a prima facie case exists. The case shall be registered under section 509 of Indian Penal Code (word, gesture or act intended to insult the modesty of a woman). |
| Sources: The Protection of Women Against Sexual Harassment at Work Place Bill, 2010; the Standing Committee on HRD Report on the Bill; the Sexual Harassment at Work Place (Prevention, Prohibition and Redressal) Bill, 2012; PRS. | ||
The Union Cabinet recently approved the launch of the National Health Protection Mission which was announced during Budget 2018-19. The Mission aims to provide a cover of five lakh rupees per family per year to about 10.7 crore families belonging to poor and vulnerable population. The insurance coverage is targeted for hospitalisation at the secondary and tertiary health care levels. This post explains the healthcare financing scenario in India, which is distributed across the centre, states, and individuals.
How much does India spend on health care financing vis-à-vis other countries?
The public health expenditure in India (total of centre and state governments) has remained constant at approximately 1.3% of the GDP between 2008 and 2015, and increased marginally to 1.4% in 2016-17. This is less than the world average of 6%. Note that the National Health Policy, 2017 proposes to increase this to 2.5% of GDP by 2025.
Including the private sector, the total health expenditure as a percentage of GDP is estimated at 3.9%. Out of the total expenditure, effectively about one-third (30%) is contributed by the public sector. This contribution is low as compared to other developing and developed countries. Examples include Brazil (46%), China (56%), Indonesia (39%), USA (48%), and UK (83%) (see Figure 1).
Who pays for healthcare in India? Mostly, it is the consumer out of his own pocket.
Given the public-private split of health care expenditure, it is quite clear that it is the private expenditure which dominates i.e. the individual consumer who bears the cost of her own healthcare. Let’s look at a further disaggregation of public spending and private spending to understand this.
In 2018-19, the Ministry of Health and Family Welfare received an allocation of Rs 54,600 crore(an increase of 2% over 2017-18). The National Health Mission (NHM) received the highest allocation at Rs 30,130 crore and constitutes 55% of the total Ministry allocation (see Table 1). Despite a higher allocation, NHM has seen a decline in the allocation vis-à-vis 2017-18.
Interestingly, in 2017-18, expenditure on NHM is expected to be Rs 4,000 crore more than what had been estimated earlier. This may indicate a greater capacity to spend than what was earlier allocated. A similar trend is exhibited at the overall Ministry level where the utilisation of the allocated funds has been over 100% in the last three years.
State level spending
A NITI Aayog report (2017) noted that low income states with low revenue capacity spend significant lower on social services like health. Further, differences in the cost of delivering health services have contributed to health disparities among and within states.
Following the 14th Finance Commission recommendations, there has been an increase in the states’ share in central pool of taxes and they were given greater autonomy and flexibility to spend according to their priorities. Despite the enhanced share of states in central taxes, the increase in health budgets by some states has been marginal (see Figure 2).
Consumer level spending
If cumulatively 30% of the total health expenditure is incurred by the public sector, the rest of the health expenditure, i.e. approximately 70% is borne by consumers. Household health expenditures include out of pocket expenditures (95%) and insurance (5%). Out of pocket expenditure dominate and these are the payments made directly by individuals at the point of services which are not covered under any financial protection scheme. The highest percentage of out of pocket health expenditure (52%) is made towards medicines (see Figure 3).
This is followed by private hospitals (22%), medical and diagnostic labs (10%), and patient transportation, and emergency rescue (6%). Out of pocket expenditure is typically financed by household revenues (71%) (see Figure 4).
Note that 86% of rural population and 82% of urban population are not covered under any scheme of health expenditure support. Due to high out of pocket healthcare expenditure, about 7% population is pushed below the poverty threshold every year.
Out of the total number of persons covered under health insurance in India, three-fourths are covered under government sponsored health schemes and the balance one-fourth are covered by private insurers. With respect to the government sponsored health insurance, more claims have been made in comparison to the premiums collected, i.e., the returns to the government have been negative.
It is in this context that the newly proposed National Health Protection Mission will be implemented. First, the scheme seeks to provide coverage for hospitalisation at the secondary and tertiary levels of healthcare. The High Level Expert Group set up by the Planning Commission (2011) recommended that the focus of healthcare provision in the country should be towards providing primary health care. It observed that focus on prevention and early management of health problems can reduce the need for complicated specialist care provided at the tertiary level. Note that depending on the level of care required, health institutions in India are broadly classified into three types: primary care (provided at primary health centres), secondary care (provided at district hospitals), and tertiary care institutions (provided at specialised hospitals like AIIMS).
Second, the focus of the Mission seems to be on hospitalisation (including pre and post hospitalisation charges). However, most of the out of the pocket expenditure made by consumers is actually on buying medicines (52%) as seen in Figure 3. Further, these purchases are mostly made for patients who do not need hospitalisation.
