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Private healthcare with public money

LiveMint logoLiveMint 24-07-2017 Anupam Srivastava

Two recent developments related to public health in India hold the prospect of changing the nature of service provision for the people. Both lean heavily on the private sector in an effort to improve the deplorable state of healthcare services for India’s 1.3 billion people.

It is imperative, nevertheless, to ensure that the association with the private sector is rooted in principles of justice rather than merely financial expedience.

Delhi government policy

More than a week ago, a new policy by the Delhi government was announced which, quite unexpectedly, said that the government would pay for surgeries of private citizens conducted at private hospitals. These surgeries would be ones that the government would not be able to conduct expeditiously at its own facilities.

Private healthcare in India usually offers quality service but is often expensive and largely unregulated. The national health policy notes “growing incidences of catastrophic expenditure due to healthcare costs, which are presently estimated to be one of the major contributors to poverty”.

The Delhi government’s new scheme is a novelty for the common man but has a precedent in several government schemes for employees which use public funds to provide private healthcare.

For example, the Central Government Health Scheme (CGHS) has existed for decades and has been emulated by several states, which have floated similar schemes that discriminate between those who are employed by the state and those who are not. This is a violation of the principles of justice, and has not been noticed by policymakers as they are the first among equals to benefit from such policies.

In this context, the Delhi government’s effort is a giant leap in establishing distributive justice.

It appears, nevertheless, that while the current scheme demonstrates an increase in the government’s ambition in making quality healthcare available to people, the inception of this idea took place earlier, when the government tied up with private laboratories for tests that require expensive equipment, such as the magnetic resonance imaging (MRI) test, computed tomography (CT) scan, and positron emission tomography–computed tomography (PET-CT ) scan. There are usually long queues for these tests at government hospitals as the equipment may not be easily available or accessible.

Delhi has a population of more than 16 million and its health infrastructure is grossly insufficient to cater to the needs of all its residents.

Delhi’s public hospitals had slightly more than 10,000 beds earlier this year, which the Delhi government plans to increase to 20,000. However, it will take time for these plans to materialize, and the government has done well to rope in private entities.

Whether the recent move on offering services through private hospitals was part of the health budget of Rs5,736 crore, presented earlier this year, is not clear. However, the Delhi government needs to be mindful of the fact that implementation holds the key to universalization of such schemes.

Niti Aayog proposal

On the heels of the Delhi government’s announcement surfaced a report by NITI Aayog on the public-private partnership (PPP) model in healthcare. From the details that have emerged in newspaper reports, it appears that the government is keen to rope in the private sector to support service provision in the districts.

The PPP model, it is stated, will work alongside the public health system and will be chargeable. However, only those patients who are not covered by any government scheme will be covered by this model.

Seen through the previous lens, the proposal does not further the idea of justice. It goes against the spirit of India’s national health policy, which seeks to provide “free, comprehensive primary healthcare services for all aspects of reproductive, maternal, child and adolescent health and for the most prevalent communicable, non-communicable and occupational diseases in the population”. The policy recommends “strategic purchase of secondary and tertiary care services as a short-term measure”, but not services people would pay for.

Low health spending

India has little to show for the slightly more than 1% of its gross domestic product (GDP) that it spends on healthcare. Countries that have robust public health systems spend much more—Canada and the UK spend 8% of their GDP on healthcare. India has set itself an unambitious target of 2.5% of GDP for distant 2025.

It is deducible that the low spending on health is a factor of governments and their employees being shielded from policies meant for the common people. Countries that have done well in providing quality care have one system for all.

A grave impact of the CGHS and similar plans on public health is that India’s ruling elite do not have an incentive to improve the system as they would never use it.

A common point between the NITI Aayog proposal and the national health policy is that both support government schemes which provide preferential care to government employees in the present and future. India’s privileged elite believe they deserve quality care before others. Economists such as Adam Smith and Amartya Sen have focused on justice as equally as economics—the two being inseparable, since without justice, economics is merely budgeting devoid of ethics.

Anupam Srivastava works in the development sector.

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