By Dr Arun Mitra
The
Punjab government through a public notice given in the newspapers has invited
expression of interest from private NGOs, doctors or others for providing
services in the government hospitals and running of health institutions
situated in difficult areas. This has drawn sharp reaction from various
sections in the state, including medical organizations, civil society groups
and political parties. Such a decision by the Punjab government to hand over
hospitals under its care to the private sector will have serious detrimental
impact on health services in the state. It will escalate the cost of treatment
and increase the out of pocket expenditure on health. Public health spending by
the government in the state is already very low. The state has more of a
curative-oriented healthcare. Public spending on preventive healthcare is only
around 8 percent compared to the recommendation of the National Health Policy
document 2017, which says that more than two-thirds of the resources should be
allocated for primary care. Therefore, because of obvious reasons of lack of
proper nutrition, lack of clean drinking water supply and sewerage facilities
and absence of proper housing, poor households have to bear the catastrophic
expenditure on healthcare.
The
research papers titled ‘Health-care utilization and expenditure patterns in the
rural areas of Punjab, India’ published in J Family Med Prim Care and
‘Sub-national health accounts: Experience from Punjab State in India’ have
brought forward some relevant points and made recommendations to improve the
healthcare in the state. The total health expenditure of Punjab is around 4.11
percent of Gross State Domestic Product (GSDP). The share of public health
expenditure is less than one-fourth of this. The out of pocket expenditure by
the patients is more than 76 percent. People have to shelve from their pocket
to get healthcare, the cost of which has gone high after increase in the
non-communicable diseases for which they go to private sector.
More
than 10 percent of the household expenditure on health is considered as
catastrophic. In the above studies it was found that catastrophic expenditure
was incurred by 7 percent of the households while seeking outpatient care and
by 53 percent while seeking inpatient care. Catastrophic expenditure was more
often borne by households in poorer quintiles. About 23.3 percent of outpatient
and 59 percent of the inpatient health-care expenditures were financed through
borrowings or from other sources such as sale of assets suggesting financial
hardship in meeting health expenses. Need to borrow even for outpatient health
care was higher in the poorer household expenditure quintiles. In rural Punjab,
67 percent of increases in poverty were estimated to be due to out of pocket
expenditure.
Global
experience has shown that dependence on the curative care does not sort out our
healthcare problems. It is, therefore, needed to spend more on preventive
aspect. The strengthening of primary health care is the only way to have
universal healthcare. The public health spending thus has to be increased to
minimum of 2.5 percent immediately followed by raising it to 4 percent in
subsequent years. Availability of medicines in public healthcare facilities should
be ensured as major chunk of expenses is incurred on purchasing medicines.
The
retraction by the Health Minister after public outcry that there is no such
plan to hand over government hospitals to the private sector is to be viewed
with skepticism. He has said that this was to strengthen the public health
system by inviting private specialists to give healthcare in the government
hospitals and that this could be a trial in a few selected hospitals. The
excuse that the government has a dearth of doctors and, therefore, need for
public private partnership is not a correct understanding. It is because of
lack facilities and infrastructure in the state hospitals that many doctors
trained in various specialties do not opt for state services. After all they want
to utilize their talent to the best of their ability. This is just an alibi to
hand over public sector facilities to the private sector. Handing over state
sector hospitals for better services has already been experimented and failed
in the state of Bihar. Medical education forms the basis of training of
doctors. Due to exorbitant fees in the private medical colleges in the state
many deserving students cannot get admission in the medical course. Last year
when some private medical colleges increased tuition fees arbitrarily the
minister stood with them and supported their increase in fees. This has already
put much burden on the medical students and their families. Expensive medical
education coupled with expensive healthcare delivery system under the PPP mode
will make healthcare even more expensive.
It is
important to control corruption in the healthcare system rather than handing
over the government hospitals to the private sector. The corporate sector would
jump into this and will further enhance the atmosphere to a unaffordable health
care. The statutory and regulatory bodies should be strengthened to control the
unfair happenings in the healthcare and check the prices of drugs and medical
devices.
It is
the duty of the government to provide healthcare to its citizens. India is
signatory to the Alma Ata declaration for universal healthcare and is thus
bound by this international treaty. However, successive governments have failed
to keep their promises. But by handing over its own hospitals the state
government has completely washed off its hands from its responsibility. (IPA Service)
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