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GS Mains Model Question & Answer: The strengthening of private healthcare at the cost of the public sector has had disastrous consequences for India

Q. The strengthening of private healthcare at the cost of the public sector has had disastrous consequences for India. (12.5 Marks)

(General Studies Mains Paper II –Social Justice: Issues relating to development and management of Social Sector or Services relating to Health)

Model Answer :

At the time of our “tryst with destiny,” we were made to believe that India was committing itself to socialist principles of governance. What went wrong that private players are predominant in the country’s healthcare sector? Unfortunately, however, health ranks low in the priorities of our rulers. At 1.3 per cent of the GDP, public spending on healthcare in India is lower than some of the poorest countries of the world. Bhutan and Ethiopia spend more on health than we do. Poverty caused by expenditure on health has doubled in India in the past 15 years.

The strengthening of private healthcare at the cost of the public sector has had disastrous consequences. In a country like ours, where caste and economic stratification play vital roles, the public sector should be dominant in healthcare delivery. But private health providers have usurped what was a wonderful healthcare delivery infrastructure, on paper.

Key Challenges facing India’s Healthcare Sector :

1) India has made strides in the expansion of public services. But there aren’t enough skilled healthcare professionals in India despite recent increases in MBBS programmes and nursing courses.
2) The National Sample Survey Office (NSSO) numbers show a decrease in the use of public hospitals over the past two decades—only 32% of urban Indians use them now, compared with 43% in 1995-96. However, a significant portion of these private practitioners may not be qualified or are under-qualified.
3) “In the past 5 years, the government has introduced several new laws to strengthen governance of the health system, but many of these laws have not been widely implemented,”. In some instances, the “scope of (some) regulations is still unclear, and there are fears that these laws have hindered public health trials led by non-commercial entities”, it added.
4) “At the heart of these constraints is the apparent unwillingness on the part of the state to prioritize health as a fundamental public good, central to India’s developmental aspirations, on par with education. Put simply, there is no clear ownership of the idea of universal health coverage within the government,”.

The private sector’s share in healthcare in India is an astonishing 78 per cent in urban areas and 71 per cent in rural areas; in Sri Lanka the share of the two sectors is nearly equal. What is more chilling is that public-funded healthcare insurance schemes in India, like the Rashtriya Swasth Beema Yojana, give more than 80 per cent of their reimbursements to the private sector. Simply put, money from public coffers is finding its way to private lockers through legitimate systems.

The UN Population Division’s World Population Prospects

The UN Population Division’s World Population Prospects reveals that Bangladesh has a better infant mortality (IMR) rate than India — 31 versus 38 per 1,000 live births. Nepal’s IMR is even better — 29 per 1,000 life births – while Sri Lanka’s IMR is better than a number of Western countries — eight per 1,000 live births. The fact that even war-ravaged Iraq has an IMR of 27 per 1,000 live births speaks volumes of the shambles in which the Indian healthcare system finds itself.

Increase in spending on healthcare, formulating relevant health policies (in a country where deaths due to diarrhea are more than deaths due to SARS) and making the healthcare system accountable are some of the urgent necessities. But private health providers are here to stay.Whether we let them thrive at our cost or make them realise that they need to complement and not surrogate the public health care system is a choice we need to make urgently.