‘In-patients will have to pay up if private agencies are allowed to use diagnostic centres to serve external customers’
The Chhattisgarh government’s move to outsource diagnostic services in public health facilities has evoked a sharp reaction from health activists, who fear that it will destroy laboratory services.
The government has issued a request for proposals for private partnership in radiology and laboratory services in 379 public health facilities. Three categories of facilities have been identified for setting up diagnostic centres in the public-private partnership mode. These include 100-bed hospitals (Category A); the newly established district hospitals, the first referral unit-community health centres and civil hospitals (Category B); and the non-first referral unit- community health centres and 24x7 primary health centres (Category C).
Under the proposal, the private partner or agency can operate the centres directly through staff members contracted by it, or they can engage ‘concessionaires’ to run the facilities on a revenue/profit-sharing basis. The contract will be valid for 10 years, and a third party will monitor the services. However, the liability for complying with contractual obligations shall rest with the agency, which will also have to ensure that each centre complies with the standards such as those specified in the Nursing Home Act.
The government will provide space, along with a separate electricity meter connection, for the laboratory and radiology centre. The agency or its concessionaire will have to pay up electricity charges.
But the bone of contention is the provision that allows the agency to use diagnostic centres to serve ‘external’ customers. “This can result in a situation in which in-patients may end up paying and the external ones may be shown as in-patients,” argues Sulakshana Nandi of Jan Swasthya Abhiyan, the Indian circle of the People’s Health Movement, a worldwide organisation that works to establish health and equitable development as top priorities.
The proposal does not define the entitlements or rights of patients; nor does it specify whether the services will be provided free. Furthermore, it does not propose any redress mechanism, the Abhiyan says. Instead of handing over the services to private operators, the government should upgrade the existing facilities, it contends.
Backing the initiative, State government officials point out that the entire population is covered by the Rashtriya Swasthya Bima Yojana, or the national health insurance scheme for the poor, which entitles them to the best health facilities. “Right from the Chief Minister to the individual covered under the below poverty line scheme there is a health card for the entire family that entitles him and his family to the best cashless healthcare from any government or private facility,” says N. Baijendra Kumar, Commissioner, Public Relations, Chhattisgarh government. The scheme, he adds, is not meant to end public healthcare system but only to supplement it. For the Abhiyan, it is incredible that the government is planning to go ahead with such a large-scale initiative, especially when there is no evidence of its working. Rather, there is evidence to the contrary: the outsourcing of diagnostics in Bihar has been strongly criticised by the Sixth Common Review Mission of the National Rural Health Mission.
Furthermore, the scheme overlooks the guidelines laid down by the Atomic Energy Regulatory Board, since radioactive X-ray machines will be installed at these centres.
The scheme will cover all community health centres, 80 per cent of the district hospitals, seven of 17 civil hospitals and 200 of the best performing primary health centres.