Even as Karnataka’s finance ministry has given cabinet approval for the Center’s Ayushman Bharat or Pradhan Mantri Jan Arogya Abhiyan (PMJAY), it is one of the few states that is yet to sign an MoU with the Center and come on board. An advisory note from the Center to states says since PMJAY cannot be implemented with the existing infrastructure, the state governments should facilitate giving soft loans at agricultural rates to private hospitals and electricity at residential price to set up hospitals in tier 2 and 3 cities. This has irked public health experts. This comes at a time when Karnataka is facing resource crunch due to the ₹45,000 crore-farm loan waiver and is staring at a grim power situation with Karnataka Power Transmission Corporation Ltd resorting to load shedding with disruption in coal supplies. A video conference will be held between all health secretaries on Tuesday to discuss this note, said National Health Mission Director Manoj Jhalani.
“Breach Candy Hospital in Mumbai, Apollo Indraprastha Hospital in New Delhi, government-run Rajiv Gandhi Multispecialty Hospital in Raichur, which was given to Apollo, are examples where government gave prime land to private hospitals to provide care for the poor. What we have seen is that the government gives land, electricity, loans and for the first few years, the hospital does what it is supposed to, but from the next year onwards, the poor have no access to its facilities,” said Dr N Devadasan, co-founder and Director, Institute of Public Health, Bengaluru. Apart from this, the draft policy developed by the Center lists a barrage of clearances/permissions required by hospitals to operate like building plan approval, fire safety, pollution control board, radiation safety etc. “Provide a clause that if authorities do not examine and issue clearances by the said stipulated time, the clearances shall be deemed to have been given on expiry of the stipulated period,” the policy says.
“Historical experience proves that all the subsidies will be captured by corporate hospitals and not the local doctor. This will increase the cost of care at the local level because theirs is the high-tech model. These are my worries. There should be strict checks and balances,” he said. “This is a continuation of NITI Aayog’s earlier policy of literally auctioning off public hospitals and public land to private entities. The earlier proposal was rejected by Karnataka government. It is becoming more and more apparent that Ayushman Bharat is more about facilitating the penetration of private sector into rural areas and less about providing healthcare to citizens,” said Akhila Vasan, Converner, Karnataka Janarogya Chaluvali. Dr Srinath Reddy, President, Public Health Foundation of India, said, “Concessions such as land and electricity have to be decided upon by state governments. They should create caution in creating the contracts since past experience has mostly been negative. Excessive dependence on private sector will make it difficult to mandate cost and quality standards.” – New Indian Express