Healthcare Reforms in India- seeking a fine balance.

The health services planning in India is characterized by its failure to take into account the holistic picture of the health care services. In the mixed economy model the social sector is planned with a view to provide for the externality and to redistribute the services in favour of the underprivileged masses. In the post independence period the growth of the private health sector has been tremendous.

The private health sector consisting of general practitioners, nursing homes and hospitals involve two thirds of the medical human power in the country. Despite this there is hardly any regulation of the practice of this sector of health. This is indeed surprising because such activity cannot be carried out without registration.

National Sample Survey’s 2015 report found that 81.7% of the Karnataka’s urban residents avail of private healthcare facilities, the highest in the country, while the figure stands at 73.2% for rural areas, the fourth-highest. This is in spite of the state having 49,454 government hospital beds, or eight for every 10,000 people. While the figure is way below the 18 beds-per-10,000 patients ratio mandated by the World Health Organisation, it is better than the national average of about five.

The reason for this situation is insufficient public infrastructure due to low governmental expenditure. According to the Central Bureau of Health Intelligence (CBHI)’s National Health Profile 2017, Karnataka spent only 0.7% of its gross state domestic product on healthcare, the third-lowest in the country after Maharashtra and Haryana. The national average comes up to 1.1%.

Karnataka has the third-highest percentage of people who pay for medical expenditure through borrowings. National Sample Survey Office data states that around 42% of the state’s population paid for their medical expenditure in this manner, after Andhra Pradesh and Telangana.

The problem with the above is that the controlling bodies are virtually non-functioning. The reason for this is not only lack of interest but also weak provisions in the various acts. They are also heavily influenced by the private health sector.

And, the private healthcare sector is alleged to exploit all these loopholes and government’s failure to prey on Patient’s and their kin and thus in a rent-seeking state which is ours Regulation of Private healthcare is must. But in the name of regulations Doctors, who are the anchors of the healthcare system should not be handled so discriminately and victimized so easily.

It’s also true that unethical practices cannot be so widespread without the doctor’s involvement but these things can be regulated very easily just by having a High-Powered, Politically Independent Regulator whose functions and powers among many be that of one to make sure that doctors are not paid commissions for referring patients to diagnostic centers or bringing them to hospitals.

One can take a cue from Narayana Multispeciality hospitals or from the Public Hospitals too where the doctors/consultants being full time work on Salaries rather than Commissions.

Having a transparent Regulator in every district could help keep profit-minded medical establishments in checks and balances but the private small scale clinics must be exempted from its purview so that Private Medical Practitioners must not be discriminated or harassed.

Along with this government should play an active role in designing and supervising the entire health system, instead of focusing only on the management of a health system owned by it?

Finally, there is so much to learn from experiences throughout the world to address:-

· -Problems of negligence: — Swedish model where both public and private healthcare providers compete with each other for public funding can be a good option. There any negligence on any one side can bring cancellation of license.

· Problem of overcharging: — Canadian model provides for fixed fees of the medical practitioners by government which can be coupled with Thailand’s model of capitation fees. This will restrict them to charge just and fairly.

· Heavy out of pocket expenditure: — Swedish model of capping the expenditure on drugs can prove to be a life saver for many Indians.

· Narrow insurance net: — It can be tackled by German based model where the discretion would be with the people to choose
insurance provider and the latter couldn’t refuse it .It will help to bring more and more people under insurance net cover.

Designing an effective health system of this type is an uphill yet achievable journey. In the 1960s, countries such as Thailand, Brazil and South Korea had health statistics similar to or worse than India’s in 2010, but transformed the status quo over four decades. In India, each state represents a different social, economic, and cultural environment, and will need a customized approach towards its health systems’ redesign. However, there is no fundamental reason why each state cannot use these guiding principles to aspire to build a strong health system.

Designing an effective health system of this type is an uphill yet achievable journey. In the 1960s, countries such as Thailand, Brazil and South Korea had health statistics similar to or worse than India’s in 2010, but transformed the status quo over four decades. In India, each state represents a different social, economic, and cultural environment, and will need a customized approach towards its health systems’ redesign. However, there is no fundamental reason why each state cannot use these guiding principles to aspire to build a strong health system.

Studies Politial Science, Public Policy and International Relations.