Bidding out space in district health centres—these include health sub-centres, primary health centres (PHCs), community health centres (CHCs), sub-divisional hospitals and district hospitals (DHs)—to private healthcare providers will add to the overall efficiency of the healthcare system in the country. The private players will set up screening and treatment facilities for four major non-communicable diseases (NCDs), including cancer and chronic kidney ailments. NCDs are estimated to account for 61% of all deaths in the country and, a 2014 World Economic Forum-Harvard School of Public Health study estimates that the probability of an Indian citizen dying from one of the four major NCDs in her most productive years (30-70) is a staggering 26%. The loss from just wasted productivity and dedicated treatment/management outgo, not surprisingly, could be huge. A healthcare focus on these, thus, can’t be overstated, and to that end, utilising the unused space at the 1,55,069 sub-centres, 25,354 PHCs, 5,510 CHCs, 1,065 sub-divisional hospitals and 773 DHs that are functional at the moment will bridge some of the infrastructure gap.
More important, this could significantly lower the costs for patients. In the case of end-stage renal disease, for instance, dialysis costs at private facilities may be as high as `2,000 per session, and a typical patient could need anywhere between 8-10 sessions per month. Public sector dialysis infrastructure, though cheaper to avail, is quite strained— that a developed state like Karnataka, as per a state government-commissioned feasibility study for setting up dialysis centres at the tehsil level, has just 120 functioning dialysis machines in its 20 district hospitals should be telling. Unable to avail services at public facilities, patients turn to private healthcare providers, and with most of the expenditure borne “out-of-pocket”, this proves a costly proposition. The NITI Aayog is looking at a pay-per-use model for the NCD PPP—this could perhaps mean that the player quoting the lowest fee per patient wins the bid. The gain from not having to first invest in developing the space to house testing and treatment facilities will translate into lower costs for the patients. This will be a much better solution than, say, the dialysis subsidy that the Union government announced in Budget 2016. The tricky part will be to get the states moving, given health is a state subject.
The proposed PPP will be a shot in the arm for healthcare in India. But realising its full potential is hobbled by the fact that the country still needs 35,110 sub-centres, 6,572 PHCs and 2,220 CHCs to be built. Treating a stunted public health outreach—radial distance covered by a CHC in Maharashtra and Andhra Pradesh is over 16 kilometres, contributing to a higher “time-to-care”—is long overdue.