Public-Private Partnership Model For Universal Health Coverage

With the Union budget around the corner, the country is filled with expectations from the government for its first full-fledged after the 2019 elections. On one hand, the healthcare industry is looking forward to experiencing a strong boost with this year’s union budget on the lines that was promised by the government - to increase its public health spending by more than 2.5 per cent of GDP by 2025. While on the other hand, the ease of adopting new technology, affordability of world-class medical equipment, investment in skill development, insurance, and more profitable public-private partnerships are on the minds of the diagnostic industry players.

In a healthcare infrastructure deficient country like ours, where the ratio between doctors and nurses per 1,000 people is dramatically lower than the World Health Organisation (WHO) average of 2.5 doctors and nurses per 1,000 people, and where only a 15 per cent of the population is covered by health insurance; a successful PPP model for diagnosis and treatment, and health insurance can become a major instrument in achieving the universal health coverage goal. One of the attractive features of Ayushman Bharat in a few of the states is an assurance from the government to clear the payment of private hospitals within 15 days of the treatment. Provisions like these make a public-private project workable for any private player. In such cases, the private players will be more proactive in engaging with the local health authorities, which will further result in benefitting patients.

Additionally, the Government needs to earmark annual allocations for establishing an autonomous body regulating the quality of services. Although curative healthcare remains a major priority area, we hope the budget injects some innovative policy interventions with respect to preventive healthcare. Preventive healthcare needs to have a fundamental role in the primary and secondary healthcare ecosystem, and diagnostics being an essential part of preventive healthcare needs to be an inherent part of the plan. We commend the intent expressed by the government regarding the goals and increased fund allocation for Ayushman Bharat - PMJAY. But what remains to be seen is the execution part of it. The government must look at better partnerships and incentives for the private healthcare and diagnostic providers if it expects to successfully achieve its target of universal healthcare for all in the country in the next few years. Therefore, pragmatic policies should be the best guide to healthcare reform.

Indian healthcare spends have a huge component of “out of pocket” expenditure. There is a need for inclusion of diagnostics spends under the ambit of insurance, which would help the Indian consumers to reduce the financial burden as well as bring in better checks and controls in the diagnostics practices. Despite non-communicable diseases being responsible for more than 50 percent of all deaths in India, health insurance schemes seem unprepared to meet this disease burden. The absence of coverage for outpatient care and pre-existing diseases is an impediment to achieving universal health coverage. Currently, in India, our healthcare policies do not see the entire healthcare value chain, which includes - prevention of diseases, treatment and health insurance, as a whole. There’s a need to connect all the dots together. The government needs to understand that diagnosis not only has important implications for patient care, but public policy decisions are often influenced by diagnostic information, such as setting payment policies, resource allocation decisions, and research priorities.

For Instance, the Prime Minister’s overarching scheme ‘POSHAN Abhiyaan’ for holistic nourishment serves as India’s flagship program to improve nutritional outcomes for children, adolescents, pregnant and lactating mothers. To achieve its ambitious target - the attainment of malnutrition free India by 2022 - the Government can embark on a health screening project, in partnership with private players, for young children to study their risk towards non-communicable diseases, anemia status, and level of micronutrients. This would assist the Government to understand the prevalence of health risks among the children across the state and formulate granular level nutrition and health programs for the children.

While we expect a stronger investment portfolio to boost the sector, skilling the workforce and strengthening the infrastructure of para-medical/ medical academic institutes across the country will also help. The government can support the industry by investing in vocational training and educational institutes focused on laboratory technology. The skilling is going to be very crucial as the industry has the potential to engage about double the workforce it employs today.

Arindam Haldar

Guest Author The author is CEO, SRL Diagnostics