It’s welcome that government think tank Niti Aayog, along with the health ministry and World Bank, has come up with a model of public private partnership to boost India’s abysmal record of healthcare delivery. Public health and hospitals in India come under the domain of state governments and the model is in the form of a template which can be used to augment treatment facilities of non-communicable disease in smaller cities. This is a useful channel to expand the provision of healthcare facilities for resource strapped governments and needs to be scaled up radically across the board, as public healthcare delivery managed solely by the public sector has had a poor record in which Indians, in general, have little faith.
To be sure, states have already experimented with PPP in healthcare delivery in a limited way. Odisha announced this year that it had picked a private healthcare provider to operate and manage a cardiac care hospital in Jharsuguda, while Karnataka and Andhra Pradesh have devised elaborate insurance schemes which make use of private healthcare facilities for surgical procedures. But there is much scope for expansion as well as a process of trial and error to see what works.
Debate in India too often gets bogged down in ideological debates on public versus private healthcare. But policy needs to be pragmatic and facilitate what works: if the capacities of government and private sector can be brought together in a synergistic way to get healthcare services to cover the entire population, there should be no objection. However, based on India’s experience so far, it is important to get the design of PPP right. In the Niti Aayog proposal, there is a benchmark for pricing. This needs to be complemented with proper oversight that will prevent unnecessary medical interventions as well as corruption.
Last but not the least, India has an abysmal doctor-patient ratio and a lot needs to be done to enhance the supply of doctors. Regulation of medical colleges emphasises more on curbs in supply than on ensuring that doctors with a licence to practice are of a minimum quality. Such irrational restrictions need to go, and Niti Aayog had some earlier suggestions to this effect which must be implemented as well. Unless India produces more doctors, whether for the public or private sector, healthcare delivery will not improve.