Indian Medical Association submits suggestions to Government of India for consideration

INDIAN MEDICAL ASSOCIATION (HQs.)
(Registered under the Societies Act XXI of 1860)
Mutually Affiliated with the British & Nepal Medical Associations
I.M.A. House, Indraprastha Marg, New Delhi-110 002
Telephones: +91-11-2337 0009 (10 lines), 23378680 / +91-9999116375, 9999116376, Fax: +91-11-23379470
Website: http://www.ima-india.org ; Email: hsg@ima-india.org
National President
Dr. Sharad Kr. Agarwal
+91-9717111942 np@ima-india.org
Immediate Past National President
Dr. Sahajanand Pd. Singh
+91-9334118698 sahajsurgery.phulwarisharif@gmail.com
Honorary Secretary General
Dr. Anilkumar J. Nayak
+91-9825051333 draniljnayak@yahoo.co.in
Honorary Finance Secretary
Dr. Shitij Bali
+91-9910755660 shitij.bali@yahoo.com
IMA/NP/2023/ 25/01/2023 New Delhi
Dear Sir/Madam,
Sub: Union Budget 2023-24: Indian Medical Association submits suggestions to Government of India for consideration
Indian Medical Association is a significant contributor to the country’s healthcare. In past 2 years, IMA contributed to India’s healthcare issues amidst of pandemic in proactive way.
Honourable Prime Minister Shri Narendra Modi has identified “Healthcare” as one of an important pillar of the People. The Indian healthcare sector is a key pillar of healthcare tourism.
There is no doubt that government’s vision of healthcare will be well supported by the Indian Medical Association. Timely studious contributions by IMA has established that it is countrywide universal representation of the healthcare sector. Need for augmentation and further percolation of healthcare to interiors makes a strong case for encouraging the investments in the healthcare sector through pragmatic incentives. Pandemic proved the IMA demands beyond doubt. The pandemic has dealt a severe strain and blow to the healthcare sector. Government’s support is crucial to propagate the much-needed basic right at a faster pace. This can be achieved through various means which are being suggested by Indian Medical Association. Rationalization of taxes and tax rates, GST, policy professional Interventions, practical solutions are must for ease of doing business. It is against this background that Indian Medical Association has submitted its suggestions proposed to be considered by the Government in Union Budget 2023-24.
The Association requests that the important suggestions be well though by the Ministry officials. We are hopeful that this year’s budget will include some favorable policy announcements that will not only aid a speedy recovery of the healthcare sector but also promote the long-pending growth and development of it.
Dr. Sharad Kumar Agarwal Dr. Anilkumar J. Nayak National President, IMA Honorary Secretary General, IMA
“One for All – All for One” …. a cohesive, collective, enhance, communicative approach to break all sectorial walls and bring all clinicians at one platform to help in building a Healthy Nation

Universal Health Care
Vision of UHC transcends the narrow, inadequate and often inequitable view of UHC as merely a system of Health insurance. UHC moves beyond ‘insurance’. The UHC is linked firmly to the Right to Health and converts an aspirational goal into an entitled provision.
For such a vision of the UHC to be realized, a tax-based system of Health financing is essential. This is also the global experience, wherein countries which have introduced UHC have mostly depended on general revenues rather than on unsteady streams of contributory Health insurance which offer incomplete coverage and restricted services.
Every citizen should be entitled to essential primary, secondary and tertiary health care services that will be guaranteed by the Central government. Citizens should be free to supplement free-of-cost services (both in-patient and out-patient care) offered under the UHC system by paying out-of-pocket or directly purchasing additional private voluntary medical insurance from regulated insurance companies.
IMA demands universal Health care with strong Public Sector investment and strategic purchase from Private Sector by the Government.
“One for All – All for One” …. a cohesive, collective, enhance, communicative approach to break all sectorial walls and bring all clinicians at one platform to help in building a Healthy Nation INDIAN MEDICAL ASSOCIATION (HQs.)
(Registered under the Societies Act XXI of 1860)
Mutually Affiliated with the British & Nepal Medical Associations
I.M.A. House, Indraprastha Marg, New Delhi-110 002
Telephones: +91-11-2337 0009 (10 lines), 23378680 / +91-9999116375, 9999116376, Fax: +91-11-23379470
Website: http://www.ima-india.org ; Email: hsg@ima-india.org
National President
Dr. Sharad Kr. Agarwal
+91-9717111942 np@ima-india.org
Immediate Past National President
Dr. Sahajanand Pd. Singh
+91-9334118698 sahajsurgery.phulwarisharif@gmail.com
Honorary Secretary General
Dr. Anilkumar J. Nayak
+91-9825051333 draniljnayak@yahoo.co.in
Honorary Finance Secretary
Dr. Shitij Bali
+91-9910755660 shitij.bali@yahoo.com
Invest in Health
Health policy 2017 promised GDP in healthcare of 2.5% by 2025. But the increase for healthcare has been negligible and still hovers around 1.1% of GDP. Of the healthcare expenditure of 89,000 Cr for last year, a major chunk of 83,000 Cr is revenue expenditure. Capital expenditure is only 5630 Cr. Substantial increase in capital expenditure is required in the proposed budget to make a meaningful change. For equitable distribution of health and attaining Universal Health care, more infrastructure and facilities need to be added. With 650 medical colleges and 99063 MBBS doctors in one year India is number one in medical education. It is time to pause and take a call on quality and sub specialization. More nursing colleges paramedical institutions and skill courses are needed. One PHC with 24×7 services should be available for every 15,000 population instead of one PHCs servicing 30,000 population for few hours in a day. More FRUs and CHCs have to be established. PMABHIM had announced spending 64,180 Cr for building infrastructure, but the allocation for the last two years taken together was only 8000 Cr. Suitably increased allotment is required.

India being a signatory for the Sustainable Development Goals to be achieved by 2030 will have to allocate more resources for the same in the health sector.
In 2022 only 37000 Crores was allocated for NHM. More allocation of funds to NHM can improve the infrastructure, Human Resources, Preventive and curative services in the States.
Human Resources development for Health and Medical Education was allocated 7500 Crores in 2022 which was not enough. There is still a huge shortage of qualified and trained Health care staff.

Prioritise – Primary care
The Covid crisis has amply demonstrated the importance of universal primary care in Public Sector. Health Policy 2017 firmly focuses on primary care: If possible, the Government should upgrade and enhance these figures and appoint MBBS doctors in the 1,50,000 wellness centers. The policy recommends that health centres be established on geographical norms apart from population norms. This would also necessitate upgradation of the existing sub-centres and reorienting PHCs.
AB-PMJAY

Funds of AB PMJAY should be used exclusively for the private sector for strategic purchase and to create a retainer system and not for critical gap funding of Government hospitals.
Deficit funding is the most important cause of lack of penetration of AB PMJY. If the funding has to be raised to at least CGHS level, then money required is around 1,60,000 crores. The money being provided now is around 12,000
“One for All – All for One” …. a cohesive, collective, enhance, communicative approach to break all sectorial walls and bring all clinicians at one platform to help in building a Healthy Nation INDIAN MEDICAL ASSOCIATION (HQs.)
(Registered under the Societies Act XXI of 1860)
Mutually Affiliated with the British & Nepal Medical Associations
I.M.A. House, Indraprastha Marg, New Delhi-110 002
Telephones: +91-11-2337 0009 (10 lines), 23378680 / +91-9999116375, 9999116376, Fax: +91-11-23379470
Website: http://www.ima-india.org ; Email: hsg@ima-india.org
National President
Dr. Sharad Kr. Agarwal
+91-9717111942 np@ima-india.org
Immediate Past National President
Dr. Sahajanand Pd. Singh
+91-9334118698 sahajsurgery.phulwarisharif@gmail.com
Honorary Secretary General
Dr. Anilkumar J. Nayak
+91-9825051333 draniljnayak@yahoo.co.in
Honorary Finance Secretary
Dr. Shitij Bali
+91-9910755660 shitij.bali@yahoo.com
crores. It is not possible to deficit finance to this level. Insufficient fund allotment is the root cause of unrealistically low package rates.
AB PMJAY should remove the unjust exclusion criteria for procedures
imposed on private hospitals.

GST and other Taxes for Healthcare Services:
a. Healthcare industry is the only industry which does not get input credit because of exemption. Actually, the GST paid by the institutions become expenditure and indirectly add to the cost of treatment. Either some percentage of total GST paid by healthcare providers be treated as advance tax or MAT (Minimum Alternative Tax) or the GST paid by them on equipment or otherwise should be reduced to 5%.
b. The Government should conceive zero rate GST on healthcare services, allowing service providers to claim Input Tax Credit. As GST is not payable on healthcare services, service providers are not eligible for input tax credit. Enabling this would ensure that input taxes are not added into the cost of the services and will provide some relief to the patients.
c. Income tax and TDS may be waived on money received from Government schemes like Aayushman Bharat and other state schemes since the pricing of the schemes is less than the cost incurred.
47th GST Council meeting has recommended that,
d. “Like CTEPs, common bio-medical waste treatment facilities for treatment or disposal of biomedical waste shall be taxed at 12% so as to allow them ITC.” This was earlier in the GST exempted category.
e. “Room rent, excluding ICU, exceeding Rs 5,000/- per day per patient charged by the hospital will also be taxed at 5% GST, without ITC.” This was earlier in the GST exempted category.
f. Exemption of social security schemes and other family welfare schemes of doctors from the ambit of GST may be considered.
g. Withdraw GST on CMEs and skill training which is a disincentive on nation building.
h. Apart from this, the healthcare sector is burdened with embedded taxes for various goods and services. It will be in fitness of things to keep healthcare away from GST. Application of GST will push healthcare towards a business model and away from being a service centric one. The burden will be on poor people.
i. Post graduate medical students receiving stipend during the course may be exempted from income tax.
j. Tax incentives may be provided to doctors working in government hospitals and private doctors establishing a practice in aspirational districts.
“One for All – All for One” …. a cohesive, collective, enhance, communicative approach to break all sectorial walls and bring all clinicians at one platform to help in building a Healthy Nation INDIAN MEDICAL ASSOCIATION (HQs.)
(Registered under the Societies Act XXI of 1860)
Mutually Affiliated with the British & Nepal Medical Associations
I.M.A. House, Indraprastha Marg, New Delhi-110 002
Telephones: +91-11-2337 0009 (10 lines), 23378680 / +91-9999116375, 9999116376, Fax: +91-11-23379470
Website: http://www.ima-india.org ; Email: hsg@ima-india.org
National President
Dr. Sharad Kr. Agarwal
+91-9717111942 np@ima-india.org
Immediate Past National President
Dr. Sahajanand Pd. Singh
+91-9334118698 sahajsurgery.phulwarisharif@gmail.com
Honorary Secretary General
Dr. Anilkumar J. Nayak
+91-9825051333 draniljnayak@yahoo.co.in
Honorary Finance Secretary
Dr. Shitij Bali
+91-9910755660 shitij.bali@yahoo.com
k. Increasing the limit of exemption for Mediclaim in tax returns from Rs 25000 to upto Rs 50000 per year for individuals and Rs 100000 for dependent parents.
Covid Martyrs and Social Security:
Country lost more than 2000 doctors during the pandemic. Unfortunately, the majority of the families of deceased doctors did not receive any help other than from whatever little IMA could marshal. A special welfare fund for doctors in general and for Covid martyrs in particular has to be set up. The nation owes atleast this gesture to the medical community.
Working capital and preferential funding

Doctors and Healthcare organizations be given access to working capital and preferential funding to ensure that the overall cost of operations is reduced
Special schemes that should be provided for formal training of doctors and
nurses to enhance skills and bandwidth to offer care to a larger population
which will help strengthen the quality of healthcare resources in the longer run.
Building capacity for intensive medical and surgical care by enhancing skills of
nurses and by providing better equipment and infrastructure.
Benefits to be given to manufacturers of healthcare equipment and
consumables under the ‘Make in India’ campaign.

Elderly care
Currently, India has the youngest workforce but with dropping fertility rates and increasing lifespan, a surge in the elderly population and health care expenses has been projected. A national level comprehensive elderly care program with geriatric clinics, day care centres, home care facilities, training and accreditation for caregivers and supply of geriatric aids has to be envisioned.
Migrant workers
Indian society and its national government as well as various State Governments need to understand and address problems of vulnerable interstate migrant workers who are seen across both rural and urban areas in India. The majority of migrant workers are unskilled and employed in unorganized sectors. AB-PMJY with its portability is supposed to take care of the health needs of migrant workers. Special fund allocation to cater to the health needs of migrant workers is urgently required.
Indian Medical Services
The Indian Medical Service which served India, so well almost for last 300 years was abolished in 1947. The COVID pandemic has exposed the vulnerability of the healthcare system. It has also brought to fore the grave paucity of professionalism in health management right from the Sub-District Office level. There is an acute need
“One for All – All for One” …. a cohesive, collective, enhance, communicative approach to break all sectorial walls and bring all clinicians at one platform to help in building a Healthy Nation INDIAN MEDICAL ASSOCIATION (HQs.)
(Registered under the Societies Act XXI of 1860)
Mutually Affiliated with the British & Nepal Medical Associations
I.M.A. House, Indraprastha Marg, New Delhi-110 002
Telephones: +91-11-2337 0009 (10 lines), 23378680 / +91-9999116375, 9999116376, Fax: +91-11-23379470
Website: http://www.ima-india.org ; Email: hsg@ima-india.org
National President
Dr. Sharad Kr. Agarwal
+91-9717111942 np@ima-india.org
Immediate Past National President
Dr. Sahajanand Pd. Singh
+91-9334118698 sahajsurgery.phulwarisharif@gmail.com
Honorary Secretary General
Dr. Anilkumar J. Nayak
+91-9825051333 draniljnayak@yahoo.co.in
Honorary Finance Secretary
Dr. Shitij Bali
+91-9910755660 shitij.bali@yahoo.com
for a drastic but holistic change in the health administration of the country by creating a specialized cadre of health administrators who would be holding the administrative responsibilities. The structure of the Indian Medical Services would be in the form of a cadre specialized in character for the dispensation of healthcare services including those in the domain of public health excluding the domain of medical education in its entirety as All India Civil Services emanating out of All India Services Act, 1951.
Protecting the middle sector
India has the unique middle sector in Health care delivery. There are large number of small hospitals and nursing homes run by doctors. They remain available and accessible. This middle sector is in between the corporate for profit and the Government hospitals.
Average Medical Expenditure per treated ailment by healthcare service providers
Sector
Rural Urban All
325 1081 344 1038 331 1062
624 566 863 714 732 624
487 592 1035 710 552 636
Government / Public Hospital
Private Hospital
Trust / NGO Run Hospital
Private Doctors/ Clinic
Informal Healthcare Providers
All
Further, as per the above-mentioned report, more than 44% of the Indian population prefers Private Doctors / Clinic / Nursing homes for their medical treatment. The average medical expenditure per treated ailment is low. Protecting this middle sector with encouragement of doctor entrepreneurs is an urgent task and has to be carried out on war footing.
IMA submits its view points to Government of India for consideration during the eve of Union Budget.
Dr. Sharad Kumar Agarwal Dr. Anilkumar J. Nayak National President, IMA Honorary Secretary General, IMA
“One for All – All for One” …. a cohesive, collective, enhance, communicative approach to break all sectorial walls and bring all clinicians at one platform to help in building a Healthy Nation
source: http://www.mospi.gov.in