How Government And Private Sector Can Come Together To Give India The Healthcare Sector It Needs
India's way forward is unleashing government spending in basic healthcare and unshackling of India's private workforce in advanced healthcare.
That 'Healthcare is a fundamental right' — has been a rallying point, across the political spectrum.
From Ted Kennedy to Barack Obama, everyone found it easy to articulate their political support for universal healthcare as a fundamental birthright. Barring few notable exceptions, affordable and universal healthcare has been an all elusive dream.
Covid-19 has reinvigorated our quest for universal, affordable healthcare. While most people believe that our healthcare system crumbled in this pandemic, this is an overly simplistic view. Covid-19 just exposed the vulnerabilities in our healthcare infrastructure. For people working in government setups, it was not surprising to witness the chaos during the peak of the pandemic in India.
As the dictum goes, 'Never miss a crisis for bringing in reforms' — owing to which it is amply clear that healthcare reforms are long overdue.
We owe it to ourselves.
That government spending on healthcare has been abysmal is an understatement. With less than 5 per cent budgetary allocation over decades, the government has virtually declared that healthcare is not a state responsibility.
Unlike other sectors, the privatisation of the healthcare system happened way before 1991 in India. Surprisingly, this drive of privatisation occurred with the government's connivance.
Small, private nursing homes mushroomed all across India. Eight-10 bedded hospitals with a 10-12 member staff payroll, and with a known and trusted doctor, served as the bedrock of our Indian healthcare system.
Also at the heart of our healthcare system were scores of trusted and competent general practitioners who became a part of extended families.
In my opinion, classifying medical practice as 'service' under the ‘Consumer Protection Act’ and labelling doctors as 'service providers' has changed the dynamics of the doctor-patient relationship.
A relationship founded on trust has now become a game of courtroom trials. In my opinion, certain judgements passed by consumer fora which ventured to opine on medical decision-making are classic cases of judicial overreach.
India can ill-afford to scare away private doctors who account for the majority of our healthcare system. The dying GP practice and shutting down of small nursing homes will be yet another blow to India's fragile healthcare system.
The Indian healthcare system has seen a flood of corporate investment in the last two decades. For once, I do believe that corporate investment in healthcare should be welcomed because it brings efficiency and quality healthcare.
A metropolitan city like Mumbai, which has five government/state-run medical colleges couldn't have managed Covid care without the enthusiastic involvement of corporate private hospitals.
I feel we need to make a distinction between basic healthcare and advanced healthcare. Corporate investments in advanced healthcare are needed. A treatment modality like ECMO (Extracorporeal Membrane Oxygenation) which has gained currency during the Covid-19 episode is a costly affair, costing around 1 lakh per day.
Its cost makes it inaccessible to the vast majority of our population. Similarly, research and manufacturing of newer monoclonal antibodies requires a lot of research input cost. Corporate healthcare investment in these areas should be welcomed.
The cost of any new modality of treatment comes down over time. It follows its journey from being a luxury to an essential good. While crony socialists may disagree, the cost of healthcare cannot defy the laws of economics.
Government involvement in nutrition, vaccination, and healthcare education programmes has been very fruitful. The seamless Covid-19 vaccination drive is not an overnight success. It's the result of years of institutional experience in handling vaccination programmes.
The government has its core-competencies and the private healthcare has its own. Covid-19 was a public health emergency, for which India had to look up to the private system.
India's low Covid-19 figures are a testament to our army of family physicians and small nursing homes. India's 'silent majority' trusted private setups for its Covid-19 treatment and it trusts the government for vaccination.
As we stand today, our healthcare system is undergoing a sea change. I firmly believe that basic healthcare should be driven by the government and advanced healthcare should be driven by the private sector.
Interfering in each other's areas of expertise is a recipe for disaster. India's socialistic obsession with price control hasn't translated into quality healthcare either. It has translated into inferior quality control.
As Former US President Ronald Reagan put it, "The government is not the solution to our problem. The government is the problem."
I believe that line encapsulates why the government must resist its instincts to regulate private healthcare systems. In the absence of massive government spending on healthcare, India's best bets are small private entities and some large islands of corporate investment.
India's way forward will include unleashing government spending in basic healthcare and unshackling of India's private workforce in advanced healthcare.
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