The Centre has proposed in the Union Budget 2020 to attach medical colleges to existing district hospitals in the PPP mode.
This is being done to ostensibly address the shortage of doctors in the country.
What is the proposal?
The proposal says that the States which fully allow the facilities of the hospital to the medical college and wish to provide land at a concession would be eligible for viability gap funding.
Several details are already available in the public domain, as part of the plan, first proposed by NITI Aayog.
What did the NITI Aayogpropose?
The NITI Aayog argues that it is practically not possible for Central and State governments to bridge the gaps in medical education due to their limited resources and finances.
This necessitated the formation of a public-private partnership (PPP) model which will combine the strengths of both sectors.
(PPP model - Collaboration between a government agency and a private-sector company to finance, build and operate projects).
What would be the impacts?
This would augment the number of medical seats available and moderate the costs of medical education.
Experts have argued that the NITI Aayog hasn’t given sufficient role to the district hospital as the pivot of primary health care in every State.
Allowing private parties to operate and maintain the district hospital could dent public health services.
It is problematic that the NITI Aayog envisages the creation of free patients versus others, because this will create a new category of have-nots.
The agreement indicates that the private firm can demand, collect and appropriate hospital charges from patients.
Why is there an opposition?
There is understandable opposition to the scheme in States such as Tamil Nadu that have a robust public health-care system, and a medical college in nearly every district.
These States are naturally loath to turning over a key unit in their health-care network to the private sector motivated by profit rather than public interest.
This is because they are already running reasonably efficiently.
The creation of quality medical professionals for a country should be on any government’s to-do list.
But destabilising people’s access to affordable public health services will be disastrous.
What could be done?
The government must consider raising health-care spending beyond the usual under 2% of GDP.
It should ensure more resources are available to provide free, quality health care to all.
If it does stay on its path of giving the private sector some control over district hospitals, it will be a small act that will lead to much larger, more serious, and less desirable consequence.
