India needs to expand healthcare in the public-private partnership mode

Jabalpur: Times today are very different from what they were when welfare states arose and cemented. Business interests in healthcare apart, the massive strides achieved in technology, the vistas and choices they have opened, and their swift diffusion across the globe have entailed those public monopolies in healthcare, poignantly yet practically, are a thing of the past. The widened frontiers of healthcare are beyond what the state could possibly offer, militating against the “equal for all” paradigms that social democratic welfare states envisioned.

The current global climate militates against reverting to outright neoliberalism in healthcare, despite the rampant privatization. With the dampening of neoliberalism in health over the past two decades, and the ensuing global push for universal health coverage (UHC), as espoused by the sustainable development goals, countries like India, in aspiring to be an economic powerhouse, are left wanting for a universal healthcare system which, apart from fueling its development engine, brings it legitimacy on the world stage.
This has entailed a host of public initiatives to expand healthcare in the public-private partnership mode, mainly through the insurance

It is assumed that the Union government is most likely in near future expanding the Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana to 85 per cent of the population from the existing 40 per cent, on a voluntary contributory basis. At its best, this will come to resemble a liberal- conservative system having multiple categories of insured beneficiaries and entitlement criteria, majorly private provisioning of public healthcare, and a significant open private care market. As practical as it may be today, it departs from the social democratic welfare principles originally enshrined in our directive principles.
The future universal healthcare system will also feature a parallel private sector that would continue to operate outside the public insurance fold, catering largely to the affluent class. This is because out of pocket payments and private insurance offer much more

lucrative deals than public schemes, and a dominant private sector will ensure their continued existence.

We may need to wistfully reconcile with the reality that social democratic, tax-financed public monopoly in healthcare is no longer practically feasible. As such, any further strides towards universal health coverage will necessarily involve accretions upon the extant public- private mix. This, however, should only inspire greater investments in the public health infrastructure to bring it on par with private players within a competitive healthcare ecosystem.
This will be instrumental in upholding healthcare quality and cost- effectiveness. The traditional bureaucratic disposition of public hospitals funded through line-item budgets will need to be modernized into a more responsive, accountable and dynamic one, with a near-full reliance on output and outcome – based funding, especially for operational expenses.
Further, in addition to countering the conventional market distortions such as supply-induced demand, adverse selection, and cream skimming, attention will need to be paid to the many practical problems presented by health insurance due to poor insurance literacy and unresponsive grievance redressal systems. The insurance setting involves a perpetual battle between private healthcare providers and insurance companies, often culminating in patients having to pay large sums out of pocket. (2 pics credit–Getty images)

*Dr. Narresh Purohit-MD, DNB, DIH, MHA, MRCP(UK), is an Epidemiologist, and Advisor-National Communicable Disease Control Program of Govt. of India, Madhya Pradesh and several state organizations.)