Implementing disinvestment policies will impact healthcare: Dr Baru

Bhopal: Reducing govt ownership through disinvestment cannot substitute inadequate state funding in healthcare services, said Professor (Dr) Rama V Baru, former faculty at the center for social medicine and community health, Jawaharlal Nehru University (New Delhi). She presented these views while delivering 11th Dr Ajay Khare Memorial Lecture on "Disinvestment in Public Health Care and Medical Education: Policies and Challenges" at Gandhi Bhawan on Thursday.

Utilising two distinct terms, commercialisation and privatisation, Dr Baru cautioned that implementing disinvestment policies would severely impact India's healthcare system, leading to detrimental consequences.

Since inception, private sector has been predominant in pharmaceuticals. She cited an example, stating that in 1980s, then undivided, Andhra Pradesh, they were the foremost to commercialise their health services. Essentially took secondary and tertiary level hospitals under a para state organisation which was authorised to invite private capital. It has proven ineffective, she added.

In the late 70s China endeavored to make public hospitals financially viable. It led to over prescription of drugs, diagnostic tests as a revenue generator. Although China has a near universal public insurance scheme the public insurance scheme could not cover these costs. So over time out of pocket expenditure in China started going up.

Citing a case for govt hospitals, she explained, COVID-19 pandemic has demonstrated that govt-run health care institutions, not private hospitals, were at the forefront of providing care to medical personnel. "It is exclusively public sector that can be held accountable legally, morally, ethically," she emphasized.

Primary health care workers are modestly compensated para workers and vital components of the public health system and preventive care. A sophisticated medical college model is particularly susceptible to private capital movement. Private capital shows no interest in preventive care. Thus, our current trajectory contradicts fundamental public health sensibilities, she elaborated.

"I must emphasise that in this entire PPP discourse, it is a conflict of opposing values. The principles embedded in any public institution prioritise collective welfare. One governed by notions of citizenship and rights, ensuring equivalent quality care regardless of identity. Markets lack values. They (private sector) pursue profit exclusively."

PPP-mode substantially depends on regulation. "When examining PPPs, numerous variants exist. The crucial aspect often overlooked is this tension between two incompatible value systems. Suggestions of reconciliation through regulation are impractical. In power dynamics between district hospitals and private medical colleges, private institutions invariably dominate," she explained.

The relevance has heightened, particularly regarding Madhya Pradesh health department's proposal to establish medical colleges through public-private partnership. The most recent proposal emerged during Global investors summit in Bhopal.