Ministry, NITI Aayog moot privatisation of select services in district hospitals (NITI Aayog’s Public Private Partnership)

Ministry, NITI Aayog moot privatisation of select services in district hospitals (NITI Aayog’s Public Private Partnership)

Context

• Under proposed PPP model of NITI Aayog, private players will get 30-year leases on space in district hospitals

NITI Aayog and Health Ministry’s Stand

• As a part of a radical ‘privatisation project’, the Health Ministry and the NITI Aayog have developed a framework to let private hospitals run select services within district hospitals, on a 30-year lease.
• In consultation with the World Bank, the government will be allowing “a single private partner or a single consortium of private partners” to bid for space in district level hospitals, especially in tier 2 & 3 cities.
• Under this Public Private Partnership (PPP), care for only three non-communicable diseases — cardiac disease, pulmonary disease, and cancer care — will be provided.
• A model contract drawn up by NITI Aayog has been sent out to State giving the states a two-week window to furnish responses.

The Drafting of the Document

• The draft document was prepared by a working group comprising representatives from the industry, Health Ministry and representatives of a few states.
• According to the draft model contract, private hospitals will bid for 30-year leases over portions of district hospital buildings to set up 50- or 100-bed hospitals in smaller towns across the country.
• The State governments could lease up to five or six district hospitals within the State
• Further, the State governments will give Viability Gap Funding (VGF), or one-time seed money, to private players to set up infrastructure within district hospitals.
• The private parties and State health departments will share ambulance services, blood banks, and mortuary services.

Issues with the Drafted Model

• While it is clear that insured patients will receive free care, it is not at all clear what will happen to the vast majority of the population.
• In particular, it is not clear how the referral arrangements will be worked.
• It says that states can, if they wish, refer 100% of patients for cashless care, it is a matter of concern that it also proposes that States can set a cap on this entitlement
• But no statement has been released with regard to the execution of the same and neither any clarification has been issued that what would be the succeeding series of action once the cap is reached.
• What is particularly disturbing is the suggestion that only Below Poverty Line (BPL) patients and those in insurance schemes will be able to access free care.
• This would effectively exclude hundreds of millions of the Indian population from vital hospital services.
• Also the policy document has come under sharp criticism for the Ministry’s failure to consult with key stakeholders from civil society and academia.

Underlying Implication: NITI’s Changing Role

• The public private partnership model drafted by NITI Aayog highlights a changing role of the board.
• Health policy is a State issue in India and NITI Aayog has no standing place for the same.
• The logic behind shutting down the Planning Commission was to ensure that policies are not centralized
• NITI Aayog was to be an advisory body but here they are rushing through a policy that will essentially hand over public assets to the private sector, leading to a further dismantling of the public services available for free.