By Chakshu Rai and Anirudh Burman What is the difference between a JPC and a PAC? A structured committee system was introduced in 1993 to provide for greater scrutiny of government functioning by Parliament. Most committees of Parliament include MPs from both the Lok Sabha and Rajya Sabha. A Joint Parliamentary Committee (JPC) is an ad-hoc body. It is set up for a specific object and duration. Joint committees are set up by a motion passed in one house of Parliament and agreed to by the other. The details regarding membership and subjects are also decided by Parliament. For example, the motion to constitute a JPC on the stock market scam (2001) and pesticide residues in soft drinks (2003) was moved by the government in the Lok Sabha. The motion on the stock market scam constituted a JPC of 30 members of which 20 were from the Lok Sabha and 10 were from the Rajya Sabha. The motion to constitute the JPC on pesticides included 10 members from the Lok Sabha and 5 from the Rajya Sabha. The terms of reference for the JPC on the stock market scam asked the committee to look into financial irregularities, to fix responsibility on persons and institutions for the scam, to identify regulatory loopholes and also to make suitable recommendations. The Public Accounts Committee (PAC), however, is constituted every year. Its main duty is to ascertain how the money granted (budget) by Parliament has been spent by the government. The PAC scrutinises the accounts of the government on the basis of CAG reports. The composition and functions of the committee are governed by parliamentary procedures. The PAC can consist of 15 to 22 members. Not more than 15 members can be from the Lok Sabha, and the representation from the Rajya Sabha cannot exceed 7 members. A minister cannot be a member of the PAC. What can a JPC do that a PAC cannot? The PAC examines cases involving losses and financial irregularities. Its examination is usually limited to the scrutiny of CAG reports and issues raised by the reports. The committee expresses no opinion on points of general policy, but it is within PAC’s jurisdiction to point out whether there has been waste in carrying out that policy. The mandate of a JPC depends on the motion constituting it. This need not be limited to the scrutiny of government finances. How many JPCs have we had so far? Although a number of joint committees have been formed since Independence, four major JPCs have been formed to investigate significant issues that have caused controversy. These are: (1) Joint Committee on Bofors Contracts; (2) Joint Committee to enquire into irregularities in securities and banking transactions; (3) Joint Committee on stock-market scam; and (4) Joint Committee on pesticide residues in and safety standards for soft drinks. How effective have JPCs been? Is the government bound by their recommendations? JPC recommendations have persuasive value but the committee cannot force the government to take any action on the basis of its report. The government may decide to launch fresh investigations on the basis of a JPC report. However, the discretion to do so rests entirely with the government. The government is required to report on the follow-up action taken on the basis of the recommendations of the JPC and other committees. The committees then submit ‘Action Taken Reports’ in Parliament on the basis of the government’s reply. These reports can be discussed in Parliament and the government can be questioned on the basis of the same. How effective is the PAC process? Between 2005 and 2010, the PAC has prepared 54 reports and examined ministries that have cumulatively received around 80% of the budgetary allocations in the last five financial years. Since it is not possible to examine every CAG audit finding in a formal manner, ministries have to submit Action Taken Notes to the PAC on all audit paragraphs. A 2009-10 report of the PAC, however, noted that there were 4,934 audit paragraphs still pending with various ministries. What can the JPC or the PAC find in the 2G case that is not already known, that the CAG and the Trai have not already said? The JPC or the PAC can only look at the documents and examine ministry officials who testify before the committee. The parliamentary committees can arrive at independent conclusions based on the documents placed before them. Members of the committee can also place dissent notes if they do not agree with the majority. Can Raja be tried and the telecom licences cancelled on basis of a JPC report or do we need a CBI report as well? Prosecution of individuals and cancellation of licences are executive functions and can only be initiated by the government. A JPC report can recommend the prosecution of a particular person or the cancellation of certain licences. However, the government can disagree with the JPC’s findings and refuse to take such action. How much of Parliament time have we lost already and how many critical Bills are stuck? The Lok Sabha and Rajya Sabha are supposed to work daily for six hours and five hours, respectively. The Lok Sabha has worked for five hours and forty five minutes and Rajya Sabha has worked for an hour and twenty five minutes in the past 12 days. Some important Bills that are listed for consideration and passing in Parliament are the Seeds Bill, 2004; the Commercial Division of High Courts Bill, 2009; and the Amendment to the Right to Education Act, 2010. Bills listed for introduction include the National Identification Authority Bill, 2010; the Protection of Women from Sexual Harassment in Workplace Bill, 2010; the Judicial Standards and Accountability Bill, 2010; Land Acquisition (Amendment) Bill; and the Rehabilitation and Resettlement Bill. This article appeared in Financial Express.
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.
