The state’s domain:

The state’s domain: )

Context: Private healthcare in India usually offers quality service but is often expensive and largely unregulated

Introduction:

• The Niti Aayog and the Union Health Ministry have put forward a proposal to allow private entities to use the premises of the district hospitals to provide treatment for cardiac and pulmonary diseases and cancer.
• Recently, the Niti Aayog and Union health ministry have also put forward a public-private partnership (PPP) model for the management of non-communicable diseases in tier 2 and 3 cities across the country, with World Bank will be serving as a technical partner.
• The private hospitals said some provisions need to be clarified. This include the rates that can be charged to patient who aren’t covered by National Health Protection (NHPS), Rashtriya Swasthya Bima Yojana (RSBY), Central Government Health Scheme (CGHS), or state insurance schemes.
• There is shortage of infrastructure and human resources, 72% of the rural population and 79% of those living in urban areas have sought access to healthcare in the private sector.

Problems:

• The proposal to allow the private sector to run district hospitals has its risks
• The potential of India’s district hospital system to dramatically expand access to quality secondary and tertiary health care has never really been realized
• The majority of patients today use the facilities created mostly by urban hospitals.
• There are only 763 functional district hospitals, with just five states led by Uttar Pradesh accounting for over 42% of the facilities

Loopholes of private healthcare in India:

• Private healthcare of India usually offers quality service but is often expensive and largely unregulated.
• Healthcare infrastructure is insufficient to cater to the needs of all its residents.
• In India there is low health spending as compared to other countries. 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 system spend much more for example Canada and the UK spends 8% of their GDP on healthcare.
• 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 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 notified by policymakers as they are the first among equals to benefit from such policies.
• 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.
• India has set itself an unambitious target of 2.5% of GDP for distant 2025.
• The Niti Aayog said that despite there being ‘concerted efforts’ to establish services to tackle non-communicable diseases, the system remains constrained.
• There is lack of infrastructure and human resources in healthcare.
• The private sector dominates healthcare delivery across the country, a majority of the population living below the poverty line (BPL)- the ability to spend Rs 47 per day in urban areas and Rs 32 per day in rural areas-continues to rely on the under-financed and short-staffed sector for its healthcare needs, as a result of which these remain unmet.
• The majority of private healthcare professionals happen to be concentrated in urban areas where consumers have higher paying power, leaving rural areas underserved.
• India mostly compares with China and US in the number of hospital beds and nurses. The country is 81 per cent short of specialists at rural community health centers (CHCs), and the private sector accounts for 63 per cent of hospital beds, according to government health and family welfare statistics.

Solutions:

• Achieving universal health coverage
• A single-payer government –led model that mainly relies on public facilities.
• Strong oversight is also necessary to ensure that ethical and rational treatment protocols are followed in the new facilities, and procurement and distribution of drugs are centralized to keep costs under control.
• A provision for audits, penalties, and cancellation of contracts is essential.
• Given the recourse to tax funds for viability gap funding and use of public infrastructure, the operations should be audited by the Controller and Auditor General of India.

Conclusion: Low spending on heath is a major factor of governments and their employees being shielded from policies meant for the common man. Countries that have done well in providing quality care have one system for all. Therefore, there is need to boost spending on healthcare in India. The National Health Policy, 2017 advocates a positive and proactive engagement with the private sector for critical gap filling towards achieving national goals. Economists such as Adam Smith and Amartya Sen have focused on justice as equally as economics-the two being inseparable, since without justice, economies is merely budgeting devoid of ethics. There is need that India’s private sector should take effort to improve the deplorable state of healthcare services for India’s large population