Complexities of corporatisation
Healthcare corporatisation excludes majority of the population and government is further unable to compel private hospitals to comply with norms
There have been several incidents recently which have drawn media attention on the exorbitant charges demanded by the corporate hospitals. Not that people were not protesting earlier; but, the media has become even more concerned about these incidences now. The poor in our country were already marginalised and devoid of quality healthcare, but now, even the vocal middle class is feeling the pinch. India ranks among the lowest 15 on healthcare expenditure by the state. Our public health spending hovers around one per cent of the GDP. Other similarly placed countries spend the double of this. The developed countries spend 10 times of this. As a result of this falling government expenditure, the private sector has abundantly mushroomed. The policies of the previous government provided ample opportunity to the corporate sector to enter the healthcare and education sector with the prospects of building a lucrative business. This trend has gained further momentum in the recent times because of the government's extreme neo-liberal approach towards economic development. These sectors have so forth been considered as being key to socioeconomic development and therefore, form an integral asset for the society. But this concept has completely changed after the shift in economic policies.
The public healthcare system comprises limited secondary and tertiary care institutions in key cities and focuses on providing basic healthcare facilities in the form of primary healthcare centres (PHCs) in the rural areas. On the contrary, the private corporate sector has little concern towards primary healthcare. Their focus is entirely on making profit. The talk of corporate social responsibility has resulted in nothing for the concrete welfare of the poor. Many of such institutions have been provided with land at highly subsidised rates along with several other benefits like waiving off customs duties on imported equipment from the government, electricity at reduced rates etc. In lieu of that, they are obliged to provide free treatment to a proportion of the poor patients. But, several state governments have been unable to make private hospitals comply with this clause. Moreover, these institutions are not covered under the RTI Act. Therefore, getting information on such contentious issues is not easy.
As per the Indian Brand Equity Foundation, the healthcare industry size during 2008-20, is expected to record a compound annual growth rate (CAGR) of 16.5 per cent and touch US$ 280 billion by 2020. The private sector's stress is on investing in the non-communicable diseases, which have increased as a result of changes in lifestyle. Advanced technologies have helped longevity and improved quality of life in the case of non-communicable diseases. The government investment in advanced technology is limited and has failed to meet the growing demand. This large gap in demand and supply of quality healthcare services and a growing capital demand owing to operational costs and technology acquisitions has propelled healthcare service providers to expand inorganically by merging with competitors or by accepting large capital injections.
In the initial stages, these private hospitals came up in the big cities. But now, they are opening units in smaller cities too. This clearly shows that they are also attracting clientage from the smaller towns. And they also get cheap land, labour and electricity, also lesser laws to open their units.
After the entry of corporates in the health sector, India is experiencing 22-25 per cent growth in medical tourism and the industry is expected to double its size from the present (April 2017) US$ 3 billion to US$ 6 billion by 2018. Medical tourist arrivals in India increased by more than 50 per cent to 200,000 in 2016, from 130,000 in 2015. Some of these hospitals have agencies in other countries, which take care of the patients from their arrival in India, their transportation to the hospital and departure from India after treatment.
Going by the Global Hunger Index, India ranks 100 out of 119 countries, which is worse than Iraq, Bangladesh and even North Korea on an index that weighs the abilities of countries to provide food security for their citizens.
It is a challenge for the nation to meet the healthcare needs of this section of the society, whose basic food requirements are even not fulfilled. It would be naïve to expect from the corporate sector to take care of their health needs. Advertisements by the corporate hospitals for reduced cost health checkup packages may please a small section of the society in the cities, but the vast majority has no access to these types of facilities. Ultimately, they are left to the mercy of quacks or faith healers.
A series of studies have been conducted on the health status of the marginalised sections, but they do not fall in the priority list of the government. The middle classes, who are now feeling the pinch of the exorbitant cost of healthcare, must also speak for this section of society because these poverty-stricken people have neither the resources nor the information. They are also not vocal enough to be able to project their issues.