Context:
- The article critiques the Public–Private Partnership (PPP) model in healthcare, arguing that it is unsuitable for delivering equitable, affordable, and accessible public health services.
- It uses Andhra Pradesh’s experience—especially proposals to expand medical colleges and hospitals via PPP—as a case study to highlight systemic risks of privatisation in a critical social sector.
- The debate is situated within India’s broader challenge of healthcare capacity gaps, regional inequities, and rising out-of-pocket expenditure.
Key Highlights:
PPP in Medical Education & Healthcare
- Andhra Pradesh expanded medical colleges rapidly, adding 17 colleges in three years, with plans for 10 more under PPP mode.
- PPP colleges involve private investment with government support such as:
- Subsidised land
- Public financing (e.g., loans via NABARD)
- Guaranteed patient inflow through government health schemes
- Critics argue PPP is driven more by investor profitability than public health outcomes.
Risks to Public Health System
- PPP at district level may fragment the public health system and weaken long-term capacity building.
- Shifts focus from preventive and primary care to revenue-driven tertiary services.
- Private partners may:
- Cherry-pick profitable services
- Undermine free care guarantees
- Increase informal privatisation of public assets
Evidence & Financial Concerns
- Government bears major risks:
- Cost overruns
- Litigation from private partners
- Long-term fiscal liabilities
- Free care for 70% of inpatients and reserved beds under schemes like Aarogyasri / Ayushman Bharat may become unsustainable.
- Lack of evidence-based assessment on whether PPP improves health outcomes or equity.
Human Resource & Equity Issues
- PPP does not address shortage of doctors in rural and tribal areas.
- Medical graduates often prefer urban or overseas employment, despite public investment in education.
- Rising fees in private institutions exacerbate inequality in access to medical education.
Governance & Regulatory Challenges
- States often lack institutional capacity to design, monitor, and enforce PPP contracts.
- Healthcare PPPs involve complex clinical, ethical, and financial dimensions not suited to rigid contracts.
- Risk of privatisation by stealth through asset transfer and management control.
Relevant Prelims Points:
- Issue: Appropriateness of PPP model in healthcare delivery.
- Causes:
- Fiscal constraints of States
- Pressure to rapidly expand health infrastructure
- Government Initiatives:
- PPP frameworks in infrastructure
- Ayushman Bharat – PMJAY for inpatient care
- Benefits Claimed by PPP:
- Faster infrastructure creation
- Private sector efficiency
- Challenges:
- Profit motive vs public welfare
- Regulatory capacity deficit
- Equity and access concerns
- Impact:
- Risk to universality and affordability of healthcare
Relevant Mains Points:
- Facts & Provisions:
- Health is a State Subject (Seventh Schedule)
- Right to health linked to Article 21 (Judicial interpretation)
- Keywords & Concepts:
- Public health systems
- Universal Health Coverage (UHC)
- Privatisation vs welfare state
- Static & Conceptual Linkages:
- Primary–secondary–tertiary care pyramid
- Preventive vs curative healthcare
- Way Forward:
- Strengthen public healthcare infrastructure directly
- Invest in primary care and disease prevention
- Evidence-based policy evaluation before adopting PPP
- Improve medical education quality and equitable access
- Build strong regulatory and monitoring institutions
UPSC Relevance (GS-wise):
- GS II: Governance – Public policy, social sector delivery
- GS III: Economy – Public expenditure, PPP models
- GS IV: Ethics – Equity, social justice, role of State in welfare