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Public-private partnership in healthcare is never easy but the National Health Policy passed by the cabinet this week lays emphasis on the role of the private sector, laying a roadmap for PPPs. Recognising that primary care will forever be in the domain of the government, the health policy talks of “strategic purchasing” of secondary and tertiary care from the private sector. It identifies ways in which the private sector can be involved — through corporate social responsibility initiatives and as providers of services via insurance or trust-based models. The National Dialysis programme launched last year is one of the first large-scale PPP initiatives. The new policy makes it clear that the days when PPP was a dirty word in healthcare are over. The health policy recognises there are many critical gaps in public services which would be filled by “strategic purchasing”.
The policy advocates the building of synergy with “not for profit organisations and the private sector, subject to availability of timely quality services as per predefined norms in the collaborating organisation for critical gap filling,” the policy document reads.
It goes on to add: “The main mechanisms of strategic purchasing are insurance and through trusts. Schemes like Aarogyasri and RSBY (Rashtriya Swasthya Bima Yojana) have been able to increase private participation significantly. Payment is by reimbursement on a fee-for-service basis and many private providers have been able to benefit greatly by these schemes,” the policy says, essentially taking off from where the 12th plan document left off.
Aarogyashri, a scheme of the Andhra government to fund tertiary care, is widely believed to have been the key behind the electoral victories of the late Chief Minister YSR Reddy. The Rashtriya Swasthya Bima Yojana provides medical insurance coverage to needy families. Formerly run by the labour ministry, it was recently transferred to health in preparation for rollout of the National Health Protection Scheme.
The new policy essentially walks the path prescribed by the High Level Expert Group (HLEG) on Universal Health Care that was formed by the erstwhile Planning Commission.
The HLEG report said: “We advocate a shift from a primary focus on garnering additional financial resources from the private sector or subsidising it, to an approach in which there is a well-defined service delivery partnership between the government as a purchaser and the private sector as a provider.”
Some of the areas for PPP that have been identified are in disaster management, manpower training, occupational health, adolescent health and accident prevention.
The private sector has also been identified as a crucial prospective partner in having fully functional primary health care facilities in urban areas essentially for the middle class population that can afford to pay a fee.
The government would act as a facilitator in these cases to offer a comprehensive health care package that will be bought from the private sector. It even recognises the roles of the private sector in more sensitive fields like immunisation, disease surveillance and organ and tissue transplant programmes.
Big hospital chains were quick on the uptake and welcomed the new policy.
Dr Prathap C Reddy, founder chairman, Apollo Hospitals Group, said: “This is a visionary step towards assuring quality of life and quality of health services to every citizen of India. Strengthening the primary care system, health education, preventive interventions along with ease of access to quality health facilities will help India tide over the communicable and non-communicable disease burden. The government’s focused initiatives have led to significant progress in containing communicable diseases, reducing infant and maternal mortality and tremendous progress across vital health parameters.”