How about a public-private healthcare model?

The Centre and the Tamil Nadu governments must be lauded for their Covid vaccination drive. It is a well-planned and executed scheme, benefiting millions. The role of the government hospitals has been crucial in this pandemic, and they rose to the occasion admirably. However, the pandemic has also brought private health providers under scrutiny. Though they may be efficient and possess the latest technology, there are questions about affordability and, in certain instances, even ethics.

Every citizen wishes for affordable and efficient health care. There have been innovations in diagnosis, treatment, and surgeries. Technology has pushed up the chances of survival, but for the majority, economics makes it unviable.

Many economists have pointed out that one instant of a health crisis in a family may result in a significant economic crisis. Private insurance cover has been of limited use, but the gap is still considerable. The public health care system can provide basic facilities for a large population to treat more common ailments. However, it is impractical to expect them to cover specialised treatments on a large scale. With the efficiency of private players in providing specialised therapies, their importance is crucial.

The infra factor

The substantial investment for these hospitals is the infrastructure. The land and building in cities like Chennai are the primary reason for the prohibitive cost of private health providers. Other infrastructure required to run the hospital, such as diagnostic equipment, operation theaters, etc., add enormously to the patient charges. With a business model based on the return of investment and profit and not philanthropy, one does not expect this to come down.

Under these circumstances, how do we extend the net for affordable critical treatment and diagnostics to a larger population? How do we bring technology and talent to a larger population who can afford the treatment costs to a limited extent?

We need a disruptive model in which public and private enterprises come together to provide the crucial gap in healthcare. Here the government provides the infrastructure, and the private sector offers the service.

As a first step, the government provides the fundamental infrastructure, the land, buildings, and essential equipment. Then the supporting staff, nurses, and administrators, including high-level administration, for running the hospital can be subcontracted, as has been done for the conservancy work of Chennai Corporation.

Secondly, the requirement for regular lab tests such as blood tests, ECG, X-rays, etc., can be allocated to an accredited laboratory. Finally, specialised equipment such as CT-scan, MRI, etc., can be run by another set of private professionals who are not paid by the government but by the patient for the services rendered.

The crucial link in patient treatment, the general practitioners, seems to be an endangered lot. There can be a separate block for general practitioners who earn from treating the patients. They rent out space in the building. The government can also establish feeder blocks in various wards for general practitioners in a city like Chennai. Here also general practitioners rent out space. These general practitioners and even other GPs can admit the patient to the hospital.

The specialists in various disciplines are crucial for a hospital to run efficiently. The specialist, a nephrologist, for example, may admit his patient under his care. Or the general practitioner can bring in a specialist to treat their patient. Such a system will also expand the availability of specialists.

So a nephrology ward and a dialysis unit, for example, can have not one but a few nephrologists or nephrology teams for serving their patients.

Likewise, a surgeon can hire the operation theatre and have his specialists visit the patient. In sum, a group of doctors comes together to treat patients with the government’s standard high-quality infrastructure.

A crucial question in a multi-specialty hospital of this kind is the array of equipment needed. The primary issue in the private setting is the return of investment of such expensive equipment.

Under the current model, let the government establish, say, four such hospital complexes in Chennai. Expensive equipment needs to be placed only in one of the units, and its facility extended to other hospitals. With time Centres of Excellence in various disciplines can be established. This will be a huge step in developing advanced treatments and making them affordable.

The patient is the “customer” in this “business model” and pays reasonable rent to the government for all the infrastructures used, pays the service providers and the treating doctors.

Lastly, a review of this scheme is essential for efficient, transparent, and honest administration. Then, the government can form a group chosen from the public, including doctors, retired civil servants, charted accountants, people's representatives, etc.

An add-on to the facilities is the establishment of research units in medicine. For the size of this country, India needs a significant boost in medical research. Tamil Nadu was the pioneer in medical education, research, and patient care. Even today, it is the health capital of India. Isn't it time we add affordability to the quality of health care?

The writer is Institute Professor, IIT-Madras

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