When India’s Home Minister Amit Shah was found to be Covid positive he was wheeled into a fancy private hospital. Mr Shah who was back home after an all clear was then admitted to the All India Institute of Medical Sciences (AIIMS) in New Delhi after he complained of discomfort and has been there since.

Health Minister of Delhi, Satyendar Jain, has successfully recovered after being taken ill by the Corona virus and is back at work. Some Central Government Ministers and a few ministers in other States too have been affected by the same virus.

But other than being infected by the Corona virus, there is something else that is common between all of them. It is the fact that they all chose to get treated at private hospitals, not at government run ones.

This pattern is seen, not just among the politicians, but also among bureaucrats who control the numerous arms of the country’s apparatus, including health-care. And it seems this lack of confidence in the government hospital set-up does not stop with them. Even the doctors running many of these establishments seem to have reservations about using the services of the very institutions they are at the helm of. In June, the Dean of Atal Behari Vajpayee Institute of Medical Sciences attached to the Ram Manohar Lohia (RML) hospital, in Delhi, also chose to get treated for Covid-19 at a private hospital over his own institution!

What does this tell us about the government-run hospitals and the public healthcare system in India? That those in power do not trust the very system they run or feel it is good enough for them. What message does this send? That the government-run services are ok for the praja but not for the rajas.

So why I am raising these questions?

Maybe because I worked for a long time as a field reporter, a large part of which was spent writing about health-care services, or the lack thereof, not just in the Capital but also in other parts of the country. Many a times I have noticed an absence of interest in boosting the infrastructure and morale of government institutions by those in-charge and in power.

Stakes, Interest and Investment

It was not always like this. There was a time when all government servants, irrespective of their seniority, used the government health facilities. From ministers to Members of Parliament, Secretaries to the Government of India to the youngest recruits – the rule was for everyone. Outside private facilities could only be accessed if a particular service was not available at the government institution, after taking due permission. This meant that the beneficiaries had a stake in making the system work efficiently.

Take Ram Manohar Lohia hospital for instance. It was once a top hospital in Delhi. It may have had its caste system with a “nursing home” section, mostly reserved for MPs and senior officials. But they were admitted and treated in the same hospital as the larger public and experienced it firsthand. And since they used its services, they had a personal stake in not just in keeping it running well but also in maintaining its standards.

But this changed in the late1990s. Under the Central Government Health Scheme (CGHS) the government then allowed its beneficiaries to use private institutions authorized by the government for their health care needs. This coincided with the time when new corporate private hospitals were being set-up in the big metros of the country. Now senior government functionaries who could access these new “five-star” facilities had more interest in facilitating these new entrants rather than strengthening their own system.

This meant a two-pronged onslaught on the prestigious government facilities. The setting-up of new, well-endowed hospitals meant that doctors had a choice to work for better pay. While money was a big draw,  lack of good infrastructure also played a part. I know many doctors who left government hospitals because they did not have access to the latest technology to treat their patients. So the lack of upgradation of state facilities and the pull of greater emoluments drained the government institutions of a substantial talent pool.

Over the years, all governments have been complicit in this process. Healthcare budget of India continues to be less than two per cent of GDP and a number of citizens, unfortunately even the poor, are having to meet a large percentage of their healthcare needs out of their own money. Data has shown that the percentage of this personal or “out of pocket” spend is increasing each year for those accessing private health care. This figure is much less for those using the public infrastructure. But with reduced and less trustworthy government health services available, the citizens are often pushed towards the private option.

In this scenario should the government not be looking at strengthening its own system rather than letting its money flow towards private operators, who provide less services for more money. I don’t have the figure for the how much money the CGHS has to dole out from its coffers to private healthcare providers each year, but over the years this doubtlessly large sum could have substantially helped augment the public heath infrastructure.

Atmanirbhar Bharat

This government may have raised some controversies but it has done some good work in the health sector. New AIIMS’s have been announced with a few having been established. New medical colleges, are also coming up. Given that India has less than two doctors and 0.55 hospital beds per 1000 people this will help meet a long pending need in the field. When Covid- 19 struck, it was the government facilities which were the first port of call as they should be. While some private institutions were forthcoming in the battle against this unprecedented pandemic, others had to be brought in line, often with some coercion.

Many of these private hospitals were given concessions by the government, in the form of subsidized land and other incentives when they were set-up, in the hope that along with making their profits they would also provide low-cost care for a small percentage of the needy poor. Those special facilities for the poor, as many reporters from my time onwards will testify, have fallen through the cracks. Nothing gets done at a private hospital without money or a bit of arm twisting as we saw during this pandemic. When even the government had to threaten some of them into reducing the cost of the treatment, how can we expect the poor or the uneducated to get their rightful due at these doors.    

A personal beneficiary

Don’t get me wrong, I am not against private enterprise in any sector and nor in the field of health. India is a vast country with a huge population and there is space for unlimited growth in the private sector. To be fair to them, today they handle a much larger burden of health care in India as compared to the government. They have a place and many in India and abroad who can pay for their services should certainly have the option.

As a daughter of a government servant my family and I have been a beneficiaries of this system. And even now married to someone who works with the Government of India I continue to avail of these services, as and when needed. Under the current system we can choose to go to a government hospital or any of the private corporate hospitals that are empaneled by the CGHS.

The case I am making is not against anyone but for a robust not-for profit public healthcare set-up which should be available to all. It is a call that was also made by the President of India in his speech on August 15 this year. He pointed out that “public health services helped the poor cope with the pandemic”, and they need to be “strengthened and expanded”. This will need investment and many experts have called for an increased percentage of GDP spend. But I think it will also need something more personal. An involvement and a stake-holding in the system.

This could be a good first step towards universal healthcare. Think of what it would do for the common person’s faith in the system to know that she and the minister or a senior bureaucrat use the same hospital. Think of what it would do for our  pride. It may result in the loss of private privileges for some of us, but I think it is well worth considering.  

An edited version of this article was published on the thedailyguardian.com on September 2, 2020