The public-private gap in health care

The recent controversy about transparency in the working of the cadaver transplant programme in Tamil Nadu has provided an opportunity to revisit the vexed question of medical rationing in India.
It is a hard reality that not all medical interventions are available to every citizen who may need it. The gap between what is technologically possible and what government hospitals generally provide widened appreciably after the technological leaps in medical care began, starting in the 1980s.
Covert medical rationing
One of the recommendations is for the government to prioritise preventive care rather than provide curative care. The document also advises the government to pay attention to stewardship of the health sector in its entirety rather than focussing on provision of health care.
The new Ayushman Bharat health scheme to provide secondary and tertiary care to those who are socioeconomically deprived has a cap of Rs. 5 lakh per family per year. It is quite obvious that many interventions cannot be accessed for this amount, certainly not human organ transplants.
Inequitable medical rationing
Health care in India is obviously not egalitarian, but is it at least equitable? The evidence suggests otherwise. Governments have been giving subsidies to private players, especially to corporate hospitals. The repeated boast that India can offer advanced interventions at a fraction of the costs in the West does not take into account the cost of the subsidies that makes this possible.
The problem of distrust
One is a distrust of the public in government hospitals. The poor expect to get from them what the rich get in private hospitals. With present policies, this is simply not possible. Without a clearly defined mandate, morale among medical personnel in public hospitals is low. The perception that doctors in the private sector are much better than those in the public sector has a severe debilitating effect on the professional image of medical personnel in public hospitals. Attempts by doctors to provide these high technology interventions in public hospitals is bound to fail without continuing commitment from policymakers; it is quite clear from policy documents, which doctors and the public do not read, that such commitment will not be forthcoming.
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