{"id":35705,"date":"2018-11-01T11:27:48","date_gmt":"2018-11-01T05:57:48","guid":{"rendered":"https:\/\/blog.forumias.com\/?p=35705"},"modified":"2018-11-01T11:27:48","modified_gmt":"2018-11-01T05:57:48","slug":"a-strange-hybrid","status":"publish","type":"post","link":"https:\/\/forumias.com\/blog\/a-strange-hybrid\/","title":{"rendered":"A strange hybrid:\u00a0"},"content":{"rendered":"<p><a href=\"http:\/\/indianexpress.com\/article\/opinion\/columns\/niti-aayog-a-strange-hybrid-public-hospitals-government-4791233\/\" target=\"_blank\" rel=\"noopener\">A strange hybrid<\/a>:<\/p>\n<p><strong>Context:<\/strong><\/p>\n<p><span style=\"font-weight: 400;\">The \u00a0Niti Aayog is all set to push states to privatise well functioning district hospitals in the Tier 2 and 3 cities like Pune, Baroda, Visakhapatnam, Madurai and so on.<\/span><\/p>\n<p><strong>Introduction:<\/strong><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">The proposed model consists of leasing out for 30 years a portion of the hospital to a private company to provide treatment for the three diseases \u2014 cardiology, cancer and pulmonology \u2014 that account for 35 per cent of mortality in India.<\/span><\/li>\n<li><span style=\"font-weight: 400;\">It\u2019s a strange hybrid that has no precedent anywhere in the world and can be called strategic, bizarre or hare-brained depending on which side of the equation you are on.<\/span><\/li>\n<\/ul>\n<p><strong>Objectives:<\/strong><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">The intention of the proposal, to hive off 60,000 sq ft of the hospital and vacant land, if any, to a private investor, is to attract private capital through equity and venture funds to build the required infrastructure to world class standards.<\/span><\/li>\n<li><span style=\"font-weight: 400;\">The private entity will have its own staff and personnel, laboratories, <a href=\"http:\/\/rxshop.ru\/\">pharmacy store<\/a>, ambulances and common services like cafeteria and bookshops down to the ATM.<\/span><\/li>\n<li><span style=\"font-weight: 400;\">It will have an assured market, access to all confidential records and information and freedom to charge user fees.<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Complicated cases will, however, be referred to bigger hospitals \u2014 their own or of government<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Government reimbursements for patients referred to them will be on par with rates paid under the CGHS or the state-sponsored insurance scheme, if any.<\/span><\/li>\n<li><span style=\"font-weight: 400;\">A grievance redressal mechanism is proposed.<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Overall accountability is confined to submitting some annual reports to the government.<\/span><\/li>\n<li><span style=\"font-weight: 400;\">In case of any violation of conditions, the government will need to seek judicial relief.<\/span><\/li>\n<li><span style=\"font-weight: 400;\">The rationale for coming up with this hybrid model is the fact that these three diseases do account for almost 35-40 per cent of total mortality in the country.<\/span><\/li>\n<\/ul>\n<p><strong>Key points:<\/strong><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">India has a plethora of PPPs in health, starting with handing over free land and extensive custom duty waivers for imported equipment, to \u201cstrategic partnerships\u201d under which public hospitals have been handed over to large corporate, outsourcing of diagnostics and dialysis units and so on.<\/span><\/li>\n<li><span style=\"font-weight: 400;\">The largest PPPs are however, under the government sponsored insurance schemes where treatment costs for eligible patients are reimbursed by government at agreed package rates that have, however, witnessed steady increases as have premiums.<\/span><\/li>\n<\/ul>\n<p><strong>Challenges:<\/strong><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">The challenge in the Niti Aayog hybrid model is its implementation.<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Every day, there are instances of patients being denied treatment in private hospitals till payment is made or preferring paying patients to the government insured ones or levying additional charges in addition to the sum reimbursed.<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Private hospitals are also known to overcharge devices like stents and drugs that are the key revenue earning centres.<\/span><\/li>\n<\/ul>\n<p><strong>Soultions:<\/strong><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">The Aayog could easily have come up with a soundly argued, evidence-based white paper on the need for hospital reform, providing various options with fiscal implications.<\/span><\/li>\n<li><span style=\"font-weight: 400;\">The model does not provide any information on the pricing strategy and its impact on public budgets.<\/span><\/li>\n<li><span style=\"font-weight: 400;\">The CGHS is an imperfect instrument to rely upon as the rates fixed under that programme are based on tenders.<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Prices quoted, therefore, include cost of capital, liabilities and profit. Since under the Aayog model, several \u201ccosts\u201d are being subsidised, rates charged ought to be half of the CGHS rates.<\/span><\/li>\n<\/ul>\n<p><strong>Conclusion:<\/strong><\/p>\n<p><span style=\"font-weight: 400;\">The Niti Aayog proposal has a sound rationale but the design is fraught with adverse implications for the existence of public hospitals that are a refuge for the poor. In the absence of government as the monopoly purchaser, such a hybrid model will be a challenge.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Niti Aayog need to consult, listen, collect evidence, analyse, understand and reflect, not prescribe based on the advice of the World Bank and a few interested corporate houses.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>A strange hybrid: Context: The \u00a0Niti Aayog is all set to push states to privatise well functioning district hospitals in the Tier 2 and 3 cities like Pune, Baroda, Visakhapatnam, Madurai and so on. Introduction: The proposed model consists of leasing out for 30 years a portion of the hospital to a private company to&hellip; <a class=\"more-link\" href=\"https:\/\/forumias.com\/blog\/a-strange-hybrid\/\">Continue reading <span class=\"screen-reader-text\">A strange hybrid:\u00a0<\/span><\/a><\/p>\n","protected":false},"author":61,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"footnotes":""},"categories":[555],"tags":[],"class_list":["post-35705","post","type-post","status-publish","format-standard","hentry","category-test-1","entry"],"jetpack_featured_media_url":"","views":{"total":0,"cached_at":"","cached_date":1704856676},"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/posts\/35705","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/users\/61"}],"replies":[{"embeddable":true,"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/comments?post=35705"}],"version-history":[{"count":0,"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/posts\/35705\/revisions"}],"wp:attachment":[{"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/media?parent=35705"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/categories?post=35705"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/tags?post=35705"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}