Busting the myth: Has there been desensitizing

corporatization of the Indian Private Healthcare Sector?

Dear Editor,

Recently, the former Chief Justice of India Mr. N.V. Ramanna commented on the 'Corporatization
of India's Healthcare System' calling it "growing and unchecked". He further went on to say that
"We are seeing hospitals being run like companies, where profit making is more important than
service to society. Due to this, hospitals and doctors alike are desensitized to the plight of patients.
They are just numbers for them." While we are at the point of talking about numbers, we'd like to
remind the ex-CJI as well as the readers about the most recent example of importance of the
'exponentially growing' private healthcare sector- COVID-19 pandemic.

It has been seen that the public sector healthcare facilities have hugely been on the mercy of
politicisation, with the biggest example of the same being a meager expenditure of 2.1% of the
Gross Domestic Product (GDP) on the Healthcare Sector. In such a scenario, private healthcare
establishments offer a haven for patient centric, unabridged and thorough medical services. This
isn’t just an abstract statement, but, has been proven during the COVID-19 pandemic, wherein,
private sector proved to be an integral and majority stakeholder of patient-care, in India.[1]

WHO define private health sector as "the individuals and organizations that are neither owned nor
directly controlled by governments and are involved in provision of health services."[2] This
umbrella definition covers over two-third of the healthcare sector in India, and gives us an
important insight- the need for public-private partnership for universal healthcare coverage for the
Indian population. During the first wave of COVID-19, around May 2020, the last reported data
claimed that there were 0.53 hospital beds for every 1000 citizens, in India. [3] Out of these, the
majority come from the private healthcare sector, which are accompanied by the majority figures in
the number of doctors as well as nursing care providers. This brings us to a simple conclusion, that,
the majority of the healthcare services could potentially be provided by the private healthcare
sector, given the majority share of numbers. However, there has been a great sense of
underutilization among the stakeholders of this sector[4], majorly pertaining to the stigmatization of
the 'prejudiced' corporatization, as also depicted by the statement of the honorable ex-CJI.

During the COVID-19 pandemic, there was a time when the private healthcare sector could not get
optimally involved in patient care due to lack of information and protocols regarding the novel
disease, however, even at such a junction, these healthcare workers contributed in many ways. We
saw a surge in Tele-health services, majorly driven by the private healthcare sector to aid non-
COVID patients in the times of lockdown.[5] There were crucial researches and trials that were
conducted and published, from the private healthcare sector in tandem with the public governing
bodies. Once the integration of the private healthcare sector into patient care for COVID-19 was
possible, there was a fluidic surge in improvement of patient outcomes; this wasn't merely the story
of the first wave, but the awakening reality of the second-wave, where the public-private integration
became integral to curb negative patient outcomes irrespective of the increasing number of cases.

Although we have utmost respect for the healthcare providers working in the public sector,
considering that the distinction of the sectors is solely based on economic and administrative control
and not that of distinction of efficiency among the doctors, if we were to qualitatively compare the

 two sectors to assess the efficiency of the statement by the honorable ex-CJI, we will have to do it
on the basis of the most important variable- Quality of care. For the same, let's refer to the most
widely used standard for this assessment, the Structure, Process and Output Framework by A.
Donabedian, along with the WHO Framework for health system performance assessment.[6,7]
Based on these standards and figures from latest reports as already cited within the text, the quality
of care in the private sector was found to be better than the public sector. If both the sectors were to
be considered equivalent for efficiency, accountability and medical effectiveness, the private sector
was still considered better with respect to timeliness and hospitality towards patients. [8]
Furthermore, if we are to talk about the highlighted remark by the honorable ex-CJI, calling the
advancement of the Private Healthcare Sector in India "growing and unchecked", we should refer to
the recent publication from the Niti Aayog.[9] The body has clearly stressed about the incentivized
investment opportunities in the said sector, and aims at further growth within it. What can be
explicitly seen is the wide array of possibilities that this sector is presenting as 'services' and
potential employment, along with the guarantee of improved patient care and quality of care, as
discussed above. As a humble reply to the claim of "profit driven approach' by the private
healthcare sector, it is integral to remember that these institutions often function without economic
support and require capital to continue providing quality of care that is optimum as per required
standards.

The afore written paragraph was only intended to do an abstract yet factual assessment and
distinction between the two arms of Indian Healthcare Services, to understand the ground the
statement from the ex-CJI stood on. If we were to believe that the statements stood no ground, it'll
be arrogant of us, not merely as individuals, but as the fraternity as a whole. There definitely are
gaps that can be targeted, to be filled. We definitely require are more fluidic public-private
partnership, where patient care can transition from one sector to another, with least disturbance to
the patient. While talking about this, we must refer to the recent novel policies initiated by the
government, where patients receive aid within their healthcare services. As it has long been seen
with the private players of the insurance market, delay in release of claims often hurt private
institutions and the patients alike. With the onset of beneficial policies by the government, there
needs to be establishment of mechanisms that could ease the transition of healthcare services
between the two sectors by allowing easier financial access to these services, majorly by increasing
the liquidity within these policies. This helps the patient as well as the institutions and potentially
relieves the issue of "excessive barriers" for the poor to access decent healthcare, as raised by the
ex-CJI.

It isn't false that there is disparity in the distribution and access to healthcare among economically
stable and weak sections of the society and, rural and urban sections of the society, however, it is a
gap that can only be bridged by the public-private partnership. Given that the government's policies
provide a mean for the same, it is only correct to harness this relationship rather than raise claims of
immoral practices towards one of the two partners. India is enroute a successful journey towards
achieving Agenda 2030, and the Public-Private Partnership in the Healthcare Sector will be key in
achieving Universal Healthcare Coverage.

 References
1. Economic Survey 2021-22. Ministry of Finance, India. 2022. Available from: https://
www.indiabudget.gov.in/economicsurvey/ebook_es2022/index.html [Accessed: September 1,
2022]

2. Joel Klinton. The Private Health Sector: An Operational Definition. Geneva. 2020.

3. Hospital beds (per 1,000 people) | Data [Internet]. data.worldbank.org. [cited 2022 Sep 1].
Av a i l a b l e f r o m : h t t p s : / / d a t a . w o r l d b a n k . o r g / i n d i c a t o r / S H . M E D . B E D S . Z S ?
end=2019&start=1960&view=map

4. Davalbhakta S, Sharma S, Gupta S, Agarwal V, Pandey G, Misra DP, Naik BN, Goel A, Gupta
L and Agarwal V (2020) Private Health Sector in India-Ready and Willing, Yet Underutilized in
the Covid-19 Pandemic: A Cross-Sectional Study. Front. Public Health 8:571419.

5. Kakar U, Tripathi S, Gogia A, Kakar A. Telemedicine: An evolving practice in India. Curr Med
Res Pract 2021;11:62-4

6. Donabedian A. Evaluating the quality of medical care. Milbank Memorial Fund Q. 1966;44(3)
(suppl):166 206. Reprinted in Milbank Q. 2005;83(4):691 729.

7. Murray, Christopher J. L, Frenk, Julio & World Health Organization. Global Programme on
Evidence for Health Policy. (1999). A WHO framework for health system performance
assessment / Christopher J. L. Murray, Julio Frenk. World Health Organization. https://
apps.who.int/iris/handle/10665/66267

8. Basu S, Andrews J, Kishore S, Panjabi R and Stuckler D. Comparative Performance of Private

and Public Healthcare Systems in Low- and Middle-Income Countries: A Systematic Review.
PLoS Med. 2012; 9: e1001244.

9. Sarwal, R; Prasad, U; Madangopal, K; Kalal, S; Kaur, D; Kumar, A; et al. Investment

Opportunities in India’s Healthcare Sector. NITI Aayog. 2021.
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