It’s a fact that sticks out starkly: 10.6% of the total amount in the Interim Budget is allocated to defence, while only 2.2.% is allocated to healthcare. Funding need not be redirected from current allocations to preventive care, but surely India can make health spending a priority, much like defence? Despite several innovations in the healthcare sector in recent times, in line with India’s relentless pursuit of reforms, the government remains woefully short of its ambition to increase public health spending to 2.5% of GDP. At present, health spending is only 1.15-1.5% of GDP.

Per capita spending on health

While the Interim Budget is responsive to the needs of farmers and the middle class, it does not adequately respond to the needs of the health sector. The total allocation to healthcare is ₹61,398 crore. While this is an increase of ₹7,000 crore from the previous Budget, there is no net increase since the total amount is 2.2% of the Budget, the same as the previous Budget. The increase roughly equates the ₹6,400 crore allocated for implementation of the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PMJAY).

According to the National Health Profile of 2018, public per capita expenditure on health increased from ₹621 in 2009-10 to ₹1,112 in 2015-16. These are the latest official numbers available, although in 2018 the amount may have risen to about ₹1,500. This amounts to about $20, or about $100 when adjusted for purchasing power parity. Despite the doubling of per capita expenditure on health over six years, the figure is still abysmal.

To understand why, let’s compare this with other countries. The U.S. spends $10,224 per capita on healthcare per year (2017 data). A comparison between two large democracies is telling: the U.S.’s health expenditure is 18% of GDP, while India’s is still under 1.5%. In Budget terms, of the U.S. Federal Budget of $4.4 trillion, spending on Medicare and Medicaid amount to $1.04 trillion, which is 23.5% of the Budget. Federal Budget spending per capita on health in the U.S. is therefore $3,150 ($1.04 trillion/ 330 million, the population).

Professor (Dr.) T. S. Ravikumar Sir, President AIIMS Mangalagiri introduced the concept of ‘Research’ to the AIIMS first batch of MBBS students on 19th December 2018. The students understood the need for doing research in medical field. Sir taught the concept of Observational and Interventional research, Translational research, public health research, outcomes research. The students learnt that Randomised controlled trial (RCT) are the most rigorous way of testing a new drug or a new interventional procedure. The students learnt the concept of ‘placebo’ and ‘blinding’ in a RCT. Sir has instilled in the young minds the concept of ‘Altruism’ in research. In ‘Altruism’ a human being is voluntarily willing to participate in a clinical trial for the larger benefit of others even though there is no direct benefit to the participant of a clinical trial.

‘T’ shape in research

Sir gave his own example of how he did research and developed novel surgical procedures and therapies to operate on liver metastases cases and thereby prolong life of patients in advanced stages of cancer. The undergraduate students learnt the concept of ‘T’ shape in research wherein the horizontal line represents the expertise and knowledge of the researcher in his or her respective field. The vertical line of letter ‘T’ resembles the depth of research which every student should strive in his or her life and achieve it. Sir encouraged all the students to develop their own research projects right from their undergraduate days.

Our students were really privileged to learn from an exceptional Professor (Dr.) T. S. Ravikumar Sir.

He articulated the concept that , even though every student will not become a researcher, every student must get a thorough grounding in research ,such that he/ she will develop “critical thinking” that will make him/ her a superb clinician. The steps in conducting good research involves developing a hypothesis, catalogue all background information, set up methods to carry out hypothesis testing, analyse the data, and arrive at conclusion , ensuring limitations ( if any)of the research thus conducted. Good clinical practice mirrors these steps: using history / physical examination to develop a preliminary diagnosis, order tests and consultations to support diagnosis / eliminate other possibilities, put together all information to render final diagnosis and treatment plan , and be aware of complications and adverse events in order to avoid/ mitigate. Therefore, a good research training makes the clinician an astute and critical thinker.