JAMMU AND KASHMIR: Public expenditure on health in Jammu and Kashmir has seen an increase over the past decade, yet current levels and allocation structures are raising concerns about the ability to meet rising tertiary and super-speciality care demands.
According to details received by The Chenab Times, health spending in the Union Territory rose from approximately Rs 1,205 crore in the 2012-13 fiscal year to nearly Rs 1,883 crore by 2019-20. The allocation experienced a peak of around Rs 2,109 crore in 2017-18, followed by a marginal decline in the subsequent two years, a trend that warrants scrutiny given the increasing healthcare requirements.
This stagnation in expenditure after 2017-18 contrasts with the upward trajectory observed in many other Indian states during the same period. Several structural issues are shaping the health financing framework within Jammu and Kashmir. A significant portion of the health budget is currently allocated to salaries and routine operational costs, necessitating a reassessment to prioritize capital investment in diagnostics, upgradation of district hospitals, and enhancement of emergency services.
While the long-term trend in health spending for Jammu and Kashmir shows an increase, its growth rate has been modest when compared to several other states. States like Punjab, Haryana, Rajasthan, and Tamil Nadu have demonstrated stronger and more consistent expansion in their health budgets. Even smaller hill states such as Himachal Pradesh have maintained relatively higher per capita expenditure, considering population size and geographic challenges.
In terms of its share of the total state budget, health expenditure in Jammu and Kashmir has generally remained between 4 to 5 percent over the past decade. This allocation has not seen a substantial structural increase despite the growing burden of diseases and the demand for advanced medical care. In contrast, some high-performing states have progressively increased the fiscal importance of health within their overall budgetary framework.
The consequences of this underinvestment are evident in the outcomes of service delivery, particularly concerning tertiary and super-speciality care. A substantial number of patients from Jammu and Kashmir continue to seek treatment for serious and life-threatening conditions in metropolitan centres such as Delhi, Chandigarh, Amritsar, and Mumbai. These complex treatments include advanced cardiac procedures, oncology, neurosurgery, organ transplants, and intricate trauma care.
While referral systems and public insurance schemes offer a degree of financial assistance, the overall economic and social costs borne by patients and their families remain considerable. High out-of-pocket expenses are incurred on travel, accommodation, and extended stays. For households with limited financial resources, this often leads to distress borrowing or the liquidation of assets to fund medical treatment.
Beyond financial burdens, medical migration also imposes significant emotional strain and can lead to delays in receiving necessary treatment. Patients from remote districts face the additional challenge of first travelling within the Union Territory before potentially being referred outside, adding further complexity and time to their healthcare journey.
The continued outward flow of patients highlights not only clinical challenges but also structural deficiencies in the region’s tertiary healthcare infrastructure and the availability of specialist medical professionals. Three primary structural constraints contribute to this situation.
Firstly, capital expenditure dedicated to building advanced medical infrastructure has been limited relative to the prevailing needs. While primary and secondary healthcare facilities have seen expansion, super-speciality capacity remains concentrated in a few key institutions.
Secondly, there is a persistent shortage of specialists in critical fields such as cardiology, oncology, neurosurgery, and critical care. Recruiting and retaining highly skilled professionals in these areas has proven difficult, attributed partly to insufficient research opportunities, limited career progression pathways, and inadequate infrastructural support.
Thirdly, diagnostic capacity in district hospitals exhibits uneven development. Delayed diagnosis of diseases often results in patients being referred for treatment at advanced stages, thereby increasing reliance on external healthcare facilities.
Addressing these multifaceted challenges necessitates a targeted and phased strategic approach, moving beyond incremental budget increases. A dedicated plan for strengthening tertiary care services in Jammu and Kashmir should be formulated, prioritizing the establishment and expansion of super-speciality wings in existing tertiary institutions across both the Kashmir and Jammu divisions. Strategic capital investment in oncology centres, cardiac institutes, and trauma facilities is crucial.
Exploring public-private partnership models for high-end diagnostic services, such as PET scans and advanced radiology, could enhance access while managing fiscal implications through structured contracts and regulatory oversight. Furthermore, strengthening specialist retention policies through competitive remuneration, research grants, housing support, and transparent promotion mechanisms is vital for long-term commitment.
The expansion of telemedicine services, extending beyond primary consultations to specialist networks, can facilitate virtual tumour boards and remote reviews, supporting district-level doctors in managing complex cases and reducing unnecessary referrals. A region-specific health infrastructure equalisation formula is also needed to guide resource allocation, ensuring districts with greater remoteness and access limitations receive increased capital support to mitigate geographic disparities.
Ultimately, data-driven planning is indispensable. A systematic audit of out-of-state referrals, categorized by disease type and district of origin, can pinpoint areas requiring immediate investment and targeted infrastructure development.
Jammu and Kashmir has made progress in increasing its public health expenditure over the past decade. However, when benchmarked against many other states and Union Territories, the scale and composition of this spending appear insufficient to address the evolving healthcare needs of the population. The ongoing reliance on other states for critical medical treatments underscores structural gaps that demand focused policy attention and strategic intervention to bolster regional healthcare self-reliance.
The Chenab Times News Desk