Making the Private Sector Care for Public Health - Editorial

Current and Existing Health Care System 

As India ventures into the second week of nationwide lockdown inflict by the centre in response to the recent outbreak of the infamous COVID-19 (originated in Wuhan, China). Considering the impact of the disease across the world, it is uncertain and debatable how well prepared our healthcare infrastructure is in combating the COVID-19 pandemic. Limited and constraint availability of the medical resources with state and central government, points towards the need for conjoint and collaborative efforts from Public and private sector healthcare instrument. From the recent events, it is very transparent and crystal clear that the government hospitals aren’t prepared well enough to effectivity manage the treatment of COVID-19 disease at a larger scale.

Making the Private Sector Care for Public Health

Urgent and Immediate Need: Cost Free Universal Health Services 

Considering the uncertain conditions surrounding the Corona (COVID-19) disease, the situation of Indian treasury and socio-economic conditions of the Indian household, the Indian government made a bold move and decided to limit cost at ₹4,500/test. This was an important decision from the context, considering of middle-class crowd of Indian society. Apparently, the financially less fortunate Indian families may not have a spare financial provision to pay for the expensive test for each and every family member. Moreover, the Indian government also not be in a situation to pay hefty prices just for mere test and their increasing demands. The conjoint efforts of the state and the central government will have to ensure no financial burden and hiccups to the Indian pockets and should be made absolutely cost-free for the patient and the entire responsibility of the associated healthcare service is to be borne by the government. The possible solution could be, Universal Healthcare Service: This certainly will require the Indian government to take a giant leap in expansion and diversification of the healthcare service through government schemes and tap the resources of the private sector healthcare companies and organization. Currently surrounded by the unforeseen circumstances of COVID-19 outbreak, the silence of the Indian government on the expected actions of the private sector is interesting and fascinating. They're definitely a possibility of Indian Government might take stand on Uniform and Universal Healthcare Services for Indian masses.

Suggestions and Proposal from the National Health Authority 

  1. The national instrument (National Health Authority) on health has proposed the COVID-19 testing and associated treatment be made available through existing scheme titled Pradhan Mantri Jan Arogya Yojana (PM-JAY), but currently on table of PMO office waiting for clearance.
  2. The current governance system and service infrastructure of the Healthcare system in India are not centralised, heavily fragmented and not welcomed by the public.
  3. The absence of the authoritative or centralised command and viable policy, which must be established under the command of the direction of the Union Ministry of Health and Wellbeing supported by the team of subject matter and domain expertise.
  4. They should be engaged to make policies whenever needed and forward them to concern state governments, considering the evolving situation.
  5. There have been some provisional measures, tentative services and facilities for individuals testing for COVID-19 to gain easy access to private testing laboratories at a lower cost.
  6. At this peak hour situation in the middle of the COVID-19 crises, and essentially before the lockdown is relaxed, it is absolutely important and necessary, that appropriate and sufficient testing & quarantine centres are created.

Making the Private Sector Care for Public Health

All-Inclusive and Thorough Policy to Safeguard Private Healthcare Capacity 

  1. A comprehensive policy from the government must showcase the preparedness and sufficiency to accommodate all levels of care including required infrastructures, medical resources & good quality equipment's, testing laboratories & facilities, and most importantly the trained medical staff with domain knowledge for effective treatment of concerned patients.
  2. With this growing concern and cumbersome task for the government to deal with such scenarios, the government hinted to bring in and put more funds in public health and infrastructure.
  3. However, the current Healthcare Systems is bleak, fragile (especially the infrastructure and not enough staff), fragmented and ineffective to cope with any sudden spike in severe cases of COVID-19 and cases that may or may not need the hospitalisation.
  4. Some private-sector organizations have voluntarily opted to offer their services and offered their help for establishing the capacity for COVID-19 patients across different parts of India. Although this for a time being is appreciable, there is need for the all-inclusive and thorough national policy is enable guaranteed public access to the private healthcare services.
  5. The state of Rajasthan, Andhra Pradesh, Madhya Pradesh, notably the Chhattisgarh already started collaborating with the private healthcare sector organization to enable access to cost-free treatment to their domicile residents.

NITI Aayog’ Proposal: To communicate the issue of shortage of well qualified and experienced doctors to address the gap in medical education, the NITI Aayog has proposed collaboration of private and public blueprint to connect or link network of medical colleges with series of government’s district hospitals to upgrade and increase the medical seats.

Spanish Parallel: Public Governance on Private Corporate Sector Hospitals 

  1. Let's take look at the scheme implemented by Spain. The government of Spain issue the directives to bring and connect all large private corporate hospitals under the public administration for a limited period.
  2. These directives from the Spanish government, was a tough move, in response to the existing fragile situation of the public healthcare system that otherwise wouldn’t be able to tackle the sudden and immediate outbreak of the COVID-19.
  3. On the other hand, In Great Britain (GB), the National Health Service (NHS) is under extreme pressure to fight against the rising number of COVID-19 virus cases.
  4. To deal with this situation, the British trade union asked the British government to make establish approximately 8000 beds in co-operation with 570 private hospitals spread through the country.
  5. This was suggested due to a large number of beds being vacant in a private hospital on contrary to the lack of enough facilities in public hospitals.
  6. The union has also been crucial of the British government commitment to rent these beds of private hospitals at an outrageous (excessive) cost to the pockets.

To Implement or Not to Implement Spanish Practice in India 

The government-backed the argument that the care and treatment for the ever-rising COVID-19 cases are already included in government existing scheme of “Ayushman Bharat”, thus the scheme accommodates the less fortunate poor class of India.  

However, the scheme fails at one point and is non-flexible when it comes to a large number of the Indian bourgeoisie (middle-class) families (making them as a large number of Indian taxpayers), tons of these they engaged in the service segment. 

They neither have secure & permanent employment from the private sector nor they have strong insurance backup cover. Crises like COVID-19 uncover the deep, disturbing realities of Indian societies. 

Road Ahead 

The Indian government has already appropriated some private hospitality firms (hotels) and got them into an agreement, to accommodate individuals quarantined for COVID-19 (in case the COVID-19 situation goes from bad to worst). A method of extending such provision (solution) would be for the government establishment and concerned authorities to ‘take control’ of the private hospitals, labs, medical centres and treatment facilities for a limited time. 

The whole idea is to ask the private hospitals to establish the ICU and isolation sections (wards) to look after the moderate and severe cases, nested under the care of the government. 

The required political directives, standard policies & protocols, skill enhancement and training of health professionals and personnel, administrative structure, should percolate from the Central government to safeguard the Indian government’s interest (people’s treatment and care).

Conclusion 

In India, private hospitals and healthcare centres of the corporate world have received an enormous subsidy and at various stages and for various initiatives, maybe it is now the right time to expect appropriate repayment in form of Public-Private collaboration and implement the government directives. 

They are very well self-assured to give specialised and intensive care and have the required domain expertise and infrastructure to deliver the much-needed treatment. 

This really is appropriate time to think of the Universal Healthcare not only from the context of the COVID-19 but also to guarantee the readiness (preparedness) for unforeseen future events like COVID-19 and the fulfilment of the purpose of the right to health of every citizen.

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