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Original Article: Private-public partnerships

One initiative adapted by governments of many states in India to improve access to healthcare entails a combination of public and private sectors. The Public-Private Partnership Initiative (PPP) was created in the hopes of reaching the health-related Millennium Development Goals. It consists of three separate projects with different focuses: Fair Price shops which aim to reduce the costs of medications and treatment options; Rashtriya Swasthya Bima Yojana which reimburses those under the poverty line; and National Rural Telemedicine Network which assists with non-medical costs. This initiative was analyzed in the states of Maharashtra and West Bengal.

Fair Price Shops aim to reduce the costs of medicines, drugs, implants, prosthetics, and orthopedic devices. Currently, there is no competition between pharmacies and medical service stores for the sale of drugs. Thus, the price of drugs is uncontrolled. The Fair Price program creates a bidding system for cheaper prices of medications between drugstores and allows the store with the greatest discount to sell the drug. The program has a minimal cost for the government as fair price shops take the place of drugstores at government hospitals, thus eliminating the need to create new infrastructure for fair price shops. Furthermore, the drugs are unbranded and must be prescribed by their generic name. As there is less advertising required for generic brands, fair price shops require minimal payment from the private sector. Fair Price Shops were introduced in the West Bengal in 2012. By the end of the year, there were 93 stores benefiting 85 lakh people. From December 2012 to November 2014, these shops had saved 250 crore citizens. As doctors prescribe 60% generic drugs, the cost of treatment has been reduced by this program. This is a solution to affordability for health access in West Bengal.

The largest segment of the PPP initiative is the tax-financed program, Rashtriya Swasthya Bima Yojana (RSBY). The scheme is financed 75% by the central government and 25% by the state government. This program aims to reduce medical out-of-pocket costs for hospital treatment and visits by reimbursing those that live below the poverty line. RSBY covers maximum 30,000 rupees in hospital expenses, including pre-existing conditions for up to five members in a family. In 2015, it reached 37 million households consisting of 129 million people below the poverty line. However, a family has to pay 30 rupees to register in the program. Once deemed eligible, family members receive a yellow card. However, studies show that in Maharashtra, those with a lower socioeconomic status tend to not use the service, even if they are eligible. In the state of Uttar Pradesh, geography and council affect participation in the program. Those in the outskirts of villages tend to use the service less than those who live in the center of villages. Additionally, studies show household non-medical expenses as increasing due to this program; the probability of incurring out-of-pocket expenses has increased by 23%. However, RSBY has stopped many from falling into poverty as a result of healthcare. Furthermore, it has improved opportunities for family members to enter the workforce as they can utilize their income for other needs besides healthcare. RSBY has been applied in 25 states of India.

Finally, the National Rural Telemedicine Network connects many healthcare institutions together so doctors and physicians can provide their input into diagnosis and consultations. This reduces the non-medical cost of transportation as patients do not have to travel far to get specific doctor's or specialty's opinions.

The results of the PPP in the states of Maharashtra and West Bengal show that all three of these programs are effective when used in combination. They assist in filling the gap between outreach and affordability in India. However, even with these programs, high out-of-pocket payments for non-medical expenses are still deterring people from healthcare access. Thus, scholars state that these programs need to be expanded across India.

Edited Article: Public-private partnerships

One initiative adapted by governments of many states in India to improve access to healthcare entails a combination of public and private sectors. The Public-Private Partnership Initiative (PPP) was created in the hopes of reaching the health-related Millennium Development Goals. In terms of prominence, nearly every new state health initiative includes policies that allow for the involvement of private entities or non-governmental organizations.^[1]

Major Programs

The largest segment of the PPP initiative is the tax-financed program, Rashtriya Swasthya Bima Yojana (RSBY). The scheme is financed 75% by the central government and 25% by the state government. This program aims to reduce medical out-of-pocket costs for hospital treatment and visits by reimbursing those that live below the poverty line. RSBY covers maximum 30,000 rupees in hospital expenses, including pre-existing conditions for up to five members in a family. In 2015, it reached 37 million households consisting of 129 million people below the poverty line. However, a family has to pay 30 rupees to register in the program. Once deemed eligible, family members receive a yellow card. However, studies show that in Maharashtra, those with a lower socioeconomic status tend to not use the service, even if they are eligible. In the state of Uttar Pradesh, geography and council affect participation in the program. Those in the outskirts of villages tend to use the service less than those who live in the center of villages. Additionally, studies show household non-medical expenses as increasing due to this program; the probability of incurring out-of-pocket expenses has increased by 23%. However, RSBY has stopped many from falling into poverty as a result of healthcare. Furthermore, it has improved opportunities for family members to enter the workforce as they can utilize their income for other needs besides healthcare. RSBY has been applied in 25 states of India.

Fair Price Shops aim to reduce the costs of medicines, drugs, implants, prosthetics, and orthopedic devices. Currently, there is no competition between pharmacies and medical service stores for the sale of drugs. Thus, the price of drugs is uncontrolled. The Fair Price program creates a bidding system for cheaper prices of medications between drugstores and allows the store with the greatest discount to sell the drug. The program has a minimal cost for the government as fair price shops take the place of drugstores at government hospitals, thus eliminating the need to create new infrastructure for fair price shops. Furthermore, the drugs are unbranded and must be prescribed by their generic name. As there is less advertising required for generic brands, fair price shops require minimal payment from the private sector. Fair Price Shops were introduced in the West Bengal in 2012. By the end of the year, there were 93 stores benefiting 85 lakh people. From December 2012 to November 2014, these shops had saved 250 crore citizens. As doctors prescribe 60% generic drugs, the cost of treatment has been reduced by this program. This is a solution to affordability for health access in West Bengal.

Finally, the National Rural Telemedicine Network connects many healthcare institutions together so doctors and physicians can provide their input into diagnosis and consultations. This reduces the non-medical cost of transportation as patients do not have to travel far to get specific doctor's or specialty's opinions. However, problems arise in terms of the level of care provided by different networks. While some level of care is provided, telemedical initiatives are unable to provide drugs and diagnostic care, a necessity in rural areas.^[2]

Effectiveness

The effectiveness of public-private partnerships in healthcare is hotly disputed. Critics of PPP are concerned of its presentation as a cure-all solution, by which the health infrastructure can be improved. ^[2] Proponents of PPP claim that these partnerships take advantage of existing infrastructure in order to provide care for the underprivileged. ^[1]

The results of the PPP in the states of Maharashtra and West Bengal show that these programs are most effective when used in combination with government services. They assist in filling the gap between outreach and affordability in India. However, even with these programs, high out-of-pocket payments for non-medical expenses are still deterring people from healthcare access. Thus, scholars state that these programs need to be expanded across India.

A case study of tuberculosis control in rural areas, in which PPP was utilized showed limited effectiveness; while the program was moderately effective, a lack of accountability forced the program to shut down.^[3] Similar issues in accountability were seen by the parties involved within other PPP schemes. Facilitators and private practitioners, when asked about PPP, identified lack of state support, in the form of adequate funding, and a lack of coordination, as primary reasons why PPP ventures are unsuccessful. ^[4]

In the most successful PPP ventures, the World Health Organization found that the most prominent factor, aside from financial support, was ownership of the project by state and local governments. ^[1] It was found that programs sponsored by the state governments were more effective in achieving health goals than programs set by national governments.^[1]

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1. Bhat, Ramesh; Huntington, Dale; Maheshwari, Sunil (2007). Public–Private Partnerships: Managing contracting arrangements to strengthen the Reproductive and Child Health Programme in India. World Health Organization. p. 3.
2. Ravindran, T. K. Sundari (November 26, 2011). "Public-Private Partnerships in Maternal Health Services". Economic and Political Weekly. 46 (48): 43–52.
3. "Public-private collaboration improves tuberculosis control in India". BMJ. 332 (7541). 2006-03-09. doi:10.1136/bmj.332.7541.0-d. ISSN 0959-8138.
4. Yadav, Vikas; Kumar, Somesh; Balasubramaniam, Sudharsanam; Srivastava, Ashish; Pallipamula, Suranjeen; Memon, Parvez; Singh, Dinesh; Bhargava, Saurabh; Sunil, Greeshma Ann; Sood, Bulbul (2017-06). "Facilitators and barriers to participation of private sector health facilities in government-led schemes for maternity services in India: a qualitative study". BMJ Open. 7 (6): e017092. doi:10.1136/bmjopen-2017-017092. ISSN 2044-6055. {{cite journal}}: Check date values in: |date= (help)