PPP model for providing universal health care in India

Prospects:

  • Enhancing affordability: There has been a steady increase in the number of drugs under price control, to make medicines affordable.
  • Enhances Inclusivity: It’s difficult for government alone to meet the healthcare infrastructure and capacity gaps in Tier II and Tier III cities as well as rural areas. To provide Health insurance- Karnataka’s Yeshasvini Cooperative Farmer’s Healthcare Scheme and Andhra Pradesh’s Arogya Raksha Scheme can be cited as successful examples.
  • Financing Mechanism: The partnership between the public and the private sectors in healthcare is important for several reasons including equity and for promoting economic development.
  • Infrastructure: NITI Aayog has sought to infuse fresh life into PPP in healthcare delivery through a new model focused on district hospitals and new norms on pricing of procedures. The provisions for making available infrastructure of district hospitals to private providers for 30 years along with viability gap funding appears that we have got the design right for the PPP model.
  • Quality of Service: Private healthcare in India usually offers quality service but is often expensive and largely unregulated. The Delhi government’s new scheme is a novelty for the common man but has a precedent in several government schemes for employees which use public funds to provide private healthcare. e.g the Central Government Health Scheme (CGHS) has existed for decades and has been emulated by several states.
  • Capacity building and training: private players can play a key role in capacity building and training through PPP modes by  working  with  the  public  sector  to  better  utilize  the  infrastructure  of  government

Issues in public private partnership

  • There lack of inbuilt mechanism to decide how the government and the private sector share revenue and risks.
  • Aim of Private sector is to maximize profit, which is inconsonance with governments aim of providing universal quality services to all
  • Lack of a proper regulatory framework to regulate the health sector and partnership.
  • Some PPP projects attempted earlier have failed, so there is apprehension about success of large scale PPP in health sector.

Measures needed:

  • Staunch and well-defined governance: An institutional structure should be set up to foster, monitor and evaluate the PPPs. This needs to be established at the state-level under the leadership of the state health ministry.
  • Equitable representation of partners in the institutional framework: Institutional structure is a cornerstone for development of a sustainable PPP project. It will help to meet consensus on shared responsibilities and roles and will facilitate communication among the partners leading to a strong sense of ownership and trust.
  • Evidence-based PPP: Systematic research initiatives and mechanisms must be established to constantly understand the evolving needs and benefits to end users.
  • Regulate user fee: One of the hurdles of engaging the private providers for public health service delivery is OOP expenditure. Therefore, it is important to regulate user fees of this sector under partnership.
  • Effective risk allocation and sharing: Risks shall be allocated to the party best able to control and manage them so that value for money is maximised.

 

  • For UHC to become a reality, it is important to expedite steps beyond infrastructural interventions to include water, sanitation, nutrition and a healthy lifestyle. The challenge is to incentivize wellness-seeking behaviour.
  • An encouraging aspect of India’s commitment to UHC has been the active and participatory role of the government.
  • From Poshan Abhiyaan, which aims to eliminate the malaise of malnutrition, to the Prime Minister’s call for a Fit India Movement, new emphasis has been given to multi-stakeholder engagements.
  • India has to align the vision of medical education with the vision of “one nation, one healthcare sector”.
  • The National Medical Commission (NMC) 2019 Bill recognizes the much-needed reforms in medical education.
  • The challenge of building capacity of people in a short time needs to be addressed through more transformational public-private partnerships (PPPs), presenting another opportunity to develop and adopt e-learning models.
  • Digital health has emerged as a game-changer in achieving UHC goals. India has taken rapid strides here and digital health is bringing healthcare within reach of 70% of our population residing in rural and remote areas.
  • With the use of digital technology, India is positioned to not only bridge gaps in our healthcare delivery but also to have the capability to contribute to global UHC goals through its telemedicine and digital health tools.
  • India’s healthcare providers are already working on new frontiers of digital technologies.
  • Machine learning, blockchain and AI will continue to strengthen India’s ability to engage effectively with other geographies towards achieving global UHC targets.
  • Regional disparities in terms of resources and institutional capabilities must be addressed. This diversity, nevertheless, can be a powerful source of policy innovation and creativity.
  • A collaborative approach aligning patients, payers and providers, along with innovative partnerships, will hasten efforts to mitigate risks, drive impact, forge stronger social returns and achieve sustainable UHC targets.

India needs a holistic approach to tackle problems in healthcare industry. This includes the active collaboration of all stakeholders’ public, private sectors, and individuals. Amore dynamic and pro-active approach is needed to handle the dual disease burden. A universal access to health makes the nation fit and healthy, aiding better to achieve the demographic dividend.