Public Private Partnership for Non-Communicable Diseases (NCDs) in District Hospitals

This post critically analyses the NITI Aayog's recent proposal for partial privatisation of district level hospitals for treatment of NCDs .

Main takeaways of proposal

• offering space to private players through competitive and transparent PPP framework.
• facility only for BPL and insurance covered

Argument in Favor :

• Issues plaguing public health system(HR, inadequate infrastructure, finance)
• rampant absenteeism of doctor
• vacancy rate of specialists - govt unable to attract & retain talent
• overloaded tertiary facility
• paltry budget allocation ~1.1% of GDP
• Positives of Private sector
• efficiency, accountability, sustainability
• continues to grow @15% pa
• five fold higher doctor density
• NCD accounts for 60% of premature death
• Cost apprehension is ill-founded as majority of patient already going to pvt facilities
• Benefits :
• Better Access - geographical disbursal of skills required for NCD care
• Quality & Affordability - provide quality care closer home at lower cost.
• help decongest tertiary level health facilities
• The proposal in alignment with new National Health Policy which seeks constructive role of private sector for promoting health.

Arguments against :

• concern regarding cost, equity, quality and health rights 
• pvt hospitals known to overcharge e.g. stents
• service only for BPL and insurance covered threatens UHC, a key for SDG
• continuous monitoring of PPP based services @ local level is weak
• experiment at RGSSH @Karnataka shows huge discrepancies
• US experience of switching to pvt health shows higher administration and transaction costs.

WF : 

• experiment in select district hospitals
• strong regulatory oversight required
• in the long run - 
• medical education - restructure MCI + NEET implementation
• implement RSBY
• greater budgetary support - 2.5%
• focus on outcomes with rankings to measure incremental improvement
• incentivise better performing states