Recent statements by the Fifteenth Finance Commission Chairman, N.K. Singh, have sparked a lively debate on shifting ‘Health’ from the State List to the Concurrent List under the Constitution. Presently, ‘Health’ is handled by the states, but there are compelling arguments both for and against this shift. Mr. Singh also advocated for a Developmental Finance Institution (DFI) focused on healthcare investments.
Reasons in Favor of Shifting ‘Health’ to the Concurrent List
The primary argument in favor of this shift centers around the Central government’s ability to bring about regulatory changes and ensure uniformity across all states. The Central government has access to multiple research bodies and departments dedicated to public health management, giving it better technical expertise to design comprehensive health policies. Bringing Health into the Concurrent list would improve regulation and reinforce stakeholders’ responsibilities towards improved healthcare provision.
Opposition Against Shifting ‘Health’ to the Concurrent List
Critics argue that the shift could challenge India’s federal structure and wouldn’t necessarily guarantee the provision of accessible, affordable, and high-quality healthcare for all. The current structure allows the central government to support the states without interfering in their work, and further centralization may reduce efficiency. Some critics also worry about burdening the Centre with more responsibilities, which could distract from its own obligations.
The Role of Developmental Finance Institution (DFI) for Healthcare
Mr. Singh also suggested the establishment of a healthcare-specific Developmental Finance Institution (DFI), drawing parallels with DFIs for other sectors like agriculture, housing, and tourism. This institution would increase healthcare access in tier-2 and tier-3 cities and provide technical assistance to ensure proper usage of funds.
Other Proposals by N.K. Singh
The Chairman further recommended increasing government spending on health to 2.5% of GDP by 2025 and allocating at least two-thirds of health spending to primary healthcare. He suggested standardizing healthcare codes across the Centre and states and creating an All India Medical and Health Service. Mr. Singh also emphasized the need for universal healthcare insurance as a large section of society remains uninsured.
The Concept of Concurrent List
The legislative power distribution in India is structured into three lists in the Seventh Schedule of the Constitution: the Union List, the State List, and the Concurrent List. Both Parliament and state legislature can make laws on matters in the Concurrent List, which currently includes 52 subjects like criminal law and procedure, civil procedure, marriage and divorce, population control and family planning, electricity, labour welfare, and more.
About Development Finance Institution (DFI)
Development Finance Institutions (DFIs) are specialized organizations primarily aimed at providing development or project finance, especially in developing countries. These institutions are typically majority-owned by national governments and funded by national or international development funds. This arrangement ensures their creditworthiness and facilitates their provision of project finance at competitive rates.
