New Delhi: The government is banking on the public-private partnership (PPP) model to try and raise an additional 160,000 hospital beds that PwC-Confederation of Indian Industry (CII) report says are needed to provide health cover under its ambitious Ayushman Bharat-National Health Protection Mission (AB-NHPM).
Billed as the world’s largest health insurance scheme, AB-NHPM, also called Modicare, aims to provide free health insurance of ₹ 5 lakh per family to nearly 40% of the population—more than 100 million poor and vulnerable families (approximately 500 million people) based on the socio-economic caste census.
At least 33% of the people covered by the scheme will have no previous health insurance coverage and will have a hospital admission incidence rate of 6% with an average length of stay of three days. A PwC-Confederation of Indian Industry (CII) report on AB-NHPM released last week highlighted that the government will require the right infrastructure strategy to meet the new bed capacity demand.
Currently, there are 1.35 million hospital beds for around 180 million people population covered under the Rashtriya Swasthya Bima Yojana, according to the report.
“From the new population, which comes under coverage for the first time, and also from increased demand from previously covered population due to higher coverage, the demand for new beds can be met by capital investments, changing the status of non-functional beds to functional, public-private collaboration, new business models and focus on preventive health care," the report said.
According to the Quality Council of India, an autonomous body to set up to ensure standards in various sectors, at least 6,000 private hospitals are likely to join AB-NHPM.
The government has long been pushing for PPP in this sector. In 2017, the government think tank NITI Aayog proposed that the ministry of health and family welfare adopt the PPP model to provide diagnosis and treatment for major non-communicable diseases in smaller cities. The majority of patients prefer the private sector over the public sector for healthcare services. According to the Economic Survey 2018, the expenditure by the government healthcare providers accounted for only 23% of the current health expenditure.
“Irrespective of ideological considerations, the fact is that the private sector does provide about 75% of outpatient care and 60% of inpatient care. Thinking of a health service delivery system without engaging the private sector is symptomatic of the refusal to face up to this reality. There is a need and space for vibrant public facilities as well as responsive private providers to take care of the patient load," said Alok Kumar, adviser (health & nutrition, financial resources, and administration) at NITI Aayog.
Several states have adopted the PPP model, with Odisha, Andhra Pradesh and Uttarakhand attempting to use the PPP framework to set up secondary and tertiary care facilities. Uttar Pradesh has also recently announced that it will establish more than 1,000 hospitals under the PPP model. The Haryana government last month entered into a PPP agreement with the Kerala-based Meditrina Group of hospitals for cardiac care.
Public health experts claim that the PPP model can be considered a key to providing universal health coverage. However, the initiative is plagued with problems. “The main problem is with the rural areas, which lack quality healthcare facilities. In rural areas and Tier 2 and Tier 3 cities, the private sector can play a pivotal role in bringing healthcare to the poor," said Prathap Kumar N, chief interventional cardiologist, chairman and managing director at Meditrina.
“The major problem is the lack of awareness among people that free and highly subsidised medical procedures are available for the poor. Even after we started providing free surgeries in Haryana, people did not know that there is such a facility," he added.