India has achieved considerable development in its health indicators. Life expectancy has improved, infant and maternal mortality have dropped, and the coverage of most of the National Health Programmes is improved. However, this progress is irregular; there are large State-wide disparities, and performance in some States is awfully low. Lack of responsibility is troubling the Indian health system.

Prerequisite of Privatization of Healthcare in India

  • Though India has improved life expectancy and decreased infant & maternal mortality rates but there are large state-wide deviations.
  • There is a dearth of accountability in the healthcare sector which is harmful to India’s overall development.
  • The efficiency of the public health sector has been low and it is often considered one of the sick units.
  • The regulation capability of monitoring the public health system is very much
  • There is a lack of managerial expertise at the state level which has a tumbling consequence down the line.

Benefits of Privatization of Healthcare

  • The nations with a high population often profit from the privatization of healthcare policies because the government may not be able to manage the necessity in all communities.
  • Unlike government hospitals, it provides elasticity in timings to patients in terms of schedules and treatments based on the person’s work timetable.
  • It provides better quality of healthcare services as the doctor-patient ratio is less than the government hospitals and patients are given proper time for treatment from doctors.
  • The private sector can be more original as it has a wider sphere of activity and disposition to try something new which will ultimately lead to enhanced healthcare service.
  • There will be a lack of political meddling on private hospitals as compared to government hospitals but there will be a constant burden from the stakeholders to improve its efficacy.

Key Drive Areas of Healthcare PPP

  • Infrastructure Growth– Development and reinforcement of healthcare infrastructure that is evenly distributed in nature and at all levels of care.
  • Management and Operations– Management and operation of healthcare facilities for technical effectiveness, functioning economy and excellence
  • Capacity Building and Training– Capacity building for formal, informal and enduring education of professional, para-professional and ancillary staff involved in the delivery of healthcare
  • Financing Mechanism– Formation of voluntary as well as authorized third-party financing machineries
  • IT Infrastructure– Establishment of national and regional IT backbones and health data storehouses for organized access to clinical statistics
  • Materials Management– Improvement of a maintenance and supply chain for ready accessibility of functional equipment and appliances, and medical supplies and miscellanies at the point of care

Challenges associated with Privatization of Healthcare

  • Privatization will increase the gap between rich and poor which will buoy up the survival of the richest, which cannot be the goal of any cultured society.
  • The public hospitals offer sponsored and other free services which make most of the people move away from private hospitals.
  • The uninsured patients will suffer from the high costs of the treatment.
  • The lack of guidelines for private players is likely to exploit its clients and customers either economically or in the flesh.
  • There is no liability of the private sector to government regulatory board over their functioning and operations.

Measures to be adopted towards improving Healthcare Sector

  • The government should make the strategies regarding the provision of services provided, areas of association, quality of services provided, and many more such factors before choosing privatization of the healthcare sector.
  • A multidisciplinary attitude with public health experts taking the lead role can help in instituting a better healthcare environment in India.
  • States should create a health advisory committee with specialists from the faculty of public health, business management/health administration institutions, not-for-profit health NGOs, for-profit health organizations, and state health departments.
  • Block-wise examination up to sub-centre level should be done for each district in order to have a shared understanding of fortes and flaws of the health system, trigger joint action plans, reduce duplication of efforts, and optimize limited resources.
  • Computerization of the health service input and output data according to the institutions shall be a chief obligation to identify better performing institutions/individuals based upon agreed minimum pointers for reinforcing accountability in the system.
  • Separate public health care at the district level should be made with suitable possibilities for up-gradation of educational qualification to postgraduate level, i.e. Master of Public Health and MD in Community Medicine.

Way Forward

  • There should be ways and means of using the taxpayers’ money to bring the health advantage to the poorest people.
  • The goal of the private firms should not involve only money-making as their impetus for the provision of quality services but they should also focus on efficacy and effectiveness in healthcare.
  • Privatization is helpful if the structures are set properly, otherwise, it will reverse the purpose and goal of healthcare.
  • For ensuring equitable representation of both private and public sector interests, it is essential that the governing body includes members designated from the private sector also.
  • The government should study the extensiveness of the healthcare landscape and benchmark the standard with other developing and developed countries and recognize critical areas and requirements.

Public-private partnership in India:
The Public-Private Partnership Initiative (PPP) was formed in the faiths of attainment of the health-related Millennium Development Goals. In terms of importance, nearly every new state health initiative includes policies that allow for the participation of private entities or non-governmental organizations.

Major programs

  • Fair Price Shops aim to reduce the costs of medicines, drugs, implants, prosthetics, and orthopedic devices. Currently, there is no competition between pharmacies and medical service stores for the trade of drugs. Thus, the price of drugs is uninhibited. The Fair Price program creates a bidding system for cheaper prices of medicines between drugstores and lets the store with the greatest price cut to sell the drug. The program has a minimal cost for the government as fair price shops replaced drugstores at government hospitals, thus removing the need to create the new groundwork for fair price shops.
  • The largest division of the PPP resourcefulness is the tax-financed program, Rashtriya Swasthya Bima Yojana (RSBY). The scheme is bankrolled 75% by the central government and 25% by the state government. This program aims to reduce medical out-of-pocket costs for hospital treatment and does so by repaying those that live below the poverty line. RSBY covers a maximum of 30,000 rupees in hospital costs, including pre-existing conditions for up to five members in a family. In 2015, it reached 37 million households comprising of 129 million people below the poverty line. However, a family has to pay 30 rupees to enroll in the program. Once deemed eligible, family members receive a yellow card.
  • Finally, the National Rural Telemedicine Network links many healthcare institutions together so doctors and physicians can participate in diagnosis and consultations. This decreases the non-medical cost of conveyance as patients do not have to travel far to get specific doctor’s or specialty’s opinions.

Effectiveness:

  • The effectiveness of public-private partnerships in healthcare is fiercely uncertain. Critics of PPP are concerned of its exhibition as a cure-all solution, by which the health infrastructure can be improved. Proponents of PPP claim that these partnerships take advantage of the existing structures in order to provide care for the underprivileged.
  • The results of the PPP in the states of Maharashtra and West Bengal demonstrate that all three of these programs are effective when used in combination with federal health services. They contribute in filling the gap between outreach and affordability in India.
  • A case study of tuberculosis control in rural areas, in which PPP was utilized showed limited success; while the program was reasonably effective, a lack of liability forced the program to shut down. Similar issues in culpability were seen by the parties involved within other PPP schemes. Facilitators and private specialists, when asked about PPP, recognized lack of state support, in the form of acceptable funding, and a lack of organization, as primary reasons why PPP ventures are ineffective.
  • In the most successful PPP ventures, the World Health Organization found that the most noticeable factor, aside from financial support, was possession of the project by state and local governments. It was found that programs supported by the state governments were more effective in attaining health goals than programs set by national governments.
  • India, set up a National Telemedicine Taskforce by the Health Ministry of India, in 2005, gave way for the realization of various projects like the ICMR-AROGYASREE, NeHA and VRCs. Telemedicine also helps family physicians by giving them easy access to speciality doctors and helping them in close monitoring of patients. Even though telemedicine cannot be a resolution to all the problems, it can surely help reduce the burden of the healthcare system to a great extent. India has grown to see numerous Telemedicine organizations like the ApolloAsk, Practo, TeleDoc, DocInsta, etc. in recent years.