It is almost two decades after liberalisation, when private enterprise took the initiative from state enterprises. In that time, privately-owned and for-profit hospitals took the burden of disease over from a moribund system of publicly-funded hospitals. But the Rs 2.4 lakh crore private health care sector is faltering in the face of a public health crisis, whose burden is being borne by government hospitals, their doctors and nurses. Private enterprise owns almost three out of every four hospital beds in India, and almost eight out of 10 ventilators, but they are handling less that 10 per cent of those critically ill with novel coronavirus. States like Bihar, where private capital owns about twice as many beds as government hospitals, have seen the private sector in complete rout. The reluctance to engage is so great that they have been turning away coronavirus patients and other patients in need of aid. In Delhi and Maharashtra, the state government has had to issue orders so that they do not turn any more away.
As a series of reports in this newspaper showed, numerous factors have been at play in this failure — pay cuts, employee reluctance, the fear of sealing, the future consequences to brand value of hospitals identified with the pandemic, the lack of established protocols and protective gear, and bureaucratic instructions, like those issued in Telangana, to refer viral patients to government facilities. Underlying all this is the economic reality of falling revenues and footfalls, accompanied by new expenses and risk. While the central and state governments should offer to underwrite the risk, the fact remains that a sector which has benefited hugely from government concessions and encouragements, and which has tried to take over healthcare in India, has abdicated its public responsibility and remains isolated from the national effort.
The pandemic offers an opportunity to policymakers to revalue the virtues of public versus private healthcare, and those of free facilities versus insurance-backed care. But both must continue to exist and the present system, however flawed, must carry the nation through the crisis. To retain its perceived value, it is imperative for the private sector to do its public duty now, and be seen to be doing so. In a crisis in which every citizen is pulling together according to ability, financial excuses for withdrawing appear to be pusillanimous and morally wrong. In their long-term interest, abstaining private hospitals must reconsider this divestment from the national effort.