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% of gross domestic product (GDP) is among the lowest in the world and ahead of only five countries—Burundi, Myanmar, Pakistan, Sudan, and Cambodia. This proportion has fallen from an already low 1.3% 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% of GDP. Employers pay for 9% of spending on private care, health insurance 5-10%, and 82% is from personal funds. As a result, more than 40% of all patients admitted to hospital have to borrow money or sell assets, including inherited property and farmland, to cover expenses, and 25% of farmers 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 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% 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.
In this time when Govt has its own limitations for improved investment in public health sector and on other hands India is home to most of the malnourished people, TB patients, AIDS patients, cancer patients and all other vector and non-vector born diseases. The health sector is mostly depended on private health care hence the same needs to be organised and regulated. Followings are few measures which can be implemented by GoI for organisation and regulation of private health care system in India:-
Monitoring of cases
Government of India should implement the digital services for monitoring the cases by use of information technology. It should be mandatory to register all cases in private health sectors on a common e-platform for creating a healthy and realistic database. Use of Aadhaar should be made mandatory to avoid pilferage by private sector for financial gains. GoI shoukd develop pan India e-platform for monitoring of cases specially the serious and life threatening cases . This will help in:-
(a) Monitoring of individual medical sector data for improvement in public health sector.
(b) Monitor the health of private health care system in India.
(c) Monitoring of Medical tourism in India.
(d) Filtration of concentration of specific diseases for treatment in private Vs public health centres.
(e) To find out the backward areas for lack of private health care.
Regulation of cost for life saving treatments
Presently people have no choice than to approach private sector for treatment for serious life saving treatments due to obvious reason that is lack of faith in public health care and absence of proper public health care system. Private health care system is using this opportunity to make medical field one of the lucrative business opportunities and people are forced to spend their earnings in this field. India where almost 40% people strive to get good food for three meals there is no question of spending their earning on better education and they have no option for health. 40% of the people have to borrow money to get treated in private hospitals and their generations suffer for the debts.
GoI should regulate the prices of minimus life saving treatments in private sector and formulate a cap on pricing based on average of generic medicine and private midicines available in market.
This will save almost millions of lives of poor and marginalized people directly and millions of their dependents indirectly.
India lives in villages even after seven decades of independence. Most of the rural sector is deprived of proper public health care and millions of lives are lost every year. People are dependents on self made doctors in villages who are mostly GNM on paper without proper training and practice. PHS are available on paper and doctors and nurses are even not reported on duty for 30% time.
Rajasthan Govt has initiated bio-metric attendance which has resulted in availability of health practitioners in rural areas. However the lack of knowledge, training, medicine and right attitude of bureaucracy is affecting the health of rural sector.
For regulation of rural health sector, GoI or the respective state Govt must make a concept of Para-Medical facilities. The details are as below:_
- Create Medical store cum tele/video conference system at every Panchayat level.
- Give CSR (Corporate social responsibility) to private sector to adopt one panchayat by a 40 bedded private hospital.
- Make all mandatory medicines available with Para Medical store with online updation of inventory to avoid stock-outs and pilferage.
- Weekly schedule for specific treatments by specialists doctors.
- Maintenance of online records with Aadhaar details for future reference and R&D.
This will address the approach of health facilities to far remote areas for essential medical facilities.
Finally , health, sanitation, drinking water and education are the basic needs of the people and Govt should come forward to improve the public health care system and better manage and regulate the private health care system. This will be a welcome step towards achievement of sustainable development goals by 2030 also.
Artical by Aman Choudhary