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Public-Private Partnerships

Any measures under the banner of 'partnership' which may lead to privatization of existing public health services should be strongly questioned and opposed, since the consequence of
such privatization has often been introduction of steep user fees, barring the poor and lower middle class from accessing services. User charges came to be levied from patients belonging to families above poverty line for diagnostic and curative services offered in health institutions while free or highly subsidized services continued to be provided to the poor and needy patients.

A majority of states have introduced user charges for services in public health facilities although there are differences in levying, collecting and utilizing user charges among the states. User charges, as an option of financing health care delivery system, need to be supported by efficient system of collection and utilizing user charges combined with improvement in the quality of health services and facilities for patients in health institutions. At the same time, access of poor and needy patients to health care should not suffer. India has one of the highest out-of-pocket household expenditure for health services. User charges further augment this expenditure. Hence, it is pertinent that mechanisms of risk pooling are designed and implemented towards improving access to health services.

The NRHM documents specify 'Public Private Partnership' as one of the Mission components. However, given the fundamentally divergent objectives of the public health system (to provide services to the general population based on public financing) and of the private medical sector (to run as profitable institutions, providing care to those who can pay), a 'partnership' of such differing institutions needs to be very clearly specified, to prevent its abuse. The variable quality of care, frequent lack of minimum standards, prevalence of irrational practices and often unaffordable price of care in the private medical sector has been documented by various studies. In this context, the foundation of the relationship between the public health system and the private medical sector must be effective public regulation of the quality, rationality and costs of care in the private sector.

There is no reason why Indian Public Health Standards cannot be applied to the private sector as well. The long-standing and glaring non-regulation of this proliferating sector and the need for strong, effective measures in this direction are only weakly addressed in the Mission document, which does not mention any specific legislative or operational mechanisms and blandly talks of the 'need to refine regulation'.

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Dr. Gursharan Singh Kainth started his career as Lecturer at Post Graduate Dept. of Economics, Government College, Gurdaspur, and later at Khalsa College; Amritsar, specializes in Quantitative & Development Economics. Has the distinction of serving Punjab Agricultural Univ, Ludhiana, for more than 2 decades and remained Director-Principal of Saint Soldier Management & Technical Institute, Jalandhar. Currently, heading GAD Institute of Development Studies, Amritsar, a self-financed research institute. Has been honoured with various awards, including Guru Draunacharya Samman, Vijay Rattan Award, etc.
Article posted on December 14, 2008.