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)