Context

As the government tries to overhaul the public health system in India, its time to take into account the advent and the role played by the private sector and its implications.

The advent of the private sector

• Increase in the role of the private sector in the post-Independence era: Post-Independence, the private sector increased its footprint in India.
  • Perpetual sub-optimal investments in public health allowed the private sector to capitalise, flourish, and increasingly gain the confidence of the masses.
  • The private sector went from having about 1,400 enterprises in 1950 to more than 10 lakh in 2010-11.
  • To doctors, this promised greater professional liberty, lesser restrictions, and higher incomes.
  • After liberalisation, the greater focus shifted to the lucrative tertiary-care sector and led to an onslaught of sophisticated private health care in cities.

The dominance of the private sector and malpractices

• The scale of dominance: Private sector has over 70% of the health-care workforce and 80% of allopathic doctors, has meant that it is scarcely possible for a health-care provider to function in defiance of its norms.
  • Pervasive malpractices: The pervasiveness of malpractices in this market has come to ensure that few could survive without condoning them.
  • Nexus of the private players: Players in this market, in much of their malpractices, have also learnt to function as a harmonious family.
  • Organised form to safeguard interest: The family plays its role in safeguarding its members, acquainting them with its norms and interests, and leveraging the power of its patriarchs to defend its interests in society.
  • Standards of success dictated by the markets: It is little wonder that the market has also come to dictate the avenues of aggrandisement and yardsticks of professional success for health-care professionals.
  • Benchmark of quality changed: Business finesse and social adroitness rather than clinical excellence and empathy become the touchstones of calibre in this market.

Failure of the government

• Absence of national system: The larger chunk of Indian health care (and health workforce) could not be brought under a “national system” having some form of overarching state control or involvement.
  • If such a system existed it could avail of essential health care without most people having to rely on a vagarious market, except as a luxury.
  • Example of the UK’s NHS: The National Health Service of the United Kingdom, remains the single largest health-care provider.
  • NHS employs nearly the entire health-care workforce.
  • NHS makes essential health care available to all practically free at the point of service.
• Consequences of the absence of such system: The absence ensures is that the profit-driven private sector, the minor component, caters mainly to the affluent lot as largely a matter of deliberate choice rather than desperate compulsion.
  • Hopes of benefits of free-market belied: The Indian example, much like the United States’, bespeaks the failure of the idea that a free market will compel players to be more efficient.
  • The exploitation of the loops by the private players: Rather than increasing efficiency, the players have found it expedient to scrupulously exploit the prevailing cracks in the system and employ devious methods in order to maximise profits.

Conclusion

• Health-care providers, just like others, are moulded by their social surroundings. When necessary controls are loosened, the connatural vices are let loose; when the habitat is conducive to values, the right traits develop.
• A system that starts off with health care as an overt tradable commodity it threatens the development of virtues in the system.
• On the other hand, a system founded on the concept of equity cultivates a totally different culture of patient care.

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