Who has slipped on oil? Back in 2005-06, the government subsidy on petroleum products was a modest Rs 2,930 crore

Since history can give us interesting perspectives on current issues, it is instructive to look back to a previous time when oil prices were at or near the current price of $60 per barrel. That was nine years ago, in 2005-06 - when India's average import cost of oil was $55 per barrel. Since then the rupee-dollar exchange rate has moved from 44 to 63, making the dollar more expensive by 43 per cent. At $60, therefore, oil imports today cost 56 per cent more, when counted in rupees. With that as background, consider what has happened to retail prices for the main petroleum products - petrol, diesel, cooking gas and kerosene - in Delhi. The figures will be different elsewhere because of local taxes.

Petrol has moved up by slightly more than 50 per cent, from about Rs 40 per litre, and diesel by 70 per cent from about Rs 30. As for the two still-subsidised products, kerosene (which has the maximum subsidy per litre) has gone from Rs 9 to Rs 15 per litre, or an increase of 67 per cent, while subsidised cooking gas has moved up by 42 per cent, to Rs 417 per cylinder. In the same period, consumer prices have doubled. Two conclusions follow. First, the retail prices of petroleum products have moved broadly in line with, or somewhat more than, the rupee cost of oil imports. Second, the prices of all petroleum products have gone up by very much less than general inflation. In the basket of total consumer expenditure, petroleum products now occupy less space.

Now let's look at what has happened to taxes and subsidies. Back in 2005-06, the government subsidy on petroleum products was a modest Rs 2,930 crore. That figure has ballooned in the 2014-15 Budget to Rs 65,000 crore, or some 22 times what it was nine years ago. The follow-on question is whether additional tax collections have neutralised the increase in subsidies. In other words, has the government taken with the left hand, as tax, what it has given with the right hand as subsidies? That might well appear to be the case. The duty from excise on petroleum products in 2005-06 yielded excise revenue of Rs 97,900 crore, plus customs revenue of about Rs 9,000 crore. In comparison, the excise revenue Budget for the current year is Rs 1.65 lakh crore; and there is no customs duty. So there is an increase of 54 per cent, over nine years, between the two revenue totals. But this is mostly explained by the increase in physical consumption. The domestic production of crude oil plus net imports totalled about 125 million tonnes in 2005-06, which compares with a likely figure of 190 million tonnes this year. The increase in physical consumption is over 50 per cent. Hence, 54 per cent higher tax revenues.

Net of subsidies, petroleum yielded revenue of Rs 1.04 lakh crore in 2005-06. It will probably yield less this year, despite vastly increased consumption. Against budgeted excise revenue of Rs 1.65 lakh core, the budgeted subsidy is Rs 65,000 crore, leaving net revenue collection of Rs 1 lakh crore. It could turn out to be less, because the subsidy bill for the first half of the year was Rs 51,100 crore, and the subsidies on kerosene and cooking gas continue even now, though at a lower level. One can refine these numbers by bringing in other factors, but there is only one broad conclusion possible. In relative terms, consumers have been protected, while the Budget has taken a hit that shows up in a higher deficit. If crude oil and retail petroleum product prices stay where they are now, the net revenue picture next year will be better. But if crude oil prices go up, as some say they will, the government should pass on the higher cost and not absorb it.

The caste of institutions There is a hierarchy of institutions set by their provenance: constitutional, statutory and administrative

Governments are lucky. They receive a lot of free advice about how they should govern. But they are also unlucky in that much of this advice is impractical. The Narendra Modigovernment is no exception to this. It has already received more than its share.

Of late, a lot has been written and spoken to impress upon it the importance of "institutions" because many of the ancien regime are convinced that it is out to destroy them. Political scientists have been leading the annoyingly persistent chatter. Economists have not been far behind.

Indeed for some of these people, institutions - only the ones they like, naturally - have become the equivalent of Einstein's elusive unified general theory, the one thing whose presence or absence explains everything in the Universe.

Hence, goes their argument, when "modern" institutions work well, a country succeeds. When they don't, it fails.

Well, hurrah, folks, well done, for telling us that a car will run if there is petrol in the tank and not if the tank is empty. We would never have guessed.

The most important strand of this jabber has been the notion of "independence". That, too, like the original idea has become an article of faith.

But who can quarrel with that? The problem, though, is there is no agreement on its meaning. So the debate is a free-for-all, which allows the government to ignore it.

Nor has anyone in India - that I know of, at least - delved into the design and evolution of institutions at the same time. They have tended to talk of either the one or the other but not the dynamics between the two.

This one-at-a-time approach has led "experts" to reach the wrong conclusions. It has been like trying to gauge the distance of something with one eye closed - very hard, and with a high probability of getting it wrong.

The caste ranking

Regarding the independence issue, Pradeep Singh Mehta, the expansive and highly successful head of the omnipresent advocacy group Consumer Unity & Trust Society (CUTS), once asked me to write something on it. They later published some of it as a discussion paper (www.cuts-international.org/pdf/Institutional_Independence_in_India.pdf).

While boning up on the topic, I realised that in India institutions created by the Constitution generally delivered better results than the ones created by Parliament and executive orders. I also realised that India's institutions can be split into three categories - constitutional, statutory and, shall we say, whimsical, like the Planning Commission, now called NITI Aayog.

The first lot, the constitutional ones - Parliament, judiciary, election commission, comptroller and auditor general, finance commission, to name a few - have generally performed well because the Constitution has guaranteed their independence. Moreover, their working has improved hugely over the last two decades as they have beaten back attempts by the (Congress) governments to subordinate them.

The second lot, the ones set up by Acts of Parliament - the Reserve Bank, the Central Vigilance Commission, the Securities and Exchange Board of India (Sebi) and so on - have also worked, but less well. One reason is that they report to the government and the scope for behind-the-scenes executive interference has been quite large.

The third lot, the ones set up by the ministries, aren't really "institutions" at all but important for the role they are expected to play. They have worked least well, or even badly, because they have been reduced to being the Gunga Dins of the parent ministry. Fortunately, these have been restricted to regulatory bodies whose decisions are subject to review.

What matters to the country is the dynamic between them. Any discussion that lumps them all into one bag is quite pointless.

The hai-tauba brigade

Once you grasp this, much of the angst over how our institutions have been "eroding" becomes like Brahminical handwringing of the "dharm bhrasht ho raha hai" variety. But there is another way of looking at it.

Change is inherent in any dynamics. To moan about it is silly. To ask for it to stop is to behave like a khap panchayat. One may well ask what constitutes good change and what bad. The short answer is we don't know. This is because no one can tell in the short run whether a change is good or bad. Thus, did Nehru do the right thing in amending the Hindu marriage and succession Acts in the mid-1950s? And so on.

That is why it is important to remember that instant judgements that are made rely more on prejudice than on any objective assessment because the evidence has not yet come into being to make a judgement.

Finally, it is also important, especially for the hai-tauba brigade, to distinguish between political and administrative interference in the working of "institutions". The two lead to very different consequences.

Someone in his or her 30s, unburdened by the foolish debates of the past, needs to study all this objectively. Even a half definitive study will help restore the proper perspective.

The burden of criminal neglect

The absence of state accountability is at the core of issues facing tribal communities

The Report of the High Level Committee on Socio-Economic, Health and Educational Status of Tribal Communities of India, under the chairmanship of sociologist Virginius Xaxa, was circulated last week. The 431-page report details the situation of tribal communities: Scheduled Tribes, de-notified tribes and particularly vulnerable tribal communities. Taking on board the findings and demands of social movements, NGOs, researchers and bureaucrats, the report consolidates what we already know about the situation of tribal communities in this country. Without detracting from its significance as an archive, it is important to revisit some basic questions at this moment that have been brought to the fore yet again.

Sixty per cent of the forest area in the country is in tribal area. Fifty-one of the 58 districts with forest cover greater than 67 per cent are tribal districts. Three States — Odisha, Chhattisgarh and Jharkhand — account for 70 per cent of India’s coal reserves, 80 per cent of its high-grade iron ore, 60 per cent of its bauxite and almost 100 per cent of its chromite reserves. Forty per cent of those displaced by dams are tribal peoples. A look at violent conflict, whether in Schedule V States or in Schedule VI States, shows that “the state is involved in all of these conflicts in some way or another.” Not surprisingly, the areas where these wars are being waged (with the state as party) are tribal areas with rich mineral reserves. The Armed Forces (Special Powers) Act guarantees impunity to state perpetrators of extrajudicial murder and assault, and there are a large number of peaceful mass movements against the appropriation of tribal homelands by the state and by corporations.

While there is a generally discernible occupational shift in tribal communities, the committee observes, the focus of national state agencies on mainstream categorisations of agricultural labourers, cultivators and the omnibus category of non-farm workers masks the finer details of tribal work-worlds and therefore obstructs an understanding of shifts therein. The need for tribal communities to have continued and uninterrupted access to forests for livelihoods and the responsibility of the state in securing these livelihoods, ensuring their viability, and providing an account of their diversity; creating enabling conditions for the dignity of work and sustainability; and plans for protecting and removing both conflict and livelihood degradation caused by the repressive presence of the forest bureaucracy in tribal areas are issues that merit greater attention.

The absence of state accountability and responsibility are at the core of the problem.

Governance of tribal areas

The question of autonomy in scheduled areas has been set out in Schedules V and VI of the Constitution. In Schedule V areas, the Tribes Advisory Council — a body with elected and community representatives from Scheduled Tribes — will advise the governor on matters of administration and governance in scheduled areas. Extensive review has shown that although governors are vested with enormous powers with respect to Schedule V areas, they have been found uniformly tardy in the matter of submission of reports and in respecting the constitutional guarantee of autonomy to tribal areas — leading the High Level Committee to recommend the setting up of a cell “in order for the Governor to properly carry out the duties of the post vis-à-vis protection of the tribes” (emphasis added) with a whisper that this cell should not just turn into another bureaucratic institution with little interest in tribal affairs. The deliberations of the Tribes Advisory Councils have been found to be tokenistic, and the councils themselves filled with bureaucrats and ministers instead of representatives of tribal communities with effective voice. Even with the Autonomous Councils in the Schedule VI States, which have a more robust formal autonomy, the committee finds that “there is a huge discrepancy between the formal rules guaranteeing autonomy and the informal workings of autonomy on the ground.”

As a remedy, the committee recommends that Governors’ Cells be set up in all Schedule V States to assist the Governor, although details about the functioning of such cells set up in Chhattisgarh, Jharkhand, Maharashtra and Rajasthan are not yet known.

Also read: Taking healthcare to India’s remote tribes

What might be the modalities for an ad hoc “cell” to show a constitutional authority the right path to ‘good governance’?

Data reproduced in the report from the years 1981-82 showed a drop out rate of 91.65 per cent before completion of tenth standard, with a participation in higher education of 1.62 per cent among the Scheduled Tribes. While flagship programmes and policies have been introduced with laudable objectives, the committee observes that inadequate infrastructure, poor teaching and learning materials, lack of focus on teacher education, and the impact of armed conflict on teacher absenteeism and school functioning, and practices of discrimination and stigmatisation in schools have affected tribal children most adversely. Added to this is the rampant and routinised corruption in government schooling system, an issue that has not been addressed, but one that has an immediate and disastrous effect on the child’s and teachers’ well-being. All of these together hold tribal children in a chokehold, pushing them back into ghettoised suboptimal learning possibilities and grinding poverty.

Tribal life-worlds

Where does the solution lie? Might common schools be an answer? Should schooling continue in the “separate and unequal” mode? And most importantly, the state and adult citizens hold the responsibility for protecting the rights of all children in trust. It is no longer a question of quibbling over numbers — of schools, teachers, dropouts, enrolment, etc. If the outcome is that tribal children do not get a decent education, the state is responsible both for the absence of due diligence and for direct derogation of fundamental rights of children. On another level, the question is not merely one of the exposure of tribal children to the world outside; more critical is the need to promote an understanding of diverse tribal life-worlds in all children through a restructuring of education.

Tribal land alienation and dispossession are at the crux of the crisis tribal communities face across the country — acquisition of land by the state using the principle of ‘eminent domain’; manipulation of records and incorrect interpretation of law; encroachment of tribal land by non-tribal people and immigrants; creation of national parks; and armed conflict resulting in forced migration and eviction from homelands. There are questions related to the routinisation of arbitrary arrest, illegal detention and torture in custody of tribal people living in conflict areas. There are no figures publicly available on the demographic profile of prisoner/detainee populations in Schedule V areas. The important guarantee under Article 21 of the Constitution — right to life and personal liberty — is in a state of perpetual suspension in tribal areas. If one were to go by the data and observations put forth by the High Level Committee, once more we learn that the state is waging war at every level against tribal communities across States. Added to this is criminal neglect and violent corruption that has systematically obstructed the delivery of public goods and services. There is a proliferation of reports — of bureaucratic writing generally —as an end in itself.

What are we to do with this information? The government set up a committee that found the state complicit both directly as perpetrator and through the absence of due diligence in genocidal neglect of tribal peoples.

Where do we go from here?

NHP-2015 V

1 Goal:
The attainment of the highest possible level of good health and well-being, through a
preventive and promotive health care orientation in all developmental policies, and universal
access to good quality health care services without anyone having to face financial hardship as a
consequence.

3.2.Key Policy Principles:
Equity: Public expenditure in health care, prioritizing the needs of the most vulnerable, who
suffer the largest burden of disease, would imply greater investment in access and financial
protection measures for the poor. Reducing inequity would also mean affirmative action to
reach the poorest and minimizing disparity on account of gender, poverty, caste, disability,
other forms of social exclusion and geographical barriers.

Universality: Systems and services are designed to cater to the entire population- not only a
targeted sub-group. Care to be taken to prevent exclusions on social or economic grounds.
Patient Centered & Quality of Care: Health Care services would be effective, safe, and
convenient, provided with dignity and confidentiality with all facilities across all sectors being
assessed, certified and incentivized to maintain quality of care.

Inclusive Partnerships: The task of providing health care for all cannot be undertaken by
Government, acting alone. It would also require the participation of communities – who view
this participation as a means and a goal, as a right and as a duty. It would also require the
widest level of partnerships with academic institutions, not for profit agencies and with the
commercial private sector and health care industry to achieve these goals.

Pluralism: Patients who so choose and when appropriate, would have access to AYUSH care
providers based on validated local health traditions. These systems would also have Government support and supervision to develop and enrich their contribution to meeting the
national health goals and objectives. Research, development of models of integrative practice,
efforts at documentation, validation of traditional practices and engagement with such
practitioners would form important elements of enabling medical pluralism.
Subsidiarity: For ensuring responsiveness and greater participation, increasing transfer of
decision making to as decentralized a level as is consistent with practical considerations and
institutional capacity would be promoted. (Nothing should be done by a larger and more
complex organization which can be done as well by a smaller and simpler organization.)
Accountability: Financial and performance accountability, transparency in decision making,
and elimination of corruption in health care systems, both in the public systems and in the
private health care industry, would be essential.
Professionalism, Integrity and Ethics: Health workers and managers shall perform their
work with the highest level of professionalism, integrity and trust and be supported by a
systems and regulatory environment that enables this.
Learning and Adaptive System: constantly improving dynamic organization of health care
which is knowledge and evidence based, reflective and learning from the communities they
serve, the experience of implementation itself, and from national and international knowledge
partners.
Affordability: As costs of care rise, affordability, as distinct from equity, requires emphasis.
Health care costs of a household exceeding 10% of its total monthly consumption expenditures
or 40% of its non-food consumption expenditure- is designated catastrophic health
expenditures- and is declared as an unacceptable level of health care costs. Impoverishment
due to health care costs is of course, even more unacceptable.

3.3.Objectives:3.3.1. Improve population health status through concerted policy action in all sectors and
expand preventive, promotive, curative, palliative and rehabilitative services provided by the
public health sector.
3.3.2. Achieve a significant reduction in out of pocket expenditure due to health care costs and
reduction in proportion of households experiencing catastrophic health expenditures and
consequent impoverishment.
3.3.3. Assure universal availability of free, comprehensive primary health care services, as an
entitlement, for all aspects of reproductive, maternal, child and adolescent health and for the
most prevalent communicable and non-communicable diseases in the populationEnable universal access to free essential drugs, diagnostics, emergency ambulance
services, and emergency medical and surgical care services in public health facilities, so as to
enhance the financial protection role of public facilities for all sections of the population.
3.3.5. Ensure improved access and affordability of secondary and tertiary care services through
a combination of public hospitals and strategic purchasing of services from the private health
sector.
3.3.6. Influence the growth of the private health care industry and medical technologies to
ensure alignment with public health goals, and enable contribution to making health care
systems more effective, efficient, rational, safe, affordable and ethical. .

EXPENDITURE
The National Health Policy accepts and endorses the understanding that a full achievement of
the goals and principles as defined would require an increased public health expenditure to 4 to
5% of the GDP. However, given that the NHP, 2002 target of 2% was not met, and taking
into account the financial capacity of the country to provide this amount and the institutional
capacity to utilize the increased funding in an effective manner, this policy proposes a
potentially achievable target of raising public health expenditure to 2.5 % of the GDP. It also
notes that 40% of this would need to come from Central expenditures. At current prices, a
target of 2.5% of GDP translates to Rs. 3800 per capita, representing an almost four fold
increase in five years. Thus a longer time frame may be appropriate to even reach this modest
target.
4.1.2. The major source of financing would remain general taxation. With the projection of a
promising economic growth, the fiscal capacity to provide this level of financing should
become available. The Government would explore the creation of a health cess on the lines of
the education cess for raising the necessary resources. Other than general taxation, this cess
could mobilise contributions from specific commodity taxes- such as the taxes on tobacco, and
alcohol, from specific industries and innovative forms of resource mobilization. Extractive
industries and development projects that result in displacement, or those that have negative
impacts on natural habitats or the resource base can be considered for special taxation thereby
allowing investment and job opportunities in education and health for affected communities.
4.1.3. Since about 50% of health expenditure goes into human resources for health, an equitous
growth of health and education sectors would also lead to increased employment in many areas
and communities, which do not otherwise benefit from the economic growth rate, particularly
where jobless growth is a phenomenon. High public investment in health care is one of the
most efficient ways of ameliorating inequities, and for this reason, this commitment to higher

public expenditures is essential. 

India lost 66 wild tigers in 2014

Tamil Nadu with 15 had the highest number of deaths

: Sixty-six wild tiger deaths were reported in the country in 2014. Two tiger deaths occurred on the last day of the year. It was the only day in 2014 when two wild tiger deaths were reported. One was at Bandipur in Karnataka and the other at Tadoba Andhari in Maharashtra.

As per statistics provided by Tigernet, the official database of the National Tiger Conservation Authority, the highest number of wild tiger deaths was reported from the forests of Tamil Nadu —15, followed by Madhya Pradesh —14. Six of the deaths in Tamil Nadu were from the Mudumalai Tiger Reserve.

The majority of wild tiger deaths was caused by poaching. The data do not give a clear figure on the number of tigers killed by poachers, but it is estimated that about 50 tigers could have been killed in this manner.

Of the 66 deaths, only one death was due to natural causes — reported from the Valmiki Tiger Reserve, Bihar. Fights between tigers, possibly for territory control, caused three deaths.

Two tigers, suspected to be man-eaters, were shot dead by police personnel. One was near Udhagamandalam on January 23 and the other near Chandrapur in Maharashtra on July 19

In the Valmiki Tiger Reserve, one cub was found dead. Wild tiger deaths were also reported from Andhra Pradesh, Assam, Kerala, Karnataka and Uttarakhand. Thirty-two deaths were reported in the first six months of the year.

The highest number of deaths was in December — 10. Wild tiger deaths had taken place during all months of the year. The first tiger death of the year was reported from the Melghat Tiger Reserve in Maharashtra on January 10.

During the year, 12 cases of seizure of tiger parts were registered. This included seizure of seven tiger skins. While three tiger skins were seized from Maharashtra, two were seized from Andhra Pradesh and one each from Tamil Nadu and Kerala.

In 2013, the number of wild tiger deaths was 63 and the highest number was reported from the forests of Karnataka —16, followed by Maharashtra, 9.

Nuclear logjam: India, U.S. to work on new proposals

Revised insurance scheme to reduce suppliers’ risk

Indian and U.S. officials are expected to meet in Delhi next week to discuss two proposals made by India to clear the nuclear logjam, with an added push coming from U.S. President Obama’s impending visit on January 24.

The Hindu has learnt that the proposals were put forward during the first contact group meeting on civil nuclear issues held on December 16-17 that had been tasked by President Obama and Prime Minister Modi with finding a way around U.S. objections to India’s supplier liability law.

According to one official present at the meeting, India put up a revised proposal of an “insurance pool” using General Insurance Company (GIC) to alleviate the risk to U.S. suppliers. An earlier proposal had been made during the UPA government’s tenure in March 2014, but had been rejected. Officials say the new offer would include a pool of GIC, New India Assurance, Oriental Insurance, National Insurance and United India, that would generate a risk cover of about $242 million.

A second proposal, that U.S. officials have taken back to discuss with lawyers and representatives of American companies GE-Hitachi and Westinghouse, would entail a “clarification of Section 46” of the law that has been described as “vague” . At present, Section 46 says that nothing in the law will “exempt the operator from any proceeding which might, apart from the act, be instituted against the operator.” This has been read to mean that U.S. suppliers could face tort claims, that is, be sued by victims of an accident where the nuclear parts are deemed faulty. U.S. officials will bring both proposals back to Delhi next week.

India’s proposals to U.S. face resistance

U.S. officials have said they were “hopeful” of some movement in the nuclear deal that has been hanging fire since it was signed in 2008. Although India has allotted project sites for two 1000 mw nuclear reactors each by U.S. companies Westinghouse and GE-Hitachi in Gujarat and Andhra Pradesh respectively, no work has started on either.

Indian and U.S. officials are expected to meet in Delhi next week to discuss two proposals made by India to clear the nuclear logjam. India put up a revised proposal of an “insurance pool” to reduce the risk to U.S. suppliers. A second proposal would entail a “clarification of Section 46” of the law on supplier liability that has been described as “vague.”

R.K. Sinha, Chairman of India's Atomic Energy Commission, told Reuters agency last month that India was working fast to address the concerns of suppliers.

“We are working on a solution with the insurance companies.” A similar pool is available to nuclear operators in the U.S., under the ‘Price-Anderson’ act. But India’s liability law includes suppliers as well.

While the insurance pool proposal would help Indian nuclear parts suppliers like L&T, Gammon and BHEL, officials said U.S. company representatives present at the contact group meeting in December found the insurance pool proposal “inadequate” as it would accept supplier liability that the U.S. says is in contravention of the International Convention on Supplementary Compensation.

Former nuclear officials, who have vocally protested any “dilution” of the supplier liability law, say the second proposal may run into trouble in India. “There can be no side arrangement with the U.S.,” former Atomic Energy Regulatory Board Chairman A. Gopalakrishnan told The Hindu. “If any clarification on Section 46 is to the U.S.’s satisfaction, it will certainly be violation of India’s act.”

Mr. Gopalakrishnan also questioned why Indian officials were proposing solutions to the logjam at all. “Why all the eagerness to procure American reactors, some of which like GE’s 1000 MW reactor haven’t been used anywhere else? Indian reactors already developed, like the 700 MWe heavy water reactors, could easily be scaled up to similar capacities.”

Publicly Financed Health Insurance:

A number of publicly financed health insurance schemes were introduced to improve access to
hospitalization services and to protect households from high medical expenses. Eight states
introduced health insurance programmes for covering tertiary care need and over time as
expenditures increased, many of these States (Andhra Pradesh, Karnataka, Tamilnadu,
Maharashtra, etc.) moved to direct purchasing of care through Trusts and reserving some
services to be delivered only through public hospitals. The Central Government under the
Ministry of Labour & Employment, launched the Rashtriya Swasthya Bima Yojana (RSBY) in
2008. The population coverage under these various schemes increased from almost 55 million
people in 2003-04 to about 370 million in 2014 (almost one-fourth of the population). Nearly
two thirds (180 million) of this population are those in the Below Poverty Line (BPL) category.
Evaluations show that schemes such as the RSBY, have improved utilization of hospital services,
especially in private sector and among the poorest 20% of households and SC/ST households.
However there are other problems. One problem is low awareness among the beneficiaries
about the entitlement and how and when to use the RSBY card. Another is related to denial of
services by private hospitals for many categories of illnesses, and over supply of some services

Some hospitals, insurance companies and administrators have also resorted to various fraudulent
measures, including charging informal payments. Schemes that are governed and managed by
independent bodies have performed better than other schemes that are located in informal cells
within existing departments or when managed by insurance companies. The insurance schemes
vary widely in terms of benefit packages and have resulted in fragmentation of funds available
for health care; especially selective allocation to secondary and tertiary care over primary care
services. All National and State health insurance schemes need to be aligned into a single
insurance scheme and a single fund pool reducing fragmentation. The RSBY scheme has now
been shifted to the Ministry of Health & Family Welfare, helping the State and Central Ministry
move to a tax financed single payer system approach. The Ministry could now compare the
relative costs per patient for alternative routes of financing viz. purchase through insurance, or
direct purchase from private sector and from public sector or free care by public sector as a form
of tax based financing, and take the best decision for a given context.