Healthcare must stay public

The union health ministry has done right to oppose the Planning Commission’s proposal asking for a reversal of the public health policy from the 12th plan onwards. The Planning Commission has suggested that the government’s dominant role in providing health services be curbed and that there be greater privatisation of the health sector. It has suggested bringing in universal health insurance coverage and allowing private operators to sell services to the government on a competitive basis. It has even suggested that the private ‘managed care’ system followed in the United States and Mexico be implemented in India. With respect to the Planning Commission, the ‘managed care’ system of these countries is not necessarily the right model to follow, as it’s working has not been particularly satisfactory, for it has led to rising costs and public disatisfaction. Indeed, the union health ministry has correctly taken a stand against what it sees as the ‘corporatisation of healthcare’. It has noted that the first priority should be strenghten the public health system and involve the private sector only for critical gap filling. In fact, India already has widespread involvement of the private sector in healthcare. The figures, from the latest World Bank data, show that public expenditure on health in India is extremely low, at 29.2 per cent of total health spending, as compared to the global average of 62.8 pe cent. There are good reasons why further privatisation of health services may not be in public interest. There is little evidence that it will improve efficiency or access to modern medicine but the public may, in fact, end up with less accountable and less responsive and thus, less efficient health services.

Moreover, various studies have noted that wherever the health sector has been privatised, the cost of treatment has increased manifold, which is simply due to the profit motive of the private agencies. This should not happen, particularly in medicine, which is not a business but a service. Indeed, prime minister Manmohan Singh had himself noted in a speech a few years ago that, ‘With excessive privatisation, we are in the danger of creating two worlds. One which is getting high class medical care and the other not.’ The less priviledged stand in danger of being excluded as the gap between the rich and the poor increases. The country cannot aspire to greatness if its population remains unhealthy, especially at the grassroots level. There is little doubt that health services must improve but this can be best done within the framework of policies that use taxpayers’ money to bring health benefits to all, including the poorest people.