Indiscipline and disruptions in Parliament are much talked about issues. Not only are disruptions a waste of Parliament's valuable time, these significantly taint the image of this esteemed institution. Commotion in Rajya Sabha over the introduction of Women's Reservation Bill and the subsequent suspension of 7 MPs has brought this issue back to the forefront. We thought it might be useful to research and highlight instances in the past when the House had had to deal with similar situations. According to the Rules of Conduct and Parliamentary Etiquette of the Rajya Sabha, "The House has the right to punish its members for their misconduct whether in the House or outside it. In cases of misconduct or contempt committed by its members, the House can impose a punishment in the form of admonition, reprimand, withdrawal from the House, suspension from the service of the House, imprisonment and expulsion from the House." Mild offences are punished by admonition or reprimand (reprimand being the more serious of the two). Withdrawal from the House is demanded in the case of gross misconduct. 'Persistent and wilful obstructions' lead the Chairman to name and subsequently move a motion for suspension of the member. A member can be suspended, at the maximum, for the remainder of the session only. In an extreme case of misconduct, the House may expel a member from the House. According to a comment in the above rule book, "The purpose of expulsion is not so much disciplinary as remedial, not so much to punish members as to rid the House of persons who are unfit for membership." There have been several instances in the past when the Parliament has exercised its right to punish members. We pulled together a few instances: Rajya Sabha
| Unruly behaviour – Some instances | |
| 3-Sep-62 | Shri Godey Murahari was suspended for the remainder of the session on 3 Septemebr 1962. He was removed by the Marshal of the House |
| 25-Jul-66 | Shri Raj Narain and Shri Godey Murahari were suspended for one week by two separate motions moved on 25 July 1966, by the Leader of the House (Shri M.C. Chagla) and adopted by the House. After they refused to withdraw, they were removed by the Marshal of the House. Next day, the Chairman expressed his distress and leaders of parties expressed their regret at the incident |
| 12-Aug-71 | The Minister of Parliamentary Affairs (Shri Om Mehta) moved a motion on 12 August 1971, for the suspension of Shri Raj Narain for the remainder of the session. The motion was adopted. Shri Raj Narain, on refusing to withdraw, was removed by the Marshal of the House |
Source: Rajya Sabha, Rules of Conduct and Parliamentary Etiquette
| Expulsion – All instances (three in total) | |
| 15-Nov-76 | Shri Subramanian Swamy was expelled on 15 November 1976 on the basis of the Report of the Committee appointed to investigate his conduct and activities. The Committee found his conduct derogatory to the dignity of the House and its members and inconsistent with the standards which the House expects from its members |
| 23-Dec-05 | Dr. Chhattrapal Singh Lodha was expelled on 23 December 2005, for his conduct being derogatory to the dignity of the House and inconsistent with the Code of Conduct, consequent on the adoption of a motion by the House agreeing with the recommendation contained in the Seventh Report of the Committee on Ethics |
| 21-Mar-06 | Dr. Swami Sakshi Ji Maharaj was expelled on 21 March 2006, for his gross misconduct which brought the House and its members into disrepute and contravened the Code of Conduct for members of Rajya Sabha, consequent on the adoption of a motion by the House agreeing with the recommendation of the Committee on Ethics contained in its Eighth Report |
Source: Rajya Sabha, Rules of Conduct and Parliamentary Etiquette
Lok Sabha
| Unruly behaviour – Some instances | |
| 15-Mar-89 | Commotion in the House over the Thakkar Commission report (Report of Justice Thakkar Commission of Inquiry on the Assassination of the Late Prime Minister Smt. Indira Gandhi; revelations published in Indian Express before report tabled in Parliament) led to 63 MPs being suspended for a week. An opposition member belonging to the Janata Group (Syed Shahabuddin) who had not been suspended, submitted that he also be treated as suspended and walked out of the House. Three other members (GM Banatwalla, MS Gill and Shaminder Singh) also walked out in protest. |
| 20-Jul-89 | Demand for resignation of Govt. because of the adverse remarks made against it by the CAG in his report on Defence Services for the year 1988-89 saw commotion in the House. Satyagopal Misra dislodged microphone placed before the Chair and threw it in the pit of the House. (Sheila Dikshit was the Minister of State for Parliamentary Affairs). No member was suspended. |
Source: Subhash Kashyap, Parliamentary Procedure (Second Edition)
The Union Cabinet recently approved the launch of the National Health Protection Mission which was announced during Budget 2018-19. The Mission aims to provide a cover of five lakh rupees per family per year to about 10.7 crore families belonging to poor and vulnerable population. The insurance coverage is targeted for hospitalisation at the secondary and tertiary health care levels. This post explains the healthcare financing scenario in India, which is distributed across the centre, states, and individuals.
How much does India spend on health care financing vis-à-vis other countries?
The public health expenditure in India (total of centre and state governments) has remained constant at approximately 1.3% of the GDP between 2008 and 2015, and increased marginally to 1.4% in 2016-17. This is less than the world average of 6%. Note that the National Health Policy, 2017 proposes to increase this to 2.5% of GDP by 2025.
Including the private sector, the total health expenditure as a percentage of GDP is estimated at 3.9%. Out of the total expenditure, effectively about one-third (30%) is contributed by the public sector. This contribution is low as compared to other developing and developed countries. Examples include Brazil (46%), China (56%), Indonesia (39%), USA (48%), and UK (83%) (see Figure 1).
Who pays for healthcare in India? Mostly, it is the consumer out of his own pocket.
Given the public-private split of health care expenditure, it is quite clear that it is the private expenditure which dominates i.e. the individual consumer who bears the cost of her own healthcare. Let’s look at a further disaggregation of public spending and private spending to understand this.
In 2018-19, the Ministry of Health and Family Welfare received an allocation of Rs 54,600 crore(an increase of 2% over 2017-18). The National Health Mission (NHM) received the highest allocation at Rs 30,130 crore and constitutes 55% of the total Ministry allocation (see Table 1). Despite a higher allocation, NHM has seen a decline in the allocation vis-à-vis 2017-18.
Interestingly, in 2017-18, expenditure on NHM is expected to be Rs 4,000 crore more than what had been estimated earlier. This may indicate a greater capacity to spend than what was earlier allocated. A similar trend is exhibited at the overall Ministry level where the utilisation of the allocated funds has been over 100% in the last three years.
State level spending
A NITI Aayog report (2017) noted that low income states with low revenue capacity spend significant lower on social services like health. Further, differences in the cost of delivering health services have contributed to health disparities among and within states.
Following the 14th Finance Commission recommendations, there has been an increase in the states’ share in central pool of taxes and they were given greater autonomy and flexibility to spend according to their priorities. Despite the enhanced share of states in central taxes, the increase in health budgets by some states has been marginal (see Figure 2).
Consumer level spending
If cumulatively 30% of the total health expenditure is incurred by the public sector, the rest of the health expenditure, i.e. approximately 70% is borne by consumers. Household health expenditures include out of pocket expenditures (95%) and insurance (5%). Out of pocket expenditure dominate and these are the payments made directly by individuals at the point of services which are not covered under any financial protection scheme. The highest percentage of out of pocket health expenditure (52%) is made towards medicines (see Figure 3).
This is followed by private hospitals (22%), medical and diagnostic labs (10%), and patient transportation, and emergency rescue (6%). Out of pocket expenditure is typically financed by household revenues (71%) (see Figure 4).
Note that 86% of rural population and 82% of urban population are not covered under any scheme of health expenditure support. Due to high out of pocket healthcare expenditure, about 7% population is pushed below the poverty threshold every year.
Out of the total number of persons covered under health insurance in India, three-fourths are covered under government sponsored health schemes and the balance one-fourth are covered by private insurers. With respect to the government sponsored health insurance, more claims have been made in comparison to the premiums collected, i.e., the returns to the government have been negative.
It is in this context that the newly proposed National Health Protection Mission will be implemented. First, the scheme seeks to provide coverage for hospitalisation at the secondary and tertiary levels of healthcare. The High Level Expert Group set up by the Planning Commission (2011) recommended that the focus of healthcare provision in the country should be towards providing primary health care. It observed that focus on prevention and early management of health problems can reduce the need for complicated specialist care provided at the tertiary level. Note that depending on the level of care required, health institutions in India are broadly classified into three types: primary care (provided at primary health centres), secondary care (provided at district hospitals), and tertiary care institutions (provided at specialised hospitals like AIIMS).
Second, the focus of the Mission seems to be on hospitalisation (including pre and post hospitalisation charges). However, most of the out of the pocket expenditure made by consumers is actually on buying medicines (52%) as seen in Figure 3. Further, these purchases are mostly made for patients who do not need hospitalisation.
