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Indian Journal of Community Medicine

Public-Private Partnership for Health Care: Competition or Collaboration?

Author(s): Rajesh Kumar

Vol. 31, No. 4 (2006-10 - 2006-12)

Health Care is delivered in India through Public and Private Health Institutions. Recent surveys indicated that people mostly avail curative health care from Private Health Institutions by paying fee-for-service whereas preventive health care such as Immunization and Contraception is availed free of cost from Government Health Services which has established a network of health centers in the rural areas where Qualified Private Health Care Practitioners are generally not available.

In last decade, a large number of people have migrated to urban areas who reside in shanty slums. These people do not get preventive care, as there is not enough government outreach health care service in urban slums.

Under the Health Sector Reform process, government is examining options for delivery of health care to urban slums. The traditional approach is to build a network of health centers in the urban slums as exists in the rural area. Alternate approach is to co-opt the existing qualified private practitioners for delivery of health care to slum population by contracting them to provide a set of preventive and curative services for which government pays them a fixed fund per year for taking care of a fixed number of families/persons (@ Rs 100 per person per year). The per capita expenditure on health in the government health service is Rs 180.

The public health care professionals oppose the provision of services through the private practitioners whereas private medical practitioners have endorsed the scheme and have agreed to refer patients for admission to government hospitals where bed occupancy rages from 60-70%. However, government health care professional perceive the scheme as a means of gradual privatization of the government health system and thus in the long run decimating the public health system. Health administrators favor the scheme as it avoids huge investment in the infrastructure and the consequent delay in provision of services and also because it makes use of the idle bed available in the government health system. However, government health care providers perceive the scheme as if they will have to compete with the private medical practitioners for clients.

How to convince the government health care providers that by co-option of the private practitioners they are extending health care to the urban poor and the same time they can improve the quality of private medical care by implementing standards for care in their clinics as part of the contractual arrangement with them. Private medical practitioners are wary of providing reports and returns which are necessary part of monitoring and evaluation. A health system, which incorporates both public and private health care institutions, needs to be established in India to optimize the available resources.

Rajesh Kumar
Deptt. of Community Medicine, PGIMER, Chandigarh
E-mail: [email protected]
Received: 22.3.06

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