The Fifteenth Finance Commission (XVFC) led by the Chairman N.K. Singh, on 19 December 2018, held a meeting on with Ministry of Health and Family Welfare including the Union Minister of Health J.P. Nadda, Ministres of State, Health A.K. Choubey and Anupriya Patel.

At the meeting, the Commission was given a detailed proposal on fund requirement by the Department of Health and Family Welfare (DoH&FW). Some of the major projects were: For untied funds: Health Infrastructure status of the States to be used as a criterion- will help States with significant infrastructure deficit and health lag to get more funds.

10% of the fund to be earmarked for the health sector with at least 2/3rd being reserved for the primary health.For performance-based incentives: composite health index to be utilized to encourage states to demonstrate performance on year on year basis – should weight 20% in the performance linked pool.

The DoH&FW informed the commission that the principal targets of the National Health Policy 2017 were: Increase public health expenditure to 2.5% of GDP, in a progressive manner, by 2025.Increase State sector health spending to more than 8% of their budget by 2020. Primary Health Expenditure to be 2/3rd of the total health expenditure.

Some of the preliminary issues on the Health Sector under the focus of XVFC are: Skilled workforce and conditional financial allocation – the two main challenges of the Health Sector today.

Infection Diseases

The change of disease spectrum from infectious diseases to degenerative diseases requiring the need to strengthen the Community Health Centers and District Hospitals in the States.The health sector as a vital driver of the 21st Century economy on account of its employment potential and need to improve the medical education in the country. Need to increase the postgraduate doctors in the country.

 Need to create 'Cooperative Model' rather than a 'Competitive Model' between Public and Private Hospitals. Integration of the initiatives taken by the Government like 'Ayushman Bharat' and 'Swachh Bharat Mission. Need for a comprehensive ban of private practice by Government Doctors.

Optimum utilization of the funds allocated by the Centre to the States on Public Health. Need to open more Medical Colleges and Hospitals, for training more workforce which could enable to build the gap between doctor-patient ratios. Need to think in the lines of the price control mechanism in the pharmacy and drugs market and thereby bring uniformity in the Health Care facility.

Proposal to include officials from National Health Accounts Division in Ministry of Health which is monitoring the funds allocated to the States. A requirement of data on funds allocated to the States and their optimum utilization and outcomes.

During the meeting, the Commission highlighted the need to focus on the following issues: The way to extract best economic returns from investment already made in the health sector.