Health emergency is the need of the hour

Governments around the world are rapidly expanding their healthcare capacity in response to this pandemic Corona and other diseases. In India, there is very little regulatory control over the private healthcare system. Of course, some states have moved in to use this private pool of hospitals. Shutting down of hospitals is no solution.

Proper nursing protocols, genuine PPE kits, ventilators, oxygen cylinders and dependable rapid tests are the urgent need of the hour. But by and large, the large pool has not been utilised. The Government of India should announce health emergency and takeover of all private hospitals in the country to fight Covid-19.

Why are the private health providers not being roped in more actively given the shortage of critical care specialists in the country? During the last four decades, the focus of the government has been on facilitating private healthcare at the cost of the public health system.

A survey conducted by FICCI shows that private hospitals and nursing homes comprise 60 per cent of the beds in India at 8.5-9 lakh and 80 per cent of the doctors in India, and cater to 60 per cent of the in-patients. As per the study, this vast network of private nursing homes and hospitals have largely shut shop during the lockdown and are incurring losses to the tune of between 14000 crores to 24000 crores.

Of course, part of the problem, corporate medical officers say, is that the cost of acquiring and maintaining personal protective equipment stocks, putting in place separate air conditioning ducts for Covid-19 patients and acquiring ventilators will run into several crores for each hospital.

The state of treatment available in public hospitals for Covid-19 patients leaves much to be desired. The patients and attendants have brought to social media to highlight the plight of government and private hospitals. Some corporate hospitals have set up separate Covid- 19 wards and are charging Rs six to 15 lakhs, sometimes which will go up if the patient is shifted to an ICU or put on ventilator support.

The recent remarkable growth of the private health sector in India has come at a time when public spending on health care at 0.9 per cent of Gross Domestic Product (GDP) is among the lowest in the world. This proportion has fallen from an already low 1.3 per cent of GDP in 1991 when the neoliberal economic reforms began.

Yet India ranks among the top 20 of the world's countries in its private spending, at 4.2 per cent of GDP. Employers pay for 9 per cent of spending on private care, health insurance 5-10 per cent, and 82 per cent is from personal funds.

As a result, more than 40 per cent of all patients admitted to hospital have to borrow money or sell assets, including inherited property and farmland, to cover expenses, and 90 per cent of labours, farmers, workers and daily wagers are driven below the poverty line by the costs of their medical care.

Despite the suspicions of the people who use the service that many private providers of health care perform unnecessary diagnostic tests and surgical procedures, Indians are choosing the private sector in overwhelming numbers. This is because the public alternative is so much worse, with interminable waits in dirty surroundings with hordes of other patients.

Many medicines and tests are not available in the public sector, so patients have to go to private shops and laboratories. Each harassed the doctor may have to see more than 100 patients in a single outpatient session. Some of these doctors advise patients, legally or illegally, to "meet them privately" if they want more personalised care.

In a recent survey carried out by Transparency International, 30 per cent of patients in government hospitals claimed that they had had to pay bribes or use influence to jump queues for treatment and for outpatient appointments with senior doctors, and to get clean bed sheets and better food in hospital.

Until about 20 years ago the private sector comprised solo practitioners and small hospitals and nursing homes. Many of the services provided were of exemplary quality, especially those hospitals run by charitable trusts and religious foundations. As the practice of medicine has become more driven by technology, however, smaller organisations have become less able to compete in the private healthcare business.

Large corporations, such as drug and information technology companies, and wealthy individuals—often from the Indian diaspora (commonly called non-resident Indians)—have started providing health care to make money.

They now dominate the upper end of the market, with five star hospitals manned by foreign trained doctors who provide services at prices that only foreigners and the richest Indians can afford. These hospitals are largely unregulated, with no standardization of quality or costs. Their success may be gauged by their large profits and ability to raise funds through foreign investments.

The medical system is failing its own people. Yet the government of India has stated: "To capitalise on the comparative cost advantage enjoyed by domestic health facilities in the secondary and tertiary sector, the policy will encourage the supply of services to patients of foreign origin on payment."

Medical tourism to India is expected to become a billion dollar business by 2020 and is starting to change the financing and regulation of certain private hospitals by encouraging private health insurance and international accreditation.

The private health sector in India has made some impressive strides but has done so at the cost of the public sector. To regulate it may be, however, just another opportunity for bureaucratic delays and corruption. A better solution might be to impose greater social accountability on private providers, making a certain proportion of private services available to the poor. The first priority must be to increase public expenditure on health care.

The government's common minimum programme promises an increase in the spending on health care from 0.9 per cent to 3 per cent of GDP in five years with a health insurance scheme for poor families. In the past two years, although expenditure on health has increased in absolute terms, the proportion of GDP it represents has declined.

The Government is receiving large number of grievances of exorbitant amount of money being charged by healthcare providers and causing hardships to the public in general during the Covid-19 pandemic. The GOI should pass an order under health emergency that Covid-19 should be treated at all private hospitals and nursing homes at free of cost.

(The authors are State President, Praja Science Vedika, Hyderabad and Assistant Professor, Institute of Public Enterprise, Hyderabad respectively)