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अंग्रेज़ी सीखने का अवसर (कक्षा प्रारंभ : 5 अक्तूबर, शाम 6 से 8)
Q. Private sector for public health: It is high time that government must involve private players to deliver universal healthcare. Comment
Jul 22, 2017 Related to : Paper-3

Ans :

Introduction-

The country's public spending on health is "little over" 1 per cent of GDP. Hence, involvement of private players or PPP becomes important to augment the public expenditure. Public Private Partnerships bridge the gap between the Government, policymakers, healthcare needs, and the range of public-funded services on the one side, and private/civil society providers of technical expertise on the other side. 

Analysis-

There is severe lack of resources in India. There is only one doctor per 1,700 citizens in India (1:1,000 stipulated by WHO), 1.3 beds per 1,000 populations (WHO guideline of 3.5 beds per 1,000 population). In rural areas and smaller towns of India, even basic health services remain inaccessible. This has consequences like high child and maternal mortality rates etc. 

Despite the fairly rapid pace of economic growth that India has experienced in the last 20 years, public health spending in the country is only about 1% of GDP (3% in China, 4.1% in Brazil and 8.3% in the US). Inadequate government spending on healthcare and lack of access to health insurance pushes almost 3% of India’s population into indebtedness and bankruptcy every year. To address this situation, the government needs to come forward and take proactive steps to implement a universal healthcare programme that ensures basic healthcare services for everyone with minimum financial burden being passed on to the patient.

India needs a universal healthcare programme that hinges on affordability and access. This calls for existing public health infrastructure to be revitalised, new medical centres built and modern ICT-based telemedicine technology to be leveraged for addressing the demand-supply gaps in terms of doctors and health facilities. There is an urgent need therefore for public health spending in India to be raised to at least 2.5% of GDP as well as Public Private Partnership (PPP) models in healthcare to be promoted.

The government alone cannot meet the healthcare infrastructure and capacity gaps in Tier II and Tier III cities as well as rural areas. In this context the recent NITI ayog’s model contact is a welcome step. 

According to the model contact, private hospitals bid for 30-year leases over parts of district hospital buildings and land to set up 50- or 100-bed hospitals in towns other than India’s eight largest metropolises, the district hospitals will need to share their back-end services such as blood banks and ambulance services with the private players. The state government could also provide part of the funds needed by these private players to set up the new hospitals. The district health administration will ensure referrals for treatment from primary health centres, community health centres, disease screening centres and other government health programmes and ventures are made to these private hospitals. Under the model contract, these private hospitals will provide secondary and tertiary medical treatment for cancer, heart diseases and respiratory tract ailments at prices that are not higher than those prescribed under government health insurance schemes. Beneficiaries of the government insurance schemes will be able to get treatment at these hospitals but there will be no reserved beds or quota of beds for free services. 

Though this model contract has detailed guidelines, it needs to address some critical areas. This is restricted to limited number of diseases, limited geographical reach. It has not come out with guidelines about ensuring quality of service delivery in these hospitals. Following are the some examples to fill these gaps.

 Rajasthan govt. has partnered with the private sector for running Primary Health Centres (PHCs) and sub-centres across the state. While the state government will provide the necessary infrastructure, medicines, equipment and operational costs, the private operator would provide doctors, paramedics and other staff, free outpatient services and 24-hour emergency services. These PHCs are already reporting encouraging results as the improvement in cleanliness and availability of staff and medicines have led to a jump in the number of patients being treated. 

The Yeshasvini Cooperative Farmer’s Healthcare Scheme, a PPP scheme involving Narayana Health and the Karnataka government, offers coverage of over 800 surgical procedures to farmers and their family members. Yeshasvini is one of the largest self-funded healthcare insurance schemes in the country. Andhra Pradesh runs the Arogya Raksha Scheme in collaboration with the New India Assurance Company and with private clinics. The scheme is fully funded by the government provides hospitalization benefits and personal accident benefits to citizens below the poverty line.

The mandated 2% CSR spending should be innovatively used to partner with the private sector to improve healthcare delivery in India through a combination of good infrastructure, latest technology and the best available medical expertise.


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