Eluding responsibilities

The Punjab government, through a public notice given in the newspapers, has invited expression of interest from private NGOs, doctors or others for providing services in the government hospitals and running of health institutions situated in difficult areas. This has drawn a sharp reaction from various sections in the state, including medical organisations, civil society groups and political parties. Such a decision by the Punjab government to hand over hospitals under its care to the private sector will have a detrimental impact on health services in the state. It will escalate the cost of treatment and increase out of pocket expenditure on health. Public health spending by the government in the state is already very low. The state has more of curative-oriented healthcare. Public spending on preventive healthcare is only around 8 per cent compared to the recommendation of the National Health Policy document 2017, which says that more than two-thirds of the resources should be allocated for primary care. Therefore, because of obvious reasons of lack of proper nutrition, lack of clean drinking water supply and sewerage facilities and absence of proper housing, poor households have to bear the catastrophic expenditure on healthcare.

The research papers titled Health-care utilisation and expenditure patterns in the rural areas of Punjab, India published in J Family Med Prim Care and Sub-national health accounts: Experience from Punjab State in India have brought forward some relevant points and made recommendations to improve the healthcare in the state. The total health expenditure of Punjab is around 4.11 per cent of Gross State Domestic Product (GSDP). The share of public health expenditure is less than one-fourth of this. The out of pocket expenditure by the patients is more than 76 per cent. People have to shelve from their pocket to get healthcare, the cost of which has gone high after an increase in the non-communicable diseases for which they go to the private sector.

More than 10 per cent of the household expenditure on health is considered catastrophic. In the above studies, it was found that catastrophic expenditure was incurred by 7 per cent of the households while seeking outpatient care and by 53 per cent while seeking inpatient care. Catastrophic expenditure was more often borne by households in poorer quintiles. About 23.3 per cent of outpatient and 59 per cent of the inpatient health-care expenditures were financed through borrowings or from other sources such as the sale of assets suggesting financial hardship in meeting health expenses. Need to borrow even for outpatient health care was higher in the poorer household expenditure quintiles. In rural Punjab, a 67 per cent increase in poverty was estimated to be due to out of pocket expenditure.

Global experience has shown that dependence on curative care does not sort out our healthcare problems. Spending more on preventive aspect is, therefore, needed. The public health spending thus has to be increased to a minimum of 2.5 per cent. Availability of medicines in public healthcare facilities should be ensured as a major chunk of expenses is incurred on purchasing medicines.

The retraction by the Health Minister after public outcry that there is no such plan to hand over government hospitals to the private sector is to be viewed with scepticism. He said that this was to strengthen the public health system by inviting private specialists to give healthcare in the government hospitals and that this could be a trial in a few selected hospitals. The excuse that the government has a dearth of doctors and, therefore, the need for a public-private partnership is not a correct understanding. It is due to lack of facilities and infrastructure in the state hospitals that many doctors trained in various specialities do not opt for state services. After all, they want to utilise their talent to the best of their ability. This is just an alibi to hand over public sector facilities to the private sector. Handing over state sector hospitals for better services has already been experimented and failed in the state of Bihar. Medical education forms the basis of training doctors. Due to exorbitant fees in the private medical colleges in the state, many deserving students cannot get admission in the medical course. Last year when some private medical colleges increased tuition fees arbitrarily, the minister stood with them and supported their increase in fees. This has already put much burden on the medical students and their families. Expensive medical education coupled with expensive healthcare delivery system under the PPP mode will make healthcare even more expensive.

It is important to control corruption in the healthcare system rather than handing over the government hospitals to the private sector. The corporate sector would jump into this and will further enhance the atmosphere to unaffordable healthcare. The statutory and regulatory bodies should be strengthened to control the unfair happenings in the healthcare and check the prices of drugs and medical devices.

It is the duty of the government to provide healthcare to its citizens. India is a signatory to the Alma Ata declaration for universal healthcare and is thus bound by this international treaty. However, successive governments have failed to keep their promise. But by handing over its own hospitals, the state government has completely washed off its hands from its responsibility.

(The views expressed are strictly personal)