Corporatisation of Public Health

Dr Ashwani Mahajan
Twelfth Five Year Plan has already started from April 2012. Despite much higher amount being allocated in the plan as compared to previous plan, essential services like health and education are being handed over to the market. Plan documents, especially Chapters on Health and Education clearly speak of government’s intention to run health and education on the path of market. Commercialisation of health and education services has been on rise during liberalization and globalisation. Though even before 1990, there did exist private ownership of education and health services, in the past two decades, the process of commercialisation of education and health has fast accentuated. As a result, education and health services are going beyond the reach of the ‘common man’.
Comercialisation of Health Services
Twelfth Five Year Plan clearly states that in the past Public Private Partnership (PPP) has helped development of infrastructure, now the same would be extended to education and health. PPP model, which was limited to roads, bridges, Airports, Seaports, would now be adopted in health and education. We know that after PPP model was adopted, people have to pay heavy tolls to go on national and state highways; air travelers have to pay airport tax, on seaports also there is a system of user charges. Now when educational and health institutions would be opened in PPP mode, these services would carry a price tag. It is possible that government may provide money for the provision of health services for poor by making payment to the institutions under PPP mode; for majority of other poor and lower middle class, these services would be available for a price (based on cost plus profit).
Health Ministry is Opposing
Health Ministry of the Central Government is upset due to this proposal of the Planning Commission. Ministry of Health says that this proposal would not only affect the provisioning of health services for the ‘common man’, this type of plan clearly contradicts the stated government policy and goal of health for all. Ministry has asked the Planning Commission to rewrite the chapter on health in 12th Five Year Plan, so that government can fulfill its basic responsibility of providing health for all.
Health Ministry says that at present public expenditure on health is hardly 1.1 percent of GDP, which needs to be increased to 2.5 percent of GDP. However, it seems that Planning Commission is in no mood to concede this demand. It argues that there is a need to make more efficient utilisation of the funds already allocated for the purpose. Nevertheless, if we make international comparison, in terms of public expenditure on health, India stands at very weak footing, as there are only 7 countries where public expenditure on health is less than that of India. In USA, public expenditure on health is 7.9 percent of GDP, Japan 6.7 percent, and UK 7.8 percent and for China, it is 2.5 percent. Therefore, demand the ministry that government should spend at least 2.5 percent of GDP in 12th Five Year Plan, and the same should be increased to 2.85 percent by the end of the plan, seems appropriate. Against this, Planning Commission has capped this expenditure to only 1.58 percent of GDP.
On the one hand, Ministry of Health wants public expenditure on health to be raised; Planning Commission is bent upon raising the stakes of private sector in health services. Ministry of Health says that without improving the public health services, it would be wrong to put the responsibility of provision of health services on private sector. Provisioning of health services to masses is not possible without establishing public sector health infrastructure. Private sector can at best play the role of gap filler. Ministry of health concedes that is past, due to less expenditure an public health, there has been erosion in the standard of public health services. Therefore, this deficiency needs to be corrected in the Twelfth Five Year Plan.
Planning Commission Has Different Intentions
Regarding commercialisation of health services, plan of the Planning Commission is that both private and public sector hospitals would compete with each other and provide their services for a price and under a Universal Insurance Plan, these services would be provided to the people. Health services would be available at a prefixed price. Intention of the Planning Commission is that government’s responsibility would be limited only to immunisation, antenatal care and disease control programme; and for rest of the treatments, government and private sector hospitals would be asked to compete with each other. Under Twelfth and Thirteenth Five Year Plan, the system would be put in place, according to which private hospitals would be paid according to per patient registered and doctors would be paid per prescription. It is beyond doubt that scheme as planned by the Planning Commission is in effect corporatization of health services in India.
This plan is exactly opposite to the recommendations given by the High Level Expert Groups (HLEG) in this regard. HLEG had suggested that for Universal Health Coverage. (UHC), that is, health services for all, central and state governments and quasi-autonomous agencies establish for this purpose would procure health services. But under the plan made by the Planning Commission, in the name of Universal Health Coverage, Planning Commission is in essence denying health services to all. While making the plan, Planning Commission has sidelined the suggestions and proposals given by the stakeholders in this regard. The proposals given by the Planning Commission in chapter on health in 12th Five Year Plan is far from the objective of health for all and is destined to destroy the present system of health services.
We should note that China had also adopted a system where doctors in government hospitals were privatised and government doctors adopted private mindset. Head of the HLEG says that in view of the rising inequalities, Chinese government is changing its Health Policy.  HLEG says that model of Universal Health Coverage (UHC) should be such that government hospitals, instead of chasing after money, should engage themselves for provisioning of quality health services. HLEG has alleged that in the name of (UHC), Planning Commission is in effect pushing its agenda of corporatisation of health services.
Treatment cost for poor has been rising day by day. We need a policy in 12th Plan, whereby we increase public expenditure on health to 2.5 percent of GDP for now and raise the same to 3.0 percent in 13th Five Year Plan, so that we strengthen the public health services, which have weakened in  the yesteryears. Only then, we can achieve our Millennium Development Goal (MDG) of health for all.


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