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India's private health industry proving to be a 'big hurdle' in containing COVID-19

By Bobby Ramakant, Shobha Shukla, Sandeep Pandey*
Along with measures to cut the chain of transmission of corona virus (such as lockdown, social distancing, masks), it is indeed important to find those who are positive for coronavirus disease (COVID-19), isolate them and provide them with best possible medical care as needed.
It appears that government is facing shortage of capacity to scale up testing across the country, and shortage of hospital beds to provide medical care to some of those who test positive and may need it. In India, there is a law (the Epidemics Act 1897) which gives government (even state governments) constitutional authority to bring all private health sector under government control.
What should be a better way to scale up testing and hospitalization capacity in the country: to bring all private health sector under government control, or try to negotiate a price with private sector?
COVID-19 is a public health emergency and is cascading into several humanitarian crises of different intensities and levels across the nation. Given the immediacy and urgency of response we need to build to have the best chance to contain COVID-19 at the earliest, some of the state governments did bring the private sector under government control.
But if all private health ‘industry’ was brought under government control nationwide, then government could have leveraged it to strengthen COVID-19 response on a range of levels, such as, companies competent enough to procure or manufacture antibody rapid and/or Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) tests, fully equipped laboratories to do these testing, hospitals and its staff to take care of those who need medical attention due to COVID-19 (and other non-COVID-19 health needs which are no less life-threatening).
But instead the national government chose the way to negotiate with private sector maximum price cap for testing. Last month, government announced that maximum price cap for COVID-19 test in private sector will be Rs 4,500. Then in early April 2020, Supreme Court thankfully ordered that COVID-19 tests will be free in private and public sector both, and private sector should be “extending philanthropic services in the hour of national crisis.”
However this order was modified by the Supreme Court a week later that free test in private sector be made available only for the poorest and government should decide which other categories of people should get this benefit, as well as private sector can charge the earlier agreed price from others.
COVID-19 testing and all medical care remains free of cost for everyone in government health sector. But in private, there is a maximum cap on cost for a test, as well as, it is reported that cost of intensive care unit and medical care for COVID-19 could be several lakhs of rupees for estimated 15 days of hospitalization.
In COVID-19 like-crisis situation, should not the government have brought all the private health ‘industry’ under its control so that all diagnostics to medical care is free of cost for a country where a lot of its citizens are already reeling under intensifying economic hardships?
Prohibitive cost of medical care is the biggest barrier that blocks those who need lifesaving care. Medical costs are also a reason to push people deeper into poverty. We in India were dealing with pandemics before COVID-19 too.
Pneumonia is biggest killer of children under five years, malnutrition affects our children most in the world, tuberculosis (TB), world’s biggest killer infectious disease, has maximum disease burden in India, non-communicable diseases (such as, heart disease and stroke, diabetes, cancers, chronic respiratory diseases, among others) have one of the biggest burdens in our population. More humbling is the reality that most of these diseases are preventable, and premature deaths could have been averted – if preventive healthcare and all necessary public health promotion activities were in place.
In COVID-19 pandemic, if intention was to encourage those with symptoms to get diagnosed and benefit from best possible care (even if no cure exists for COVID-19), then government should have first removed the exorbitant cost barrier by bringing all private health sector under government control, with all infrastructure, supplies and skilled human resource, and collectively contribute to the crisis which has challenged our nation.
Cuban doctors
Countries like Spain have nationalized health services during COVID-19 crisis whereas about 30 countries including Canada, United Kingdom, Brazil, South Africa, Cuba and Sri Lanka have had a government funded healthcare system.
While most countries of the world are overwhelmed with the current COVID-19 crisis a small country like Cuba has sent its doctors to 19 countries including one of the worst affected Italy to handle the emergency and allowed a British ship with five people affected by coronavirus to dock near its shore when other countries had refused such a permission. One can imagine the strength of public healthcare system there. 
Why is there no government-to-government arrangement to procure COVID-19 testing kits like in the case of Rafale deal?
A recent controversy that came afore was around Government’s attempt to procure over five lakh rapid test kits. A company called Matrix, imported the rapid test kits at Rs 245 per kit price (total cost of 5 lakh kits is Rs 12.25 crore), another company called Rare Metabolics bought these kits from Matrix after paying Rs 7.75 crore more (so total cost went up to Rs 21 crore). And Rare Metabolics gave these kits to Indian government at a price of Rs 600 per kit (Rs 30 crore in total).
However, Government of India’s press release issued on April 27, 2020, said that not a rupee has been paid to any company as entire order stands cancelled.
The Indian Council of Medical Research (ICMR) was directly involved in above procurement of rapid test kits. ICMR tweeted on April 27, 2020 that “price range approved by ICMR is Rs 740-1150 for RT-PCR and Rs 528-795 for Rapid Test.” It is inexplicable why, when the ICMR has rejected the abovementioned rapid test kit on the basis of unsatisfactory performance, the Delhi High Court has put a price cap of Rs 400 on these kits?
Should not citizens question the government then on what basis has it allowed private sector to charge maximum price of Rs 4,500 per test (when entire test kit costs much less as told by ICMR in its tweet)? When everybody is being expected to make a sacrifice, government employees have had to involuntarily give up one day salary, Member of Parliaments have agreed to a 30% cut in salaries, MP Local Area Development fund has been suspended for 2 years, medical staff are exposing themselves to risk in ‘national service,’ why is the private sector being given a free hand to milk more profits even when nation reels under such a severe crisis?
Why is a government-to-government arrangement not being made to procure COVID-19 testing kits like in the case of Rafale deal? Is the coronavirus threat any less serious than matter of national security?
Dr Richard Horton, Editor-in-Chief of "The Lancet" wrote in March 2018 that “politics is the ultimate determinant of health”. On April 24, 2020, Dr Horton wrote: “The idea you can strip out politics from medicine or health is historically ignorant”.
Nationalizing health services is among the most important corrective political actions which governments can take in wake of this pandemic. But health security for everyone can only come when we address inequalities and injustices in every other sector. 
That is why ending privatization and protecting public health, public water, public education, public transport, and other public services along with social security for everyone, are among the acute needs today.
---
*Bobby Ramakant and Shobha Shukla are with Citizen News Service,.and Sandeep Pandey is social activist and vice president of Socialist Party (India)

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