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Tuesday, October 24, 2017

Risky proposal

Saturday, 12 August 2017 11:48
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Indian healthcare system that was designed to dramatically expand and provide access to common masses to quality secondary and tertiary medical needs has not come up to the mark during the past 70 years. This is despite the fact that medical advancements have failed to percolate down to the common citizens even when the central government launched a scheme for providing healthcare facilities at the door steps of the people in rural and urban areas. This is the reason that majority of patients today use the facilities created mostly for profit urban hospitals shelling out their hard-earned money. Even the poor people are forced to avail the private medical facilities when they are disappointed by the state-run hospitals. Now the proposal of the NITI Aayog and union health ministry to allow private sector to use the premises of the district hospitals to provide treatment for cardiac and pulmonary diseases and cancer is likely to upset that asymmetry, though in small part. A quick scaling up of the medical care for non-communicable diseases is possible under the arrangement since there are over 750 functional district hospitals with just five states led by the most populated Uttar Pradesh, accounting for over 42 percent of the facilities in the country. But sourcing out of services in the unregulated and mainly commercial private system is fraught with dangers. The previous moves in some of the states have been opposed not only by the concerned citizens but also by the doctors working in the government-run hospitals. Under the existing arrangement, doctors in the government hospitals have been providing medical facilities to the poor masses despite the fact that there has not been a big hike in the budgetary allocations for this sector. One major concern in such an arrangement has been to ensure that the bulk of the health spending goes into actual medical care provisioning and capping the administrative expenditure under the contract. Moreover, in consonance with the goal to provide health for all under the National Health Policy, medical care should be universal, and free at the point of delivery. A market-driven approach to providing district hospital beds for only those with the means would defeat the basic objective. Instead of sourcing out the medical services to the private entities, the central government should aim at consolidation of the existing healthcare network across the country so that improvements can made for the welfare of the common masses. In the socialist system, the centre needs to pay attention to increased financial allocations so that the deficiencies in the existing network are removed. Providing 50 or 100 beds in a district hospital may expand access to care, but such arrangements do not offer a cure for the larger problem of the growing non-communicable disease burden. Lifestyle choices and social determinants, such as tobacco and alcohol use, and environmental pollution, are often linked to such diseases. Controlling the epidemic, therefore, also requires other policy approaches. Given the already high prevalence of cardiac and pulmonary conditions, some arising from diabetes and hypertension, and cancers, having more beds for treatment is a necessity. It is incongruous, however, to opt for contracts of 30 years, given the move towards achieving universal health coverage and, aspirationally, a single-payer government-led model that mainly relies on public facilities. Strong regulation is also necessary to ensure that ethical and rational treatment protocols are followed in the new facilities, and procurement and distribution of drugs are centralised to keep costs under control. Ultimately, the success of such systems depends on medical outcomes on the one hand, and community satisfaction on the other. Both dimensions must find place in a contract, and be assessed periodically. In fact, the government should concentrate on regulation of the existing private hospitals, which have been fleecing the patients. 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 Comptroller and Auditor General. This will ensure that public funding is not used by the contractual private entities for their own profits.


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