The Congress governments in Madhya Pradesh and Chhattisgarh have junked a plan to link private medical colleges with government district hospitals through public-private partnership.
Pointing to the shortage of qualified doctors, the NITI Aayog, the Centre’s policy think-tank that drafted the scheme, admitted that it was “practically not possible” for the Central and State governments to bridge the gaps in medical education with their limited finances. Hence, the scheme, by combining the strengths of the public and private sectors, would increase medical seats and rationalise the cost of education.
“We reject this scheme in its totality and will not implement it,” Madhya Pradesh Health Minister Tulsiram Silawat told The Hindu . “The intent of the State government is to provide complete healthcare services...”
“If district hospitals are handed over to private players, where will the poor go? Dalits, Adivasis, labourers, all depend on these hospitals. How can we give them to private players,” he asked.
Chhattisgarh Health Minister T.S. Singh Deo had earlier termed the “selling” of public healthcare to private players by the BJP government “unacceptable” and “condemnable”. “This assault on the common man by the BJP to help its few rich friends will not be tolerated. Allowing private players in healthcare means higher expenses for the people.”
Furthermore, he wrote on Twitter, the move also amounted to an attack on cooperative federalism. “By snatching the subject of healthcare from the States, the BJP wants to further its authoritarian agenda. We must oppose this tooth and nail... The BJP should not try to impose its anti-poor, crony capitalist agenda on us.”
Additional expenditure on defence and the burden of economic slowdown have compelled the Centre to see public health services as a source of revenue, according to Jan Swasthya Abhiyan, a network of non-profit organisations.
Under the scheme, the concessionaire, a private party, shall design, build, finance, operate and maintain the medical college and upgrade, operate and maintain the associated district hospital with a minimum annual student intake of 150 for the MBBS.
The model agreement will allow the party’s control over the land and assets for 60 years, with a provision for extension. Moreover, the lease agreement for the site of the college would be for 99 years, at a subsidised lease rent of “8% of the circle rate of the land”.
“It is incomprehensible how the proposal to hand over public facilities to private entities for 60 years — that is for a whole generation — is being made,” said Amulya Nidhi, member of the Jan Swasthya Abhiyan. “This means a whole generation will be at the mercy of this revenue generation model.”
The model distinguishes between ‘free patients’ and others based on their ability to pay. The ‘free patients’ require an authority’s sanction to procure a document for proof. They will be provided free consultation, drugs and diagnostics, but will have to pay ₹10 in registration fee. The others will be charged at “market competitive rates”.
Moreover, all the beds will be categorised as ‘regulated beds’ and ‘market beds’. With at least 750 minimum beds at a hospital, a minimum of 300 plus 20% of the remaining beds would be for the ‘free patients’. Yet, the concessionaire will have the discretion to charge all patients alike for the use of ancillary facilities such as parking lots or cafeteria.
“The ‘regulated beds’ are implicitly for patients who are covered by Ayushman Bharat or other health insurance schemes. So, though it is stated as ‘free’ care, the payment for these patients will mostly come from the government itself,” said an analysis document prepared by the Jan Swasthya Abhiyan.
The ‘free patients’ will get medicines free and the others will pay subsidised rates.