Image source: LiveMint

Unprecedentedly, the world humanity has been at peril since the spread of the Coronavirus, which emerged first in Wuhan, China in December 2019, and it reminds us about the two World Wars and a host of plagues of the past. The initial attitudes of both China and the World Health Organization in communicating the massive spread of the virus were not impressive, despite the best use of their collective powers and advanced science and technology in identifying the deadly virus’s life cycle and nature of reproduction.

The global community is in an abject condition fighting the tiny, yet deadly virus for the past six months and has become more fragile now than ever in human history. Authorities across the globe have responded varyingly depending upon the velocity of the virus spread and its sustainability and longevity. 

The public health systems across the globe, even though with their limited resources, have become a machinery of warriors in the fight against COVID-19.The collaborative systems have become dynamic to save lives by preventing the spread. A health emergency like COVID-19 was a big blow to the public health system in a country like India in many ways more than the shortage of doctors, nurses, ventilators, masks, bed capacities, ICU, etc. But the actual realities are undermined to some extent. It is now close to four months since the first COVID-19 positive case was reported in India. Now, COVID-19 has gone beyond a metaphor testing the capacities of the government system in India.

The public health systems in Indian States are in different stages of evolution and are far away from the capacity of handling emergencies like COVID-19. They are by and large not well equipped with the necessary medical equipment and thereby causing more mental stress to patients and medical staff. Nevertheless, the State’s health systems responded swiftly, despite their systemic limitations, to best handle the COVID-19 patients. But despite the best efforts to observe a complete lockdown, the number of COVID-19 positive cases have been significantly increasing in major populated States.

Now, two months after the total lockdown forced by the Indian government to contain the pandemic, one of the pertinent questions arises is about its failure to engage private sector hospitals optimally. As on May 31, there are only 676 testing labs across the country, of which only 204 testing labsof private hospitals are approved and engaged by the Indian Council of Medical Research (ICMR) to conduct the testing. Given the growing number of COVID-19 positive cases in the country, especially in the major populated States, the number of private hospitals approved are nothing but a drop in the ocean.

Private hospitals in India have 80 per cent of the available ventilators but are handling less than 10 per cent of the critical care for COVID-19.[1] All the private hospitals empanelled under the Ayushman Bharat Scheme—the State’s own health insurance scheme—have a huge capacity to complement the public health systems to effectively fight COVID-19. But the nexus between the National Health Mission and the private sector healthcare infrastructure seems to be completely underutilised at this very critical juncture. Efficiency and quality cannot improve without choices for services like healthcare in a country like India. There is neither a legal nor a logical basis for excluding private sector hospitals from the fight against COVID and allowing only government hospitals, despite their acute shortcomings, to treat the patients.

The testing of patients for COVID-19 is still very low compared to many countries and one of the main reasons might be the failure of the Indian government to strategically engage the private sector hospitals. The most contested issue now India faces is the low level of testing of people who may have symptoms, which has not been taken seriously even now by the State authorities. It is evident from the global experience that early testing is imperative for containing community spread which otherwise could devastate the country more than any cyclone or an earthquake.

Why is there no effort from the Union Government to bring out a comprehensive policy framework to engage private hospitals across the country to augment the efforts of public health systems in the fight against COVID-19? Without bringing out comprehensive guidelines for involving private hospitals and providing a level playing field with price parity under insurance schemes, different State governments have enforced their power and authority to use and misuse the facilities of private hospitals across the country, setting a bad precedent.

Moreover, voices were raised from some quarters in the country for the nationalisation of private hospitals. But even doing it for the cause of COVID-19 would be suicidal to the vibrant private healthcare sector in the long-term perspective. Without unified guidelines of the Union Government, both the State governments and private hospitals have gone into a firefighting over the mode of operandi.

Fighting COVID-19 is a peculiar challenge for all the State governments in India. Different State governments have enforced the colonial law, the Epidemic Diseases Act, 1897 or their own health emergency law in a hasty way to take over private hospitals and their medical staff. Uttarakhand was the first State to announce on March 24 that all private hospitals have to reserve 100 or more beds—at least 25 percent of beds—for COVID-19 patients, which essentially meant for government utilisation.

Similarly, States like Chhattisgarh, Rajasthan and Madhya Pradesh issued orders that the entire private hospitals would be temporarily utilised by the governments for the treatment of COVID-19 patients; though, later Chhattisgarh withdrew its order. The Delhi government had issued an order to reserve at least 20 percent of beds for COVID-19 patients in private hospitals that have 50 or more bed capacity. The government also threatened private hospitals and issued a show-cause notice to a private hospital for refusing to admit patients.

The Telangana State government had prohibited private hospitals and diagnostic centres from conducting COVID-19 tests and treatment. Recently, the Telangana High Court has passed a judgment that the State Government cannot force its citizens to get testing or treatment/isolation for COVID-19 done only at government hospitals if they are willing to pay the cost and get their blood samples tested in ICMR-approved private hospitals or laboratories having requisite infrastructure.

Further, the most severely affected State of Maharashtra announced that the entire expenses for COVID-19 treatment in private hospitals would be borne by the State Government. But private hospitals urged the government to withdraw the order due to the unfair terms and conditions under which private hospitals’ medical facilities are utilised. Lack of a unified public policy to rope in private hospitals paves only confusion and contradiction in the collective fight against the pandemic.

Interestingly, the Pune district has initiated setting up a Public-Private Partnership (PPP) model, a first of its kind in the country, for financing COVID-19 patients’ treatment not covered under any insurance scheme at private hospitals. Pune Platform for COVID-19 Response (PPCR), which is a multi-stakeholder platform including nearly 100 corporates as well as civil society members, aims to raise private donations for the scheme and has already mobilised around Rs12 crore.

We cannot ignore and undermine the private healthcare sector by just utilising about 10 percent of its facilities. We should make a strategic plan for effective partnership with private hospitals and make them part of the country’s strategy in the fight against COVID-19. If the private sector is facing trust deficits and cost overlaps, the government should come up with the right kind of policies to build confidence in the private sector without which the country cannot manage the pandemic, especially after lifting the lockdown.

Views expressed are personal and need not reflect or represent the views of Centre for Public Policy Research.

[1]Raghavan, Prabha, Tabassum Barnagarwala, and Abantika Ghosh. 2020. “Covid Fight: Govt System in Front, Private Hospitals do the Distancing.” Indian Express, April 30, 2020.

Chandrasekaran Balakrishnan
Chandrasekaran Balakrishnan
Chandrasekaran Balakrishnan is Research Fellow (Urban Eco-system and Skill Development) with CPPR. His areas of research interest are economics of education, vocational education and skills development, economic reforms, liberal vision for India, water management, regional development, and city development. Chandrasekaran has an MA in Economics (University of Madras) and an MPhil in Social Sciences (Devi Ahilya Vishwavidyalaya University, Indore).

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