<p class="MsoNormal" align="center" style="text-align:center"><b><span style="font-size:11.0pt">PRESS STATEMENT</span></b></p>
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="font-size:11.0pt"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="font-size:11.0pt">Planning Commission of India to hand over Health
Care to Corporate Sector</span></b></p>
<p class="MsoNormal"><span style="font-size:11.0pt"> </span></p>
<p class="MsoNormal"><span style="font-size:11.0pt">The draft health chapter of
the 12the Five Year Plan document is being discussed for final adoption by the
Planning Commission by the end of August, 2012. The Jan Swasthya Abhiyan (Peoples
Health Movement – India) expresses concern regarding the present
recommendations and plans outlined in the draft chapter. <b>The chapter fails to build on the recommendations of the High Level Expert
Group (HLEG) set up by the Planning Commission, misquotes the Group’s recommendations
in many places and ends by proposing a plan for restructuring the country’s
health system that would effectively hand over health care to the corporate
sector.</b> It is particularly problematic that the plan document invokes the
concept of Universal Health Care, while actually proposing a strategy that is
far removed from the basic tenets of Universal Health Care.</span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"> </span></p>
<p class="MsoNormal"><b><span style="font-size:11.0pt">The Plan
document recommends increase in public expenditure on health from the present
1% to 1.58% of GDP. This is in sharp contrast to the HLEG recommendation of
increasing this expenditure to at least 2.5% of the GDP and also at variance
with the earlier pronouncements by the Prime Minister. Secondly it proposes
that the Central government’s (which collects most of the taxes ) share in the
additional health expenditure would be less than half of what states would
contribute and that Centre’s contribution would be conditional on states’
contribution! </span></b><span style="font-size:11.0pt"> The Planning
Commission seems to have decided that <b>India</b><b> will continue to be among the bottom 10 nations
in terms of percent GDP spending on health.</b></span><span style="font-size:11pt;font-family:Cambria,serif"></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"> </span></p>
<p class="MsoNormal"><span style="font-size:11.0pt">What is of even greater concern is the strategy
proposed for restructuring of the country’s health system in the document. The
Plan document proposes a transition from: “</span><span style="font-size:11.0pt">….<i>the
present system which is a mixture of public sector service provision plus
insurance, to a system of health care delivered by a managed network</i>”.
There is, thus, a road map envisaged where the <b>Government will abandon its central role of providing health care and
become primarily just a ‘manager’ of the new system envisaged. </b></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"> </span></p>
<p class="MsoNormal"><span style="font-size:11.0pt">The document’s vision
of ‘universal provision of public health care’ includes two components. “<i>..preventive
interventions which the government would be both funding and universally
providing</i>” (see annexure) and “<i>clinical services at different levels,
defined in an Essential Health Package, which the government would finance but
not necessarily directly provide</i>”. What, in essence, this formulation
proposes is that the Government would, over time, confine itself to providing a
small package of services and would be primarily just a purchaser of virtually
all clinical services from the corporatised
private sector. <b>The Government would thus
finance (with public money), strengthen and bolster an already resurgent corporate
sector providing medical services.</b> On the face of it, this appears an
almost diabolical ploy to hand over the profit-making clinical services sector
to corporate hospital chains. <b>It would
also decisively halt and eventually reverse the moderate achievements of the
National Rural Health Mission,
in expanding public health infrastructure and services in parts of the country.</b></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"> </span></p>
<p class="MsoNormal"><span style="font-size:11.0pt">The public health
system will now be asked to compete with the private sector to attract
patients. A system is envisaged where: “<i>each
citizen family would be entitled to an Essential Health package in the network
of their choice. Besides public facility networks organized .. private and NGO
providers would also be empanelled to give a choice to the families</i>”. Even
this truncated role of the public system is qualified by the proviso that” “<i>..public facilities will have to be
strengthened, networked, and their managers provided sufficient autonomy to
purchase goods and services to fill gaps as per need</i>”. In other words, <b>public only in name, but would be vitiated
by the logic of the market and by the incorporation of private players into its
fold.</b></span></p>
<p class="MsoNormal"> </p>
<p class="MsoNormal"><span style="font-size:11.0pt">The HLEG had, in its
report, commented that: “<i>…</i></span><i><span style="font-size:11.0pt">since there
is virtually no focus</span></i><i><span style="font-size:11.0pt"> </span></i><i><span style="font-size:11.0pt">on primary
level curative, preventive, and promotive</span></i><i><span style="font-size:11.0pt"> </span></i><i><span style="font-size:11.0pt">services and
on long-term wellness outcomes, these</span></i><i><span style="font-size:11.0pt"> </span></i><i><span style="font-size:11.0pt">traditional
insurance schemes often lead to inferior</span></i><i><span style="font-size:11.0pt"> </span></i><i><span style="font-size:11.0pt">health
outcomes and high health care cost inflation</span></i><span style="font-size:11.0pt">”. Yet the Planning Commission’s document repeatedly talks about
expansion of the health insurance scheme called RSBY and its vision of
Universal Health Care is nothing but a more expanded version of the RSBY
scheme.</span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"> </span></p>
<p class="MsoNormal"><span style="font-size:11.0pt">The document
announces another bonanza to the corporate medical sector in the form of grants
to set up hospitals and private medical colleges. It says: “<i>Health has now been included with other
infrastructure sectors which are eligible for Viability Gap Funding up to a
ceiling of 20% of total project costs under a PPP scheme. As a result, private
sector would be able to propose and commission projects in the health sector,
such as hospitals and medical colleges outside metropolitan areas, which are
not remunerative per-se, and claim up to 20% of the project cost as grant from
the Government</i>”. It may be noted that the only eligibility requirement is
the location, and not any contribution to public health goals. </span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"> </span></p>
<p class="MsoNormal"><span style="font-size:11.0pt">This document
proposes that public health facilities
will have “flexibility” to raise their own finances. The Plan document says: “<i>Tertiary care facilities would have an
incentive to generate revenues if they are provided an autonomous governance
structure, which allows them flexibility in the utilization of self-generated
resources within broad policy parameters laid down by the Government</i>”.
There are several ways in which such flexibilities can be misused, including in
the form of levying of user charges and arrangements with private entities that
seek to extract benefits that conflict with the public health goals of public
institutions.</span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"> </span></p>
<p class="MsoNormal"><span style="font-size:11.0pt">The HLEG had recommended
: “<i>enforcement of price controls and
price regulation on essential and commonly prescribed drugs</i>”. However, this
document does not even mention<b> drug price regulation, in spite of a
pending Supreme Court directive that the Government should expeditiously put in
place a system to control the prices of drugs</b>. Neither is the recommendation
of the Expert Group, that the production
of drugs and vaccines in the public sector be incentivised, reflected anywhere
in this Planning Commission’s chapter.</span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"> </span></p>
<p class="MsoNormal"><span style="font-size:11.0pt">The ideological bias of the Planning Commission’s
report is clear when it says: “</span><i><span style="font-size:11.0pt">A pure public sector delivery
system involves funding a large public sector health system, with little
incentive for the service providers to deliver a quality product”</span></i><span style="font-size:11.0pt">. <b>Such an assertion flies in the face of
global evidence that the best performing health systems are those that are
publicly financed and where health care is provided either almost entirely by
the public sector or by a combination of the public sector and non-corporate providers.</b> Neighbouring Sri Lanka has
been long held as an example of such a system, where over 90% of in-patient
care and over 50% of out-patient care is provided by the public sector.
Mortality and morbidity rates in Sri Lanka
are far better than in India,
in spite of the country having a lower per-capita GNP. Thailand, in
recent years, has made rapid strides in providing universal access to health
services by increasing public finances and by significantly expanding public
provisioning of health services. In contrast, the United States, provides ‘choice’ between
public and private providers but is by far the worst performing health system
among all developed countries, in spite of spending over 8% of GDP on health
care.</span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"> </span></p>
<p class="MsoNormal"><span style="font-size:11.0pt">The Planning
Commission’s recommendations, perhaps make some sense if seen purely in the
context of neoliberal economic policies. Injection of public funds into a
floundering economy through the financing of the private, corporate controlled,
hospital sector may seem attractive in such a context. But the strategy is
disastrous in public health terms, and is designed to finish of the vestiges of
a public health system that still survives in the country. </span></p>