Industry opens bag of expectations from Union Budget 2020-21 – BSI bureau

The Union Budget for 2020-21 is all set to be presented on Saturday, February 1, 2020.

What is likely to be announced and what not will be answered soon. Nevertheless, the industry is ready with its bag of expectations.

BioSpectrum brings to you the industry expectations from the Union Budget 2020-21-

“Clear central government guidelines to enable Public Private Partnership in the diagnostics segment to realise the vision of quality advanced diagnostics at affordable cost with accountability and better clinical outcomes

Higher allotment for health sector to help schemes like Ayushman Bharat to reach larger section of population with measurable outcome

Investment in Diagnostics Services sector in tier 2 & 3 towns to get similar tax breaks & subsidies like hospitals

To avoid any ambiguities in GST in health sector including diagnostics services segment

Tax free spending limits for annual preventive HealthCheck to be enhanced to promote preventive medicine and wellness focused health care initiatives”

 G. S. K. VELU, Chairman & Managing Director, Neuberg Diagnostics, Chennai

“With about 80% of the medical workforce in 10 cities serving only 28% of the total population, access to quality healthcare is still an aspiration for many. India will double the number of smartphones by 2023. The mHealth market is growing rapidly at a CAGR >42%. Policies and budgets towards adoption of clinically validated mHealth will help address last mile access challenges, improve quality of care and reduce costs.

Combating inflation and currency depreciation, requires exports to be a backbone of the economy. Entire industries and job markets in India come from exports, like the IT sector that draws 75% of its revenues from exports and constitutes 6.7% of India’s exports market. Affordable, clinically validated healthcare IT solutions can drive significant exports as healthcare spends are 8-18% in more developed economies compared to 1.2% in India and clinically validated solutions like digital therapeutics (DTx) are growing at a CAGR of >20% globally. Government benefits and forward thinking policies to this category can help drive exports and help an already ready talent and entrepreneurial base in India help boost the economy”.

 Abhishek Shah, Cofounder Wellthy Therapeutics, Mumbai 

“This year’s Budget comes at a time when we head into a new decade and there are high expectations for a certain paradigm shift in healthcare services across the country. It is important to strengthen the infrastructure, capacity and financing for the healthcare sector while envisaging a complete overhaul of the sector in a way that will expand its scope and scale.

India has one of the lowest spending on healthcare globally. So, it is more important than ever now to revitalise the public health system to ensure access, outcome, quality and affordability. The focus must be on finding solutions, which are affordable, scalable and yet high quality.

A main focus in Budget 2020 must be given to transforming the home healthcare industry. Non-communicable diseases (NCDs) — or chronic diseases — are presently a challenge for India’s health sector since they are increasing at an alarming rate. These are diseases of long duration and generally slow in progression. Unlike the largely short-term effects of communicable diseases, the dual health and economic impacts of non-communicable diseases on individuals, families and households are both devastating and long-lasting. The ratio of hospital beds to the number of patients is low. Focus is required on developing home healthcare which can address the gap in hospital beds and patients by offering care for terminally ill patients at home in a hospital-like setting.

Home healthcare is also currently not recognized as a mainstream sector. If this sector is brought under government schemes like the Ayushman Bharat Yojana, there can be an increase in the limits on reimbursement of expenses on diagnostics, preventive health check-ups, etc.

The government needs to promise comprehensive primary care that has continuity with higher levels, improved access and affordability of services through a combination of public hospitals and strategic purchasing of services from the private health sector. The most crucial element for the implementation of the budget is a strong public health infrastructure. While there was a commitment to increase the healthcare spending to 2.5% of the GDP by 2025, as of now it still remains at 1%. This requires some attention in Budget 2020.

The preventive health check-up segment also requires some attention. Currently, preventive health check-ups account for less than 10% of the total market and this segment is witnessing a CAGR of 20%. The government needs to increase the tax exemption on preventive health check-up from the current Rs. 5,000 per person to Rs. 20,000 under section 80-D of Income Tax Act 1961. This will encourage more people to go for health check-ups.

As technology is making great inroads in all sectors including healthcare, this year’s Budget will have to bring a mindset shift by identifying healthcare as an important pillar in improving both quality of life and economic prosperity of the nation.”

Dr. Rohinton Dastur, Director Medical-Bhatia Hospital, Mumbai

“The Indian Budget should focus on increasing public spending on healthcare, considering India’s demographics, growing population and increasing disease burden. The Budget of 2019-20 saw Rs62, 398 crore outlay for the healthcare sector which was just 1% of GDP. This should be increased to 2.5% or around Rs150,000 crore to drive the health sector fast forward. Along with the private spend of 1.5% the total GDP percent shall go to an acceptable 4%. In developed countries it is 10% and in the USA it is 18% of the GDP. This will help in making healthcare accessible to marginalized populations.

There is a requirement for a viability gap funding by the government for smaller hospitals in Tier 2 and 3 cities by the government to increase the provider base for Ayushman Bharat. There is also a requirement for increasing the package rates of Ayushman Bharat for more hospitals to take this up and make the program a success.

Focus on increasing the number of healthcare professionals as the doctor: patient ratio is 1: 1,445 against the WHO recommended 1: 1,000. Government should ease the rules and regulations for establishing more medical teaching and training institutions to produce more medical professionals to fill the gap. The recent decision to allow medical colleges by joint venture between trusts and companies is a welcome step with the PPP model attached to government hospitals. The establishment of National Medical Commission (NMC) aims to address the skill gaps but more clarity on increasing UG and PG seats should be brought in.

The government should give a boost to digital healthcare to increase accessibility. Although the National Digital Health Blueprint (NDHB) is a step in the right direction, there needs to be further action and investment for developing infrastructure for electronic health records, for data portability, privacy and security. Telemedicine connectivity between the Primary Health Centers, Taluk Hospitals, District Hospitals and Medical Colleges must be increased to provide expert opinion  in the peripheral centers.

Compulsory rural service for two years after MBBS and PG doctors and other para medical graduates with higher pay scales supported by government should be rolled out to get more doctors to the rural areas.”

Dr. Azad Moopen, Founder Chairman & Managing Director, Aster DM Healthcare, UAE

“The cost of hospitalisation is increasing and medical treatments are becoming more expensive . With the upcoming Budget 2020, we expect the government to focus on increasing its overall allocation on the health sector. Unfortunately, in India, the awareness about insurance is very low which is one of the major reasons for low-level of insurance penetration. Before Ayushman Bharat Yojana was introduced, very few people had any kind of health insurance, thus the government should also consider on introducing measures to increase health insurance penetration . The industry expects tax deduction cap for medical insurance under Sec. 80D to be increased further from Rs.25,000 to Rs.50,000 for self, and from Rs.50,000 to Rs.75,000 for elderly and dependent parents. This could be a huge relief for those who are apprehensive about the rising healthcare costs. The government should also consider reducing GST slab for health insurance premiums paid, tax benefits for health checks ups and should also focus on primary care and prevention as these could be driving factors for customers to invest in health insurance.  To sum it all, these measures would help in increasing health insurance penetration in India as well as bolster a culture of preventive healthcare in India.”

Mayank Bathwal, CEO, Aditya Birla Health Insurance, Mumbai

“In the upcoming budget, we expect the government to focus on bringing more people under the ambit of Life Insurance, promote long-term savings and encourage capital formation. In a country with inadequate social security, protection offered by life insurance is inevitable; however, lack of its penetration is plaguing the industry.  Introducing separate deduction of Rs 50,000 for first time life insurance buyers and an additional capping of Rs 50,000 for someone purchasing a pure protection (term) plan will put life insurance on fast track. Another important move would be to encourage women to insure their lives and savings. Extra tax benefit for women policyholders will be a significant step. Moreover, relaxation of section 10(10)(D), where minimum sum assured is required to be 10 times of annual premium will be a desirable move. The budget should also bring about measures to bring parity between pension products offered by life insurers and NPS. Lowering rate of GST at 12% (with input tax credit benefit) will be beneficial for both policyholders and companies. These measures will pave the growth path for the LI sector, besides increasing the security net of the nation’s people at a very low cost.”

Kamlesh Rao, MD & CEO, Aditya Birla Sun Life Insurance, Mumbai

“The economy is going through a phase of low GDP growth, Finance Minister should adopt softer interest rates to encourage new investment and expedite Capex cycle aiming at generating more employment opportunities and roll out tax benefits for individual taxpayers so consumption can also get a boost.

Enhancement of weighted tax deduction on R&D from 150% to 200% will enable new discovery and innovation. If the government gives proper financial support to SMEs from technology upgradation fund for Pharma SMEs, then the pharma SMEs in India can graduate to the next level and can become exporters.

Indian Pharma industry is facing challenges such as increased scrutiny from drug regulators, stalled new product approvals and price control in the home as well as developed markets affecting the growth. With the government’s initiative, not only can the industry support the government in providing affordable and efficacious medicines it will also help to mark its presence in the global markets.”

Mahendra Patel, Managing Director, Lincoln Pharmaceuticals, Ahmedabad

“Over the last few years, the government has taken some major steps to improve Healthcare in India. But there is a lot more to be done, so the government should continue to invest  in medical education and the healthcare infrastructure. The government should invest in best of breed digital tools that supplement the new competency based curriculum, thus enabling the students to learn better, being on par with their counterparts in other countries. We must also ensure that medical colleges and hospitals have access to world class evidence based content and technology solutions, that accelerate learning and readiness to practice. These investments will go a long way towards reducing medical errors and improving healthcare outcomes”.

Shireesh Sahai, CEO – Wolters Kluwer India, Gurugram

“Molecular diagnostics and genetic testing for preventive screening of cervical, breast and ovarian as well as prostate cancer is known to be significantly more accurate than regular tests and are routinely used in the developed world. However the higher costs of these tests dissuade doctors in India from prescribing them to the lay man, while the lack of scale inhibits R&D activity to come up with lower cost and South Asian genome relevant tests. If the tax exemption on preventive health check-ups is raises from the current Rs. 5,000 to Rs. 20,000 under section 80D of the Income Tax Act, it will significantly accelerate the adoption of a better level of healthcare in the country.” 

Nickhil Jakatdar, CEO, GenePath, Pune

“Over the last few years, healthcare sector hasn’t received adequate attention in the Union Budgets. This year, we anticipate that the Government will introduce measures to improve the quality of healthcare and make it more affordable to common citizens. Over the past decade, healthcare is in a state of constant transformation, as a new revolution in the sector is setting in to transform the sector  – mainly driven by mobile technology, artificial intelligence (AI), Big Data analytics and other emerging technologies. The Government should earmark budgetary allocations to deploy newer technologies for enabling access to better healthcare to the farthest corners of the country. Special emphasis needs to be on improving the state of rural healthcare as majority of our population still continues to dwell in villages and smaller towns”.

Dr Somesh Mittal, MD & CEO Vikram Hospital, Bengaluru

“The government should set aside funds to support the development of a federation of healthcare data. This will be the biggest lever for research and growth in the sector and without a government level push, individual players will be unable to do a whole lot. Second, the government should set aside incentives for organizations that are collecting, storing and streamlining their data assets in a manner that allows for the deployment of the data protection bill.

Despite the intention of the government to promote data privacy through proposals such as the Digital Information Security in Healthcare Act (DISHA), the reality on the ground is fraught with a lack of systems to collect, de-identify, store or control access for data. I hope that the budget will allocate funds to support data privacy initiatives as well.

I strongly believe that this next decade will be a decade of data in healthcare, the budget must reflect this focus as well”.

Zoya Brar, Founder and CEO, CORE Diagnostics, New Delhi

“India is a country of over a billion people and has many key areas to focus on including healthcare, education, agriculture and employment amongst others. Currently, India spends less than $100 average per person on healthcare, which is amongst the lowest across the world. While the government has taken positive steps over the last few years in ensuring universal healthcare for its citizens. Ayushman Bharat is a good step in the right direction, however, inclusion of tertiary care is critical to making it beneficial overall. We also expect more clarity on the policy front for healthcare to benefit the patients and hospitals alike in order to ensure quality treatment and clinical excellence.

Cancer is a heavy burden on our society and thereby the economy. We anticipate the government take cognizance and increase taxes on tobacco and related products to curb their consumption.    

 Overall, we are optimistic about the government proposing tax cuts for both capital gains as well as income tax. This should help revive the economy and improve consumer spending which is good for businesses especially startups”.

Rashie Jain, CEO & CO-founder, Onco.com, Bengaluru

“As we look forward to some key announcements in 2020 Union Budget, there is also high expectation from the healthcare sector. As a Gynecac endoscopic surgeon and IVF specialist, I would expect a favorable budget for patients suffering with infertility. Welcoming a baby is a life changing decision but infertility diagnosis is not completely covered as insurance companies might cover one kind of treatment, but they might not cover another. I hope that the government takes some important step towards covering these treatments. Another important point that we hope the Government focuses on is to reduce GST exemptions on medical equipments so that we can invest on newer medical equipments and in turn give quality healthcare at low cost to vast majority of population across the country. GST has increased the cost of various medical equipments due to which we end up paying more tax and at the end we are unable to procure the best of equipments that is currently available. So, to make healthcare more affordable, high taxes levied on medical equipment need to be reduced.”

Dr Vidya V Bhat, Medical Director, Laparoscopic Surgeon & Fertility Specialist, Radhakrishna Multispeciality Hospital & IVF center, Bengaluru

“We all are aware of the fact that non communicable diseases (NCDs) have undeniably become a healthcare priority in India. We have also observed that the pattern of NCDs in rural India appears to be largely similar to that in urban India. Hence, it has become crucial to encourage Indian population to go for regular screening for early diagnosis of NCDs. Early detection and timely treatment can be helpful in reducing the overall burden of the last stage treatment expenses and overall economic growth of the country. In addition, we have seen a potential in new technologies like Genetic testing for diagnosis in terms of how it can help in knowing the predisposition of various NCDs so that people can take necessary steps to control them. Besides, it can contribute in personalizing the health and wellness aspects for an individual thereby reducing the curative costs. Having said so, we strongly recommend to increase the tax exemption limit on preventive health checkup including genetic testing under section 80D to Rs 20,000 per person annually. This will encourage people to go for regular health screening and help us make India a ‘Healthy India’. Furthermore, specific tax benefits for preventive healthcare should be given to corporate on per employee basis, so that they are motivated to invest in their employees’ health and well-being. Also, there is a need to bring in Zero-rating GST on healthcare services as it would reduce the cost for healthcare providers. As a result of which, the benefit will be passed on to the end consumers which will lower down the overall medical care cost.”

Amol Naikawadi, Joint – Managing Director, Indus Health Plus, Pune

“India is the pharmacy of the world and accounts for approximately 20 per cent of the market share globally in terms of volume. We have a competitive advantage in the global Pharmaceutical Industry. It is important that the industry moves up the value chain by focusing on innovation and quality. For creating an enabling research eco system, the starting point would be to increase expenditure on healthcare from the current about 1.2 per cent to 1.5 per cent of GDP this year and about 5 per cent by 2030, in line with the developed European and North American economies.

The pharma industry must move from branded generic drugs to discovering and developing new drugs; for that creating an enabling research system is a must. The forthcoming budget provides the government with an opportunity in this respect by reinstating weighted tax deduction of 200 per cent on R&D. The budget should also provide for incentives to set up 4-6 bulk API and innovation clusters to reduce dependence on API imports and to align with the idea of Make in India to Discover in India. The industry aspires to become world’s largest supplier of quality medicines; for this to happen, the growth would have to come from increasing exports to large and traditionally underpenetrated markets such as Japan, China, Africa, Indonesia and Latin America.”

Sudarshan Jain, Secretary General, Indian Pharmaceutical Alliance, Mumbai

“The disease burden of non-communicable diseases is steadily on the rise. They are currently responsible for 61 percent of deaths in the country. We need major incentives and tax breaks and formulate strong policies to achieve universal health coverage. With a shortage of over 600,000 doctors and 2 million nurses, and just 0.9 hospital beds per 1000 people, our healthcare system needs more manpower and infrastructure in both rural and urban sectors. The government needs to allocate funds to bridge course authorising community health workers to practice modern medicine can help make up for the chronic lack of availability of primary care physicians in rural and remote areas. With dismal insurance penetration rates and the lack of insurance for primary OPD visits, India also has one of the highest out of pocket health expenditure rates globally, pushing over 58 million people into poverty annually. The temporary economic slowdown also means that public spending on health might shrink, which is not something we can afford. More importantly, as long as the government spending remains low, the labour productivity in the health sector is not going to go up. However, Niti Aayog’s latest report identified five areas of focus for the future of the health system, including restructuring health financing, integrating service delivery, educating patients, and boosting digital infrastructure to increase access to quality healthcare. The government needs to put all these things under consideration while allocating the budget in the healthcare industry and revamp the state of healthcare in India.

Also, as a woman entrepreneur, I expect that Narendra Modi government’s Union Budget will once again lay its emphasis on the achievement of females in various fields. As women constitute just 14 percent of the national entrepreneurial force, there should be a committee that will ensure gender equality, boosting confidence on the part of investors, a safe social environment, and the ease to juggle work and family life. Government should continue encouraging more women entrepreneurs to come forward and spread their wings. There should be a committee to evaluate and suggest measure to improve women’s welfare and this move would be beneficial to empower the fairer sex in the society. There should be easy loans schemes which will help in boosting more women entrepreneurs to come forward and spread their wings. It is essential to understand that empowering women entails equipping them to be completely independent, financially, physically and mentally. The Government should step up measures to improve women’s safety, starting with round the clock helplines, crisis centers, fast track courts, and programs to educate them on their rights. Legal authorities must be welcoming towards women so that criminal acts do not go unreported.”

Savitha Kuttan, CEO, Omnicuris, Bengaluru

“The countdown of Union Budget 2020 has already begun and the expectations from everyone have risen already. Even we as a firm believer of naturopathy are expecting major initiatives from our Government, who has been taking enormous steps to promote ayurveda and yoga in day-to-day life.  Time and again it has been seen that AYUSH systems have immense potential to tackle the rising healthcare burden of Non Communicable diseases (NCDs) in India. Besides yoga, Government should promote naturopathy and make it a part of school and college curriculums, and set up a committee to introduce naturopathy practices in universities. Standardizing naturopathy practice is the need of the hour as it will enable us to lay down strict standards that have to be adhered to by all Naturopaths. With a population of over 133 crores, the government really needs to leverage the resources of alternative medicine systems so that universal health coverage can be achieved. Legitimizing naturopathy and conducting mass awareness campaigns to educate the masses is the right way forward.”

KR Raghunath, Senior Chairman, Jindal Naturecure Institute, Bengaluru

“The Union Budget 2020 comes at a crucial time when the country is struggling to keep up with the rest of the world for Universal Immunization Coverage amongst children. While it was stated that the government would increase healthcare spending to 2.5% of the GDP by 2025, it continues to stand at around 1.4 % in 2019. We sincerely hope that this increase in India’s healthcare budget will come in effect in this Budget. We also hope that a large portion of this will be spent towards bridging the early child-health gap by ‘Leaving No Child Unattended’, eliminating disparities of vaccination and nutrition.

India committed about Rs. 52,000 Cr. for its immunization program between 2018 and 2022, however with GAVI’s support ending this year, India will need an additional Rs. 18,000 crore by the year 2022 in order to achieve 90% universal immunization coverage.

With the launch of Intensified Mission Indradhanush 2.0 (IMI 2.0), India has the opportunity to achieve further reductions in deaths among children below five years of age, and achieve the Sustainable Development Goal of ending preventable child deaths by 2030. However, this cannot be done with the old paper-based vaccination records, and only technology can help in achieving this aggressive and important target. The government must intensify its partnership with private health-tech companies who are into bridging the immunization gap, and must allocate funds towards adoption of technology solutions for measuring and managing the key denominators of early child health.

The future of India is in its children’s health and as a country we must start allocating more funds towards full immunization coverage to secure the future health of children and that of the nation.”

Neeraj Mehta, CEO, ImmunifyMe Healthcare Technologies, New Delhi