Dr. Sylvia Karpagam
The government of Karnataka has been flip-flopping around the issue of healthcare. The initial posturing by the health minister about bringing the private sector under strict regulatory guidelines was welcomed by citizen groups.
It also unleashed a unified, large scale protest by the private hospital doctors, led by a strident Indian Medical Association (IMA) and Private Hospitals and Nursing Homes Association (PHANA), protesting against regulations that weren’t even there either in the original Karnataka Private Medical Establishments (KPME) Act, or in the Amendments. This throwing of rationale and reasonable engagement to the wind was spearheaded by Dr. Devi Prasad Shetty, an entrepreneur who had initially taken his Yeshaswini health insurance model to the policy making table and then gradually moved onto the board of the Suvarna Arogya Suraksha trust, the Karnataka Knowledge Committee to the Steering committee on health for the 12th 5 year plan.
A comparative study of health insurance schemes in Karnataka by the Institute of Socio-economic Change (ISEC) found that hospitals located at Bangalore such as Narayana Hrudayalaya & Multispecialty Hospital, BGS Global Hospital, Sagar hospital, Vydehi hospital and Bangalore Institute of Oncology have accounted for over 53 per cent of patients from Gulbarga and over 60 per cent of amount spent. Patients from Gulbarga have obtained treatment mostly from super specialty hospitals located at Bangalore. There is mounting evidence that health insurance schemes disproportionately benefit large corporates that resist any form of regulatory mechanism, on the one hand, and complete breakdown of public health systems with their larger social mandate of preventive, promotive, curative and rehabilitative care. Health insurance leads to fragmentation of health care and pushes more and more people towards the private sector, often centrally located. The out of pocket expenditure for screening, diagnostics, food, accommodation for attenders, travel, post-operative complications add up to huge amounts.
The Narayana chain’s ambitious project in the Cayman Islands has also encountered serious criticism, with the Public Accounts Committee stating that ‘the facility has not only failed to attract all but a fraction of the number of patients predicted, but also competing unfairly with existing health care providers with no ‘monitoring of the extensive package that the facility has received’. The criticism also extended to the ‘lack of any framework surrounding the governance of medical tourism, including issues such as quality control and doctors standards.’ Delroy Jeffersson, the medical director and the Health Services Authority said that without a governance structure and framework and a regulatory body to ensure adequate oversight to monitor quality, there was a situation where goalposts were being moved as things went along. Because of moving goal posts as they went along, the NH hospitals were also accused of competing with local hospitals unfairly as they have benefits that other hospitals and healthcare providers are not getting.
It is astonishing that the Karnataka government is now considering handing over a brand new super-speciality hospital of the Bruhat Bengaluru Mahanagar Palike on Broadway road in Shivajinagar, to Narayana health, without any process of public consultation. The investment in this public hospital, built on 20 thousand square feet, has been in the range of 40 crores of tax payer’s money for a lease period of 30 years. In addition the NH has demanded an additional 11.7 crore to cater to National Accreditation Board of Hospitals (NABH) Standards. The intent of these standards is to eliminate the ‘competition’ offered to the corporate health sector, from the government and charitable institutions. The Indian Public Health Standards (IPHS) are a more egalitarian system of ensuring accountability and quality of care within the public facilities. These are never referred to by the private sector. This move to privatise the government super-speciality hospital, initially intended to cater to the economically marginalised, is being opposed by the health department of the BBMP and citizen’s groups, but the state government feels well within its right to hand over the government structure to a private entity that has been on the forefront opposing regulations. 10% beds will be given free while the rest of the beds are available to NH to generate resources – and this after they have vociferously resisted any form of price control. How will the state government keep the NH in check if there are violations of cost, procedure and patient rights? When the state government is being dictated terms on how private hospitals should and should not be regulated, can this decision to hand over a super-speciality hospital to the very same corporate hospital be considered as another extreme form of coercion of the state government by the corporate sector?
The government does not seem to feel accountable to the people who are contributing to these public hospitals. It is clear that the state governments are being held to ransom at secret close door meetings where corporate agenda seems to be the only priority. With medical tourism, surrogacy, clinical trials, vaccines without clear testing are being pushed onto communities, the situation of health care will only become more dire. As a form of slow genocide, those who are poor will be pushed out of all social safety nets to exist only to provide informal labour from the fringes as a kind of half hungry, half healthy, half demanding population while the corporates rake in tax-payers hard earned money, in collusion with a government that couldn’t care less about the health of its citizens.
The writer is a public health doctor and researcher