Differing priorities

Privatisation of district hospitals under NITI Aayog proposal is not the ideal solution for the problem of providing free universal healthcare

The NITI Aayog has come out with a plan to hand over district hospitals to the private sector. According to them, this has been done "to fill the gaps in medical education as the government does not have enough resources and finances to provide medical education. This will be done by combining the strengths of the public and private sectors. Accordingly, a scheme to link new hand or existing private medical colleges with functional district hospitals through Public-Private Partnership (PPP) would augment medical seats and also rationalise the costs of medical education".

To achieve this, the NITI Aayog has developed a concession agreement under which concessionaire shall design, build, finance, operate and maintain the medical college and also upgrade, operate and maintain the associated district hospital. The medical college will admit a minimum of 150 students annually. The government will provide land on lease to concessionaire as per clause 10.1 of the NITI Aayog document.

Out of the 750 mandatory beds in the hospital, 300 beds plus 20 per cent of the remaining beds shall be for free patients and for which treatment shall be provided free of cost. This would mean that around forty-five per cent of beds will be free, while for other beds, the charges will be levied as per the medical market rates. The concessionaire will also be required to implement all the national or state level health care programs.

According to the article 22.2.1, the concessionaire shall provide health care services in two categories, the free patients and the paid patients. The category of free patients shall be determined by a representative of the designated authority. Any patient approaching the district hospitals for availing health services as a free patient will have to procure an authorisation certificate from this designated officer in accordance with clause 22.2.

As per clause 23.4, the concessionaire shall ensure that the outpatient health care services are provided free of cost to the patients. It will also be mandatory to provide the drugs listed in the national list of essential medicines free of cost to the patients falling in the free patient category.

All the above clauses need a critical review. There are already instances where the government has given land on lease at throwaway prices to the private sector. There have also been agreements that a stipulated number of patients will be given free treatment in lieu of the land allotment. But this has hardly been followed by these hospitals. There is no independent audit to ascertain this. Since these private medical facilities are not covered under the RTI Act, it is not possible to find out the exact situation.

Till date, all the patients attending the district hospitals run by the government are entitled to free medical care. But now, the number of patients for such entitlement will be reduced to less than half. Since the patient seeking free medical care will have to get authorisation from the designated officer, this will mean that the people from already marginalised sections will have to beg for the free treatment and make several rounds to the designated officer. It will be at his/her whims as to whether free treatment is granted or not. In the not so transparent system prevailing in our country, there are many chances for malpractices to occur.

Medical education is already very expensive and out of reach of the majority of deserving candidates. The addition of so many colleges in the private sector will lead to further exclusion of such students.

It would be naïve to expect the private sector to participate in the National Health Programmes. The track record of the private sector speaks of this. Despite spending crores of rupees on the Revised National Tuberculosis Control Programme (RNTCP) through the Indian Medical Association (IMA), the active participation of the private sector was hardly seen. Such programmes are both for prevention and curative treatment. The database collected in such programmes helps in planning the health programmes in future. More dependence on the private sector will be detrimental to our healthcare delivery planning.

Healthcare delivery system in our country is already in shambles. Because of very minimal spending on healthcare by the government, the patients have to shelve money for treatment from their pockets. This is pushing 6.3 crore people below the poverty line every year. The utilisation of private sector has been observed more often in diseases such as cancers, accidents, heart disease, and other non-communicable diseases (NCDs). People use public sector for communicable diseases, obstetrics and gynaecology-related needs.

In the absence of growth of the public sector, the private health sector has mushroomed rapidly, though in an unregulated manner, to meet the growing needs for NCDs. The NITI Aayog's scheme to give district hospitals to the private sector will give a further push to the private sector profit. Without increasing and updating the government spending on health care, rather handing over district hospitals to the private sector at throwaway prices, will only benefit the latter.

Global experience has shown that dependence on curative care does not sort out the healthcare problems. The district hospital is the centre of planning and provision of preventive treatment. Strengthening of primary health care is the only way to have Universal Health Care. To expect the private sector to do this job is a completely misplaced option. The public health spending has to be increased to a minimum of 2.5 per cent immediately, followed by raising it to 6 per cent in subsequent years.

Expensive medical education coupled with expensive healthcare delivery system under the PPP mode will make healthcare even more expensive. 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. But by handing over its own hospitals to the private sector, the government has decided to completely wash off its hands from this responsibility. It has to be realised that health is not a business but a service, not a liability but an asset and an essential component for the nation's development.

Views expressed are strictly personal

****Photo Caption: Expensive healthcare treatments in India push 6.3 crore people under the poverty line every year****

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