Lack of healthcare funding left Karnataka at mercy of private sector, say experts
The decision of around 6,000 private hospitals, clinics and diagnostic centres to shut their outpatient departments at Bengaluru in protest against a regulatory bill has brought Karnataka’s healthcare sector to its knees.
Private doctors oppose the Karnataka Private Medical Establishments (Amendment) Bill-2017 because it seeks to regulate pricing, create a charter for patients’ rights, and bring about a new grievance redressal mechanism.
Many in the state see this as a desperate move by the government to regulate the private medical sector, which has been burgeoning in the absence of adequate public resources. “The state government is trying to make the private sector do its work. It is not working towards increasing public capacity,” Dr Sudarshan Ballal, chairman of Manipal Hospital, told HT.
Dr Ballal’s assertion about the state’s dependence on the private sector is backed by the National Sample Survey’s 2015 report. It found that 81.7% of the state’s urban residents avail of private healthcare facilities, the highest in the country, while the figure stands at 73.2% for rural areas, the fourth-highest. This is in spite of the state having 49,454 government hospital beds, or eight for every 10,000 people. While the figure is way below the 18 beds-per-10,000 patients ratio mandated by the World Health Organisation, it is better than the national average of about five.
The reason for this situation, experts say, is insufficient public infrastructure due to low governmental expenditure. According to the Central Bureau of Health Intelligence (CBHI)’s National Health Profile 2017, Karnataka spent only 0.7% of its gross state domestic product on healthcare, the third-lowest in the country after Maharashtra and Haryana. The national average comes up to 1.1%.
Karnataka has the third-highest percentage of people who pay for medical expenditure through borrowings. National Sample Survey Office data states that around 42% of the state’s population paid for their medical expenditure in this manner, after Andhra Pradesh and Telangana.
Devi Shetty, founder-chairman of Narayana Hrudayalaya, said capping prices is a problem because it would affect the ability of hospitals to pay well for talent. “We want the brightest kids to become doctors,” he said.
Remuneration is a big worry in a state that has the highest number of private medical colleges. According to the CBHI, Karnataka has 40 private medical colleges – way higher than Maharashtra’s 29 and Tamil Nadu’s 26.
Akhila Vasan – a healthcare activist with the Karnataka Janaarogya Chaluvali – believes that the private healthcare sector in the state has become predatory. “The government has been brought to its knees because it made no attempt at regulating the sector in the recent past,” she said.
E Premdas Pinto, director of research and advocacy at the Centre for Health and Social Justice, said the state was responsible for eroding the capacity of the public health sector and, thereby, aiding the growth of the private sector. “This situation has not come up overnight. The health policy in the state, and the country as a whole, has been to prioritise the private sector over the public,” he added.
Pinto said that while it was difficult to say how much a state should spend on healthcare, simply maintaining the existing infrastructure would require at least 1.5% of the gross state domestic product. The state’s failure to even match the national average is the reason for its private healthcare sector turning into a near-invincible monster that’s holding it to ransom, he added.