Skip to main content

Demise of Ayushman Bharat? Why healthcare privatization is no solution amidst Covid

By Sanjib Pohit* 

No doubt, the pandemic has exposed the fragility of India’s health sector. The shortage of doctors, hospital beds, ventilators, oxygen, medicine etc. is the stark reality of the day. The story is true across all over India. Incidentally, none of the metros have stood apart in this pandemic disaster even though health infrastructure is quite well developed in metros than small towns. 
Frankly speaking, few of us are aware of the ground realities in peri-urban/small towns as India media hardly covers them in their stories as most of their clientele are located in metros/urban India. Unlike in west, very few papers are published from small towns.
In recent years, the health sector reform in the Indian context has basically given push for bigger role for the private health sector provider to curb out inefficiencies in the government health systems. In earlier times, the under privileged used to go to public hospital for medical care. However, this trend has now been reversed. 
While the privatisation of the health sector has been going on since quite some time, it got a big push with the introduction of Ayushman Bharat, a flagship scheme of Government of India, to achieve the vision of Universal Health Coverage (UHC). This initiative has been designed to meet Sustainable Development Goals (SDGs) and its underlining commitment, which is to "leave no one behind”.
Ayushman Bharat has adopted a continuum of care approach, comprising of two inter-related components, which are (a) Health and Wellness Centres (HWCs) and (b) Pradhan Mantri Jan Arogya Yojana (PM-JAY). HWCs basically involved in transforming the existing Sub Centres and Primary Health Centres. These centres are supposed to deliver Comprehensive Primary Health Care (CPHC) bringing healthcare closer to the homes of people. They cover both, maternal and child health services and non-communicable diseases, including free essential drugs and diagnostic services.
On the other hand, PM-JAY was launched in 2018 as the largest health assurance scheme in the world which aims at providing a health cover of Rs 5 lakh per family per year for secondary and tertiary care hospitalization to over 10.74 crore poor and vulnerable families (approximately 50 crore beneficiaries) that form the bottom 40% of the Indian population. 
The scheme provides cashless and paperless access to services at the point of care. Till January, as per the provisional report, over 40,000 beneficiaries were treated for covid-19 under the scheme. Also, over 400,000 diagnostics tests for covid-19 were performed.
However, when the pandemic struck in India, and continued for more than a year, we observe that privatisation by itself did not lead to capacity augmentation in the domain where it is the need of the hour. All over India, the government/army has to step in for human well-beings. The access to insurance does not automatically lead to access to health facility even in urban India. If in the end the government has to step in, what is the point of this privatisation push? Or, are we overlooking crucial issues in health eco-system?
Firstly, the private health service provider is purely governed by profit motive. They are more inclined to invest in capacity augmentation where there is chronic demand and profit per person is high. By the same logic, they would not like to increase their capacity of beds with ventilator support significantly as these asset will not be in demand when pandemic is over. For this reason, even though private health service provider have got a year time to increase their capacity of Covid related treatment, they did not invest on same. 
Also, as many of the State governments have capped the rate on Covid related treatment, private health service provider have limited leverage to spike their charges on Covid treatment. Thus, private health service provider has played safe: it is best not to build up health assets which are primarily used for Covid treatment.
If in the end government has to step in, what is the point of privatisation push? Are we overlooking crucial issues in health eco-system?
Secondly, how does the profit per patient in case of Covid treatment stands vis-a vis other diseases? This is the other yard stick which private health service provider takes into account while deploying resources for augmenting health infrastructure. Of course, profit numbers are hard to obtain. We are thus tempted to draw our inferences based on cost numbers which are publicly available.
Typically, on an average, 10 days treatment cost of a normal Covid-19 carrier with ICU ventilators ranges between 1 lakh to 3 lakh depending on the States and capping of expenditure in private hospital by state governments. Of course, the treatment in most patients continue on an average for 14 days. By contrast, the treatment cost in India of cancer treatment can go upwards of ₹10 lakh, for heart ailment, the expenses can easily reach ₹3-5 lakh or even more.
On the other hand, a kidney transplant costs around Rs 7 lakh whereas dialysis can cost you anywhere between Rs. 18,000-20,000 per session. Moreover, the cost can go up to Rs 20-30 lakh if you choose to take treatment at reputed private hospitals. And in case one chooses to go for a Robotic surgery – which is becoming quite popular in India – the cost of treatment may further increases by Rs 5-7 Lakh.
Moreover, the private health service providers are not at all regulated in their costing structure in these diseases unlike in case of Covid treatment. Thus, it make sense for them to invest their resources for capacity augmentation in these diseases than solely for Covid related infrastructure (ventilators, etc.) which may be of little use once the Covid phase is over.
In sum, insurance-led private health care is not a remedy in times of pandemic and especially if the treatment cost is not in par with other critical diseases. This is very true even in case of metros. May be the government need to have rethink on the health policy and the role of government in the same.
---
*With National Council of Applied Economic Research, New Delhi. Views are personal

Comments

TRENDING

'Enough evidence' in Indian tradition to support legal basis for same-sex marriage

By Iyce Malhotra, Joseph Mathai, Sandeep Chachra*  The ongoing hearing in the Supreme Court on same-sex marriage provides space for much-needed conversations on issues that have hitherto remained “invisible” or engaged with patriarchal locker room humour. We must recognize that people with diverse sexualities and complex gender identities have faced discrimination, stigma and decades of oppression. Their issues have mainly remained buried in dominant social discourse, and many view them with deep insecurities.

Buddhist shrines were 'massively destroyed' by Brahmanical rulers: Historian DN Jha

Nalanda mahavihara By Our Representative Prominent historian DN Jha, an expert in India's ancient and medieval past, in his new book , "Against the Grain: Notes on Identity, Intolerance and History", in a sharp critique of "Hindutva ideologues", who look at the ancient period of Indian history as "a golden age marked by social harmony, devoid of any religious violence", has said, "Demolition and desecration of rival religious establishments, and the appropriation of their idols, was not uncommon in India before the advent of Islam".

Swami Vivekananda's views on caste and sexuality were 'painfully' regressive

By Bhaskar Sur* Swami Vivekananda now belongs more to the modern Hindu mythology than reality. It makes a daunting job to discover the real human being who knew unemployment, humiliation of losing a teaching job for 'incompetence', longed in vain for the bliss of a happy conjugal life only to suffer the consequent frustration.

Victim of communal violence, Christians in Manipur want Church leadership to speak up

By Fr Cedric Prakash SJ*  The first eleven days of May 2023 have, in many ways, been a defining period of Indian history! Plenty has happened in a rapid-fire stream of events. Ironically, each one of them are indicators of how crimes and the criminalisation of society has become the ‘new norm’; these include, the May Day rallies with a focus on the four labour codes which are patently against the rights of workers; the U S Commission on International Religious Freedom (USCIRF) released its Annual Report on 1 May stating that conditions for religious freedom in India “continued to worsen in 2022”; the continued protest by the Indian women wrestlers at Jantar Mantar for the expulsion of the chief of the Indian Wrestlers Federation on very serious allegations; the Elections in Karnataka on 10 May (with communalism and corruption as the mainstay); the release of the fake, derogative and insensitive film ‘The Kerala Story’; the release of World Free Press Index on 3 May which places India

Polygamy in India "down" in 45 yrs: Muslims' from 5.7 to 2.55%, Hindus' 5.8 to 1.77%, "common" in SCs, STs

By Rajiv Shah Amidst All India Muslim Personal Law Board (AIMPLB) justifying polygamy, saying it “meets social and moral needs and the provision for it stems from concern and sympathy for women”, facts suggest the the practice is down from 5.7 per cent of Muslim families in 1961 to 2.55 per cent in 2006.

India joining US sponsored trade pillar to hurt Indian farmers, 'promote' GM seeds, food

Counterview Desk  As many as 32 civil society organisations (CSOs), in a letter to Union Commerce Minister Piyush Goyal on the Indo-Pacific Economic Framework (IPEF) and India joining the trade pillar, have said that its provisions will allow the US to ensure a more favourable regulatory regime “for enhancing its exports of genetically modified (GM) seeds and GM food”, underlining, it will “significantly hurt the livelihoods of Indian farmers.”

Unlike other revolutionaries, Hindutva icon wrote 5 mercy petitions to British masters

By Shamsul Islam*  The Hindutva icon VD Savarkar of the RSS-BJP rulers of India submitted not one, two,or three but five mercy petitions to the British masters! Savarkarites argue: “There are no evidences to prove that Savarkar collaborated with the British for his release from jail. In fact, his appeal for release was a ruse. He was well aware of the political developments outside and wanted to be part of it. So he kept requesting for his release. But the British authorities did not trust him a bit” (YD Phadke, ‘A complex Hero’, "The Indian Expres"s, August 31, 2004)

Modi govt 'wholly untrustworthy' on Covid data, censored criticism on pandemic: Lancet

By Rajiv Shah*   One of the world’s most prestigious health journals, brought out from England, has sharply criticised the Narendra Modi government for being “wholly untrustworthy on Covid-19 health data”, stating, the “official government figures place deaths at more than 530 000, while WHO excess death estimates for 2020 and 2021 are near 4·7 million.”

Undermining law, breastfeeding? Businesses 'using' celebrities to promote baby food

By Rajiv Shah*  A report prepared by the top child welfare NGO, Breastfeeding Promotion Network of India (BPNI), has identified as many as 15 offenders allegedly violating the Indian baby food law, the Infant Milk Substitutes Feeding Bottles, and Infant Foods (Regulation of Production, Supply and Distribution) Act 1992, and Amendment Act 2003 (IMS Act), stating, compliance with the law “seems to be dwindling by the day.”

Delhi demolitions for G-20 summit: Whither sabka saath, sabka vikas?, asks NAPM

By Our Representative  Well-known civil rights network, National Alliance of People's Movements (NAPM), even as expressing solidarity with “thousands of traumatized residents of Tughlakabad and some other bastis in New Delhi whose homes have been demolished and whose lives have been ravaged both prior to as well as in the lead-up to the G-20 Summit”, has said this is in utter disregard to “their minimum well-being and gross violation of their rights.”