Sunday, February 15, 2015

VIDYA KRISHNAN - Private Practice - On the condition of India’s health care

The Indraprastha Apollo Hospital was famously given fifteen acres of land in Delhi’s Sarita Vihar for a grand total of Rs 1, in exchange for the hospital providing a generous amount of free care to poorer patients—but the conditions of the lease, it turned out, were subsequently repeatedly violated...

... As the Bharatiya Janata Party-led government seeks to make real headway in solving India’s health crises, it is confronted with two broad challenges. The first is to combat the health sector’s severe shortage of human resources. The second is to calibrate the role of insurance in public health care, which has grown in importance, and will play a vital role in shaping future health policy. In both cases, private interests stand to gain tremendously from business-friendly government decisions.

The rewards will be rich. On 1 January this year, the government released a draft national health policy, which remains in the public domain for suggestions and open consultations until the end of February. It projects that the private health-care industry, currently valued at $40 billion, will grow to be worth $280 billion by 2020. As a “perennially and most rapidly growing area of the economy,” its current growth rate, of 14 percent, is expected to leap to 21 percent over the next decade.

The industry’s dramatic growth, however, will struggle to keep pace with India’s looming health crises. Strategies employed to combat them will be decisive factors in the country’s development in the coming decades. For years, entrepreneurs have been lobbying the government to implement expensive solutions, by way of public-private partnerships, at both the state and central levels. These solutions include the state purchasing care from private hospitals; increasing cover on government insurance schemes; providing subsidies for infrastructure, including land, power and water; and offering tax rebates to entrepreneurs willing to set up hospitals in underserved areas.

Interviews with several medical entrepreneurs, officials in the health ministry and Trehan’s aides all confirmed the widely held view that Trehan is heavily invested in ensuring that private players have a central role in whatever reforms are planned for the health sector. Some of these people also pointed out that private interests would clash with the larger aim of the public good—and, indeed, may already be doing so. Many critics point out the government’s current penchant for pro-industry policy is proving ruinous to public health facilities, already long-neglected, and falling behind in the race to capture talent. Coupled with the high cost of private medical care, the overall situation is likely to prove detrimental to national health targets.

In the course of several conversations with Trehan over the last three months, it was clear that he saw the aligning of government and private interests as inevitable. “We have to pull up our boot straps,” he told me. The private sector has spare capacity to offer the government. But the government has to appreciate that the private player “has a cost of delivery, and a 10 to 15 percent margin,” he said. As long as that was understood, “I think we could make a big difference.”

A senior official in the health ministry, speaking on condition of anonymity, said that the speed of Trehan’s ascent set him apart. The official added, “We can keep arguing for better quality, affordable prices—and yes, private players are, indeed, profiting from poor patients—but we cannot argue that Trehan does not deliver.”

As an example of how he operated, the official pointed to the CII’s role in organising the agenda of the Healthcare Sector Skills Council, which was formed in early 2012 to lay down educational and clinical standards for health-care professionals, including lab technicians and compounders, who currently learn their skills on the job rather than through formal training. It was Trehan who took into account the demands of multiple groups, including the Planning Commission, the health ministry and various industry bodies, to manouevre the CII into control of the new agency...

read more: