By Dr. R. Balasubramaniam

An elderly person met me recently and wanted to know some details about the ongoing COVID vaccination programme. He was keen on understanding whether it would be better to get the shot at the Government Hospital or at a Private Hospital nearby. While the Government offered fully free services including the vaccine, people have to pay a nominal amount of Rs. 250 to Private Hospitals as a service fee. 

This person was hesitant to go to a Government Hospital while he seemed to be comfortable taking the vaccination in the Private Hospital, despite my explaining to him that the location by itself would not be a major factor as the vaccine is supplied by the Government. It seemed clear that this person had more faith in a Private Hospital while being unsure of the hygiene, quality of personnel, or the waiting time in a Government Hospital. 

For most of us visiting a Hospital is indeed a stressful experience. One needs to bear in mind the quality of care, the competence and experience of the attending Physician, the waiting times, the efficacy of medicines distributed and our inherent trust in the health system that is delivering the care. While it is easy to appreciate that we are the bearers of the cost of care in the private system, one tends to believe that public systems offer ‘free-care.’ This belief of ‘free-care’ is fundamentally flawed and is usually driven by our appreciation of only the ‘out-of-pocket’ expenses that we may actually incur or not incur when we seek care in public facilities.  

Deeper thought will reveal how every citizen pays for health care in public facilities in advance itself.  It is a pre-payment to the system that some of us may never really use but offered to us as a matter of our right as a citizen.  Since this is never really perceived by many of us, we tend to not only not use the facility, but also let the public providers off the hook and do not think of demanding accountability from them. 

Going back to the question of whether the private or the public sector is better for one to avail of health care facilities, we will have to ask ourselves why only 34 percent of Indians use public facilities whereas the vast majority of us visit the private providers. Is it driven by mere choice alone or by the quality of care that one associates with payment.  Are our public facilities comparable in terms of personnel, competence and treatment outcomes? With increasing privatisation on the cards and the offer of State Insurance for availing health care in Private facilities, one needs to take an objective and critical look at this.  We must also bear in mind that our taxation revenues are contributing more than Rs. 2 lakh crores towards the allocations made in this year’s Union budget towards providing health care for us.  

Taking an unbiased view will reveal that both the private and public facilities have their own pros and cons.  The stereotypical view that all Government Hospitals deliver less than the required quality of care while Private facilities deliver quality care also needs an objective re-assessment. One needs to keep in mind that Private Hospitals with a mere 20 percent of the total health infrastructure in the country caters to 66 percent of the population. Expecting them to deliver quality consistently with transparent declaration of health outcomes in such situations may be a tough ask.  All Government-run institutions hire and appoint only qualified personnel unlike the private sector where several small nursing homes are run with nursing and laboratory personnel not having the required qualifications. Very few Private Hospitals have a rational and well-defined pricing policy that is transparently shared with the patients availing of their services. Most patients are not aware of their rights and very few of them demand to know all this.  This being said, several public health facilities are stretched and resource limitation is a real constraint, especially at the primary health care level. Things are now improving with the introduction of Community Health and Wellness Centres in the public health system and one can surely hope to see its impact in a few years from now. 

Traditionally, Government is the dominant and effective responder to all public health challenges. The ongoing COVID crisis has clearly demonstrated how effectively the public health facilities functioned.  It goes to the credit of our policy planners and the providers across all levels of the system that we are still able to contain the crisis across the nation.  This has also been the time when private providers responded to the demand of the Government and joined hands in doing their bit. The Government not only expanded its own capability of providing care, but also ensured timely reimbursement at pre-fixed rates to the Private Hospitals that provided COVID treatment. The ongoing vaccination programme being rolled out through the Private Hospitals stands testimony to this evolving partnership. 

This is the ideal time for each of us to realise that what truly matters is that every Indian citizen receives the best possible care that one can hope for under the current circumstances. While market forces will determine how many of them will use private facilities, the Government needs to also step up in reducing the trust deficit in the rest who seek public facilities. Defining quality of care driven by treatment outcomes, ensuring common regulations to both private and public sector, ensuring proper prescription audits, and working with the strengths of each other would be the best way to build this much-needed partnership. It is in the interest of the citizens and the nation that the public and private sector comes together and transcends the traditional roles that each has been playing, and join hands  in a mutually beneficial partnership with the collective mandate of ensuring Universal health coverage to the 1.3 billion people of the country.    

[Dr. R. Balasubramaniam, Founder of Swami Vivekananda Youth Movement and GRAAM, is a public policy advocate and development activist. He is a Visiting Professor at Cornell University and IIT-Delhi.  He can be reached at: [email protected]]