Universal healthcare coverage: Privatisation

Recently, Montek Singh Ahluwalia advocated large private participation in the newly framed Universal Healthcare Coverage (UHC) by saying, "The healthcare network could include some private providers on suitable terms. As a matter of policy we are taking up this in the 12th Plan period". This shift to a "managed healthcare network" model will apparently allow a large network of private hospitals to play a domineering role in treatment of the people of India while leaving the government to play a mere regulatory role. The private hospitals which will take care of all clinical services will be reimbursed by the government.

The government has roped in a High- Level Expert Group (HLEG), led by Dr K Srinath Reddy, as an advisory body to assist Ahluwalia. However, Reddy later said, "We need to develop a model of UHC wherein the private sector will assist the public sector in serving a public purpose rather than privatising the delivery of public sector healthcare." The Union Health Ministry too chided the Planning Commission of "introducing ideas and approaches which have never been subjected to any level of consultation or discussion". Amartya Sen, in his 2011 Public Declaration, emphasised on how poor in India will be stifled by such a move. Poor people still can easily be fooled by the private hospitals because of informational asymmetry that will be forced upon them by unnecessary services.

But the Planning Commission seems to be still swayed by Ahluwalia’s doctrine, which seems to be inspired by UHC through private practitioners prevalent in developed economies like the US and Canada. What Ahluwalia may be missing is that vast differences in socio-economic dynamics between India and countries like Canada or the US dilute the scope of adopting such a model. Contributory social insurance will run counter to India's interests where an overwhelming 93 per cent of the population is employed in the unorganised sector and a vast number lives below the poverty line.

Outcast nations like Cuba and North Korea also provide free healthcare to all their citizens; so much so that there is not even a single private hospital in Cuba and hardly any in North Korea. Cuba singularly has been exemplary in ensuring world class health standards to its citizens. WHO's Director-General Margaret Chan, on her visit to North Korea portrayed its healthcare to be an envy to the developing nations. Given this, India should replicate Cuba and North who are successful in providing affordable public healthcare to all than ape the American way.