Friday, August 10, 2012

Privatising health care: A planning commission proposal

The Planning Commission of India came up with a radical proposal to move the mechanism of managing and delivering primary healthcare from the government to a select network of private organisations. Though this is still a proposal and the final outcome may differ, it is a dangerous move. Of course, we agree that the current government handled system of primary health care is in shambles, but then privatisation is not the answer to improvement of services.

The Planning Commission, instead of suggesting a sustainable mechanism of improving easy accessibility to and availability of healthcare, wants the government to get out of it to a large extent. Instead, it wants the these activities outsourced to the private sector!! Nothing could go far wrong from that. Do you think any private sector healthcare provider would want to invest in remote and rural areas? The Planning Commission wants the healthcare centres modelled along the lines of those in the US and Mexico. But do you know that around 50 million people in the USA are uninsured and hence, do not have access to healthcare. That amounts to 16 % of the population in a country which is the world's largest economy. Did the concept of 'managed care' (as defined in the Planning Commission's draft) help assure access to healthcare?

The health industry in India itself is testimony to the fact that the private sector isn't interested in spreading into areas which are not financially viable. So, we see big hospital chains only in metro cities. The small towns and villages are served either by small individually operated hospitals or government ones. Of course, I am not asking super specialty facilities in every town, but that's the point. Run a search through the internet and you will find thousands of instances where private hospitals have not reserved beds for treating the poor people free of cost, despite this being mandated by law and Supreme Court judgements. And we want to leave basic health care in the hands of the private enterprise?

Another case is about drug research. The pharma industry too has been spending millions of dollars (rupees, pounds, etc.) on developing drugs that cure lifestyle diseases, but very very few are involved in discovering medicines for T.B., which kills thousands of poor every year!! This is a fact and can be searched easily on the internet. The point I am trying to make is that the private sector, by definition, will be looking to maximise its return on investment. Hence, they are not going to willingly venture into areas where they see losses or no return on capital!

We in India hail the telecom sector as an example of what privatisation achieved. Sure, we have the lowest call rates in the world, sure mobile usage has peaked and reached various corners of the country. But, this was partially fuelled by the government's decision to give spectrum at affordable cost. And still, many taluka headquarters aren't served by anyone else other than BSNL! Forget remote places, but on the popular beach of Ladghar in Dapoli (Ratnagiri, Maharashtra), the only network they ever receive is BSNL's (March 2012). Moreover, when it comes to customer service (and especially billing disputes), most readers would agree that the private sector is as good (or bad) as BSNL. So much for the private sector's achievements.

The Health Ministry has rightly torn into the Planning Commission's proposal and the furious uproar has led to the Commission saying that these are proposals and not final action plans. I hope this is not implemented. It will be the beginning of a dark era in primary health care. And till now, I haven't even talked about what the unholy nexus between private parties and those in the government can possibly do to see that the private sector is not unnecessarily burdened with the social objectives of the government. That would lead to a cheap game of playing with the lives of the vulnerable people.

I am waiting for P. Sainath to say something about this. It would turn out to be a wonderful piece by him.
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