Progressive public-private partnership must to make India's healthcare robust, effective
Seethalakshmi S
With a pathetic public health system, around 70% of India’s population look to the private sector for their healthcare needs. Sadly, the public-private relationship has never been on a healthy partnership mode. It’s time the government took along the private hospitals and work towards making India one of the best health systems in the world.
Patna’s Nalanda Medical College and Hospital, one of the largest government-run facilities in Bihar, had the body of a Covid-19 victim lying on a hospital bed in a room filled with other coronavirus patients. And for a full 24 hours. It was only after a doctor on duty alerted hospital authorities that the body was removed.
The scene was no different down South in ‘progressive’ Karnataka where pigs roamed freely inside the hospital premises even as doctors went about treating Covid-19 patients.
This at best describes the state of public health facilities in a country of 130 crore people hit by a pandemic.
The reasons were not too far to seek. India currently spends cumulatively 4.2% of its GDP on healthcare with the government’s contribution being just over 1%, among the lowest anywhere in the world. Countries like Canada and Britain spend about 10% of their GDP. Even the projected government’s contribution by 2025 (at 2.5%) is unlikely to significantly change the way poor get healthcare in the country.
After seven decades of independence, the poor in India struggle to get basic healthcare. And, the sector stood exposed by Covid-19 with our fragmented public health systems facing near collapse.
Not surprisingly, in March 2020 when the viral outbreak started spreading rapidly, governments scrambled to get adequate ventilators, beds and even personal protective gears (PPEs) for doctors and other paramedical staff as the numbers began to soar.
With doctor shortage in most of the district government hospitals, the poor ran from pillar to post for treatment.
So, why does a country where private players dominate the healthcare sector collapse when a pandemic arrives? Why do the country’s middle class and poor struggle to get good medical care when India is home to some of the best hospitals and doctors? Why have successive governments turned a blind eye to the private sector capabilities and outcomes which are on a par and sometimes better than many international hospitals?
Health policy analysts say there is no cohesive collaboration between the government and the private healthcare players. The government competes instead of collaborating with the private sector and the relationship has never been on a partnership mode, complementing each other.
And at the core of the problem lies the cost of medical care in India. With huge investments required, private players naturally look for returns on their investments and price healthcare at a premium. With no investments in the public health systems, the successive governments expect these private hospitals to treat the poor for free.
Leading medical practitioners have been pestering successive governments to do the costing and then prescribe or fix rates. Break down the per day cost of staying in a private hospital ICU, add all the ingredients for the stay and arrive at a cost which is acceptable to both the private sector and the government. In the absence of this exercise, it is wrong to conclude if the cost of treatment is fair or unfair. Little wonder that the friction between the government and private healthcare sector never ends.
Like Bihar’s Nalanda Medical College & Hospital, most government hospitals in India stare at lack of basic facilities for the sick. With no universal health insurance, the out-of-pocket expenses for the middle class is the highest in India. Going to a private hospital with a major illness can wipe out a family’s lifetime savings.
In Canada, the government finances health insurance, and the private sector delivers a majority of care. The government ends up paying for about 70% of healthcare spend. In the UK’s healthcare system, government spending accounts for 80% of the entire healthcare spending. It not only finances care, but also provides it through the National Health Service.
Singapore, France, Australia - all these countries have an effective health system and a structured health insurance for the citizens.
In all these countries, the dependency for citizens on private hospitals is minimal unlike India where dependency is nearly 70%. In India, the trust in getting cured at a government hospital is lowest and predictably so.
In spite of this reality staring at them for decades, a majority of the state governments believe in holding the gun against the private hospitals and refuse to sit-across-the-table to talk to them. Hospitals argue that unless their bills are settled they cannot re-invest in providing good quality healthcare. The maintenance costs of some of the high-end medical devices in private hospitals runs into crores of rupees.
Yes, regulations must be in place. When a private hospital overcharges a patient, it should be punished. But for that the right costs for different kinds of care must be fixed. What is right for the private sector is not right for the government that continues to focus on cheap care for high number of patients. Also, it’s important to take medical negligence seriously and amend the laws to make it stricter (eg. the US where the fines are heavy if the doctor or hospital management has erred). But these regulatory moves cannot be coated with vested interest. For instance, if a minister or a politician does not favour a particular hospital, he cannot bring a law for all hospitals. Put mechanisms in place to monitor them, but professionally.
Time has come for the government to work hand-in-hand with the private sector. Time has come for the government to align its goal to provide quality healthcare for all (irrespective of their economic status) and urgently build an equitable health system. Covid-19 should be a turning point in India’s health policy making. It is high time the hand-shake between the private healthcare sector and the government happens so that the poor in India have easy access to world class medical care.
Seethalakshmi S is Director (Policy & Strategy) at The Institute for Policy Research - A Centre for Multidisciplinary Studies, Bengaluru
Reach out to the author at: seethalakshmi@theipr.org