Private Healthcare

Though the global spending on health is rising worldwide, people were still paying too much out of their pockets. This article examined the comparative expenditure on hospitalised care in India using three rounds of the National Sample Surveys. As there is low footfall in public facilities, the Government of India needs to take necessary measures to strengthen the public health system.

India’s health system is dominated by the private sector and as a result, out-of-pocket expenditure is very high. To provide financial risk protection and avoid catastrophic health consequences, policy emphasis is on the Ayushman Bharat programme which targets to cover 50 crore people. Such a large-scale insurance scheme needs huge infrastructural and administrative support. Unincorporated private healthcare providers comprise 99% of private health providers in India, the majority of them being small scale, employing less than 10 workers and having a strong urban bias. To better promote universal health coverage, policy emphasis on better monitoring, administering regulations, transparency in system, and ensuring quality in delivery of service is needed.

This paper examines the growth and regional spread of medical education in India, particularly in the private sector. An important feature of the considerable growth of medical education, especially after the 1990s, has been the setting up of numerous private medical colleges in the country. Interestingly, this growth has occurred primarily in the more developed states with better health outcomes, while the low-income states with poor health indicators have lagged behind. This unequal distribution of medical colleges has had an impact on the availability of medical services and has resulted in regional differences in access to doctors in the country.

The Rajasthan government has planned to hand over its public health centres to private operators through a process of bidding. However this will have a debilitating effect on the inadequate and under-resourced public healthcare system in the state. 

This paper contributes to the debate on the Draft National Health Policy 2015 by analysing and critiquing some of its key recommendations within the prevailing social, economic, and political context of the country. This policy seems to suggest that strategic purchasing of curative health services from both the public and private sectors can enable India to achieve the goal of "universal healthcare." The draft policy is based on two assumptions. One, policy interventions since the National Health Policy 2002 have been largely successful and two, there is harmony of purpose between public and private healthcare delivery systems which allows the private sector to be used for achieving public health goals. This article argues that these assumptions are flawed, highlights the various contradictions in the policy and cautions against over-optimism on publicly-financed health insurance schemes.