By Abhijeet Singh
Jaipur: As the country is going through a critical phase marked by an exponential rise in population compounded by a large-scale migration of people both inter and intra state, the state of Rajasthan is no – aloof of this social change and has made its governance even more complex and crucial, spawning a quagmire for both public and private actors particularly in the state’s public healthcare ecosystem.
Addressing such challenges calls for a more comprehensive approach wherein the much discussed public-private partnership (PPP) model stood up as the frontrunner with its USP of shouldering the responsibility between public and private stakeholders for achieving larger societal objectives along with their embedded individual goals.
Identifying such opportunities in the realm of public health with the aim of achieving universal healthcare for all denizens of Rajasthan at the Economic Times Rajasthan Business Summit, ETHealthworld conducted a trialogue on ‘Ensuring Health Assurance for All: Strategies to Achieve Universal Healthcare Coverage by Public Private Partnership’.
The speakers for the session included Dr Rakesh Shah, Cluster Head, Shalby Hospitals; Sandhya Sriram, Group CFO, Narayana Health; and the session was moderated by Dr Harsh Mahajan, Founder & Chief Radiologist, Mahajan Imaging & Labs.
Opening the discussion with her remarks over the possibility of PPP models in healthcare Sriram, underscored, the challenge of scaling such models which are driven by corporate social responsibility (CSR) funds and further elaborated that, “at the next level of PPP’s where the healthcare institutions participate in govt schemes; works on cross subsidisation model where we (hospitals) sometimes recover the variable cost and sometimes don’t which eventually transfer the burdens on rest of the patients who don’t come under the schemes.”
“The survival of healthcare entities becomes difficult at the rates these schemes operate and creating a business model through such schemes is very difficult,” added Sriram.
One big positive of this model is that it has been able to deliver very high quality care but in the current dynamics, current realisation and schemes scaling up this as a successful repeatable commercial model is difficult
Building on her remarks another speaker, Dr Shah stressed, “With respect to achieving universal health coverage (UHC), there are two major challenges, one is affordability and second is access which the the proposed PPP model tries to address; but to make it a success we need to create an ecosystem wherein both the parties get benefitted but CSR can’t help to scale the model anywhere. To provide quality healthcare under centre and state government schemes is a challenge.”
Commenting on whether insurance is the only way to achieve UHC giving its fiscal burden which may not be sustainable for a private hospital, Sriram remarked, “For a country like our’s which is operating at a tax to GDP ratio of 11 per cent, I don’t think it’s affordable no matter the vision of our country to create a universal health platform and the current model employed for making budgetary allocations private hospitals will always have to work in certain kind of mix but to balance the cost of realisation and cost of running the hospitals is very difficult.”
“We have to create a health insurance model based on a low cost premium which can be achieved by eliminating the cost of mistrust in the ecosystem because today there are a lot of contradictory incentives, lack of transparency and hidden agenda leading to loss of trust between the insurance provider, patient and hospitals,” she added.
Contributing to the discussion the moderator Dr Mahajan noted, “India is the cheapest quality healthcare destination in our neighboring region and specifically we are 20-25 per cent cheaper than them. However, there is a limit to which we can go down in cost and even at such low costs affordability of our population is a problem so health insurance schemes can help in that but its about 2 per cent of the insured who actually seek inpatient care and the rest of the population is defraying those costs.”
With respect to the adoption of technology and modern innovation to improve public healthcare initiatives Dr Shah shared, “The penetration rate of digital technology in health is at 7 per cent, how we have adopted financial models of UPI, something like that can be done on healthcare. Traditionally the Indian healthcare setup is largely dominated by curative treatment setups but now we need to focus on promotive-preventive healthcare and then we can reduce the disease burden. By prioritising more screening campaigns and increasing the peripheral reach we can overcome the challenges in promoting preventive health checkups in India.
A large part of the rural and semi-urban populace in India is deprived of specialist and super specialist healthcare but we can bridge this gap through peripheral OPD setups, preventive health checkups and AI is going to be the next game changer.
Over the lack of scientific study to determine the cost of government schemes under PPPs, Sriram underlined that, where these models are going wrong is when they are compared with the cost incurred in government setups where the original fixed cost (cost of running a setup) is taken for granted, so it requires a realisation that this math needs to be approached differently considering the cost of both private and public setups.”
As a potential solution she proposed, “For those at the bottom of the pyramid who need access to care and may not be able to afford even a low cost insurance that care can be delivered through the schemes but more people needs to be encouraged to move towards insurance segment where private players could employ their cross subsidisation strategies and will be able to deliver the schemes at a certain budget.”
Concluding the discussion Dr Mhajan emphasised, “It will still take us many years to get the adequate number of doctors, nurses and paramedics to cater the existing demand but if the health and wellness centres like Ayushman Arogya Mandirs could become centres for preventive health along with telemedicine and some innovative technologies we will be able to deliver primary and some level of secondary care to the targeted population.”
