Healthcare in India: Going public, and private

By Dr. Karan Thakur

May 26, 2017

With the unveiling of the much awaited National Health Policy (NHP) 2017 by the Government of India, the country now has in place a clear road map on the objectives and intended outcomes for the health sector. Given the reformist mindset of the current government and the fact that the previous health policy was issued way back in 2002, the document was the veritable need of the hour.

Amongst the clear departures from the previous policy has been the focus on target based outcomes, ensuring access to primary health care, reducing health expenses, promoting wellness, integrating all forms of medicine into a composite service and co-opting and partnering with the private health sector for the delivery of services. In doing so, the Government has given a clear policy thrust towards a “multi-stakeholder approach with partnership and participation” for the health system in India. This is an initial step towards creating a more participative and inclusive health delivery system is a concrete step.

The existence of private healthcare in India has undergone dramatic changes since Independence. From a disparate and disjointed delivery mechanism of nursing homes and single doctor practices, the evolution to large hospitals, clinics and health insurance have all helped improve access to care.

As per a Brookings Study, over 75% of all outpatient services and over 55% of inpatient care is from private provisioning, signals the sectors increasing role in delivery of health services in India. Although, the issue of increased out-of-pocket expenses, affordability and equity of access to private health services remains an area of concern that needs addressing as the sector further matures and evolves.

Most praise worthy has been Government’s intent to bring “strategic purchasing” of health services where the public sector is unable to deliver them. Government plans to use the private sector in such areas in order to improve access, bring efficiencies and help strengthen public health systems. If done well, purchase of, and access to, quality health services through the use of private health infrastructure can prove to a win-win-win for governments, patients and the private sector. Training of healthcare workforce is also an area of joint work, which the NHP identifies, and the government is showing keen interest to get private sector participation.

For all the expansionary and inclusive attempt, the government is also looking to create a health system and formulate policies that co-opt the private sectors to align its growth and operations towards public health goals. The need to co-create a health system, with a spectrum of entities – private, public and not-for-profit, providing more effective rational, safe, affordable and ethical health services is laudable.

The private and not-for-profit sector must use this opportunity to partner with Government to shoulder the public health challenges that the country faces. One positive step towards this has been the rollout of the National Dialysis Scheme by the Health Ministry. Through out-sourcing and assuring scale and transparency, the Government and private partners are today working towards managing the crippling disease burden of renal disease across the country.

Similarly, the government is initiating dialogue with the private sector for co-creating infrastructure, managing urban public health institutions, rolling out a Universal Health Insurance scheme and conducting universal health screening for common Non-Communicable Diseases like diabetes, hypertension and cancer. These and other interventions hold tremendous potential for India to win the battle against illness and move towards an era of wellness.

The need to work together is not optional but critical.