Health cover: Answer may be PPP with checks

With an ally walking out charging it with being anti-poor and with the Food Security Bill hanging fire, there are hardly any surprises in the UPA's efforts to package free drugs and universal health coverage as tickets to its return to "aam aadmi" policies.

The baffling PPP question hanging between the Planning Commission and Health Ministry is an irritant but one that may hold the key to successful adoption of universal health coverage without, as some are afraid, "selling healthcare to the private sector". It could even be the great leveller in the quality vs quantity aspect of the private vs public debate. In a system where hospitals manage primary, secondary and tertiary care as unified networks and get paid on per capita basis for providing a specified package of services, competition can work both ways.

While the public healthcare provider will be required to ensure quality to attract registrations, government reimbursement at pre-fixed rates would automatically rationalise prices in the private sector.

Lost somewhere in the strident positions against PPP, though, is the question of regulation, a virtual vacuum in the healthcare sector where the dirty work — primary healthcare and public health — has forever been the domain of the government and lucrative tertiary care, the business of private providers without any effort to merge them.

There is a need to integrate primary, secondary and tertiary care not just because it makes economic sense but because medical science firmly believes that a tertiary care procedure may be prevented by timely primary care. It is interesting that the Universal Service Obligation Fund concept from telecom — that requires service providers given licences for urban areas to serve rural and remote areas at reasonable rates — was not replicated in a sector far more fundamental to development.

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