The proposes facilities under the PPP model are expected to provide minimum screening, diagnostic and treatment procedures or services for cardiology , oncology and pulmonology . There will be two kinds of patients, selfpaying ones and those paid for by the government under various schemes, but both would pay the same rates. The rates would be those fixed for a state health insurance scheme or, where none exists, the central government health scheme (CGHS).The Niti Aayog wrote to all chief secretaries last month seeking the states’ comments on the draft model concessionaire agreement and guidelines prepared with the help of the World Bank and “working groups comprising the industry“. Prevention measures for non-communicable, the cheapest intervention, are entirely the government’s responsibility. Complicated cases the PPP facilities can’t deal with would be referred to government tertiary hospitals or medical colleges or to private hospitals empanelled under government health insurance schemes.
The proposal has been criticised by public health activists, who said this was a bid to privatise public health facilities which would raise healthcare costs and lead to exploitation of patients for profiteering by the private sector.
Consultations on minimum services to be offered were held with working groups constituted by Niti Aayog. Those involved included private health care providers, the Union health ministry , a few states, an expert group of healthcare providers, regional workshops organised by the Confederation of Indian Industries, and representatives of some district hospitals. The Niti Aayog letter, however, has no mention of any civil society groups, public health activists or patients’ representatives being consulted.
“The experience within India and globally has been that when you outsource services the cost goes up. The cost of regulation is huge, about 30%, and even then the regulation isn’t perfect. So you either spend on regulation or open yourself up to unethical practices like over-investigation or patients being lured into more complicated procedures not covered by public funding,“ said Dr Amit Sengupta of the People’s Health Movement.
The health ministry maintains that the proposal “is not exactly privatisation of public healthcare“ and is rather in line with “strategic purchase of services for secondary and tertiary care, as has been envisaged in the National Health Policy by the ministry“.
Treatment of non-communicable diseases is expensive and is often unavailable at district level hospitals. “The model contract has been drawn with a view to make such sophisticated services available to patients at local levels and at a government determined price,“ the senior official in the health ministry said.
When asked if this can lead to increase in healthcare costs, the official said the government will fix pricing through tendering for different services. Moreover, prices under government insurance schemes have been set as benchmark. For BPL patients, services will be provided free or at pre-determined prices.
For any private hospital, one of the biggest expenses is the cost of land. The other big challenge is to ensure adequate patient footfall. With this PPP model, both are taken care of as land will be provided by the district hospital and the government is supposed to refer patients to the PPP facility .
As of now, the contract model will be run on pilot basis and is likely to be implemented only in two states. The Niti Aayog is awaiting comments from states to move ahead with the plan.