Since people of India have always been suffering from heavy shortage of doctors, nurses, and hospitals, increasing their numbers in the country has been a long-standing demand. However, to soften the adverse political impact of not fulfilling the demand, PM Modi came out with an innovative idea of providing health insurance under Ayushman Bharat scheme. The intentions was clear – it was to shield dismal performance of the government in opening new medical colleges, nursing schools, and hospitals. The demand was related to the Ministry of Health, but PM Modi’s solution for health insurance is related to the Ministry of Finance. Numerous cases have come to light how this health insurance scheme was dishonestly exploited by the private hospitals for earning illegal money.

It was a common sense that health insurance is a different thing than the availability of doctors, nurses, and hospitals. PM Modi knew it very well, but he had no option but to divert attention from his governments failure in providing the health services and facilities, which was just replaced by financial services like health insurance because healthcare has become unaffordable for majority of the people. Out of pocket expenditure of Indian households have been very high and the latest WHO report from March 2022 has estimated that it is pushing some 55 million people into poverty every year, which for 17 per cent of them proves catastrophic. As per the latest ILO estimates, 76 per cent of the workforce in India is not covered under any social security, and the latest ESCAP report said that working poverty in the country has been rising and 70 per cent of them are already in dire poverty. Rising cost of healthcare and medicines has just become unaffordable for them.

It was in this backdrop PM Modi tried to tempt such people with health insurance scheme called Ayushman Bharat. It is true that people need financial assistance in time of need, but more important was to open affordable hospitals and increase availability of doctors and nurses, which Modi government did not do. It is due to lack of affordable healthcare and social protection, 243 million people in the country were pushed into poverty according to a UN estimate.

It goes without saying that these people, by and large go to government hospitals, because they cannot afford the private hospitals. A large number of them go to district hospitals for treatment. PM Modi’s move for privatization of district hospitals is thus unwise if we give priority to health, and wise only if we give priority to wealth. Modi has given priority to wealth, and he has all along taking about making India wealthy worth $5 trillion economy by 2025. While he has been trying to make India wealthy through his policy instruments, the earnings of only 14 per cent of people are increasing, and the highest earner was his friend Gautam Adani followed by his another friend Mukesh Ambani. The rest 86 per cent of people have reported earning loss.

The rising prices in the market, especially petroleum and food articles, have led to further impoverishment of the people. Job market has been volatile and only few job opportunities are available. Millions of people have just lost their jobs. The common people have not enough money to spend them on even essential items, such as on food articles and medicines. It would lead soon to a large scale health crisis in the country. Privatisation move in this backdrop is dangerous.

This bloody idea of privatization was officially mooted first by the NITI Aayog, the government think tank in January 2020, just before the COVID-19 outbreak in March 2020. Not only that, it may seem unethical but let it be so, the government urged states to adopt the idea of selling district hospitals to private companies in the middle of the pandemic in 2021, when people were dying even without access to hospitals and healthcare system.

Modi government’s propaganda is that the district hospitals handed over to private healthcare companies would also run medical colleges attached to the sold district hospital on a public-private-partnership (PPP) mode. A report on medical education in India has said the not only the five states mentioned previously are in the process of finding bidders for this project, but state governments across India are actively pursuing the PPP mode to bridge the financing gap for setting up medical colleges.

It should also be noted that the two BJP ruled states – Gujarat and Karnataka – have already tried the PPP model on which Niti Aayog had developed Concession Agreement Guiding Principles for setting up medical colleges in the country. This privatization move indicates that the Modi government is more than willing to shed its responsibility of increasing public investment in healthcare system of the country. However, the million dollar question is – Can common people be left on the mercy of the unaffordable private hospitals?

According to the plan, the state governments are supposed to provide land to the private partner on a 99 year lease, and in addition will provide 300-bed district hospital to the partner.
Even another BJP ruled state Madhya Pradesh intends to set up medical colleges in several districts on DBFOT (design, build, finance, operate, and transfer) basis. Uttar Pradesh has adopted one-district-one-medical-college policy which would be financed by Central Government’s Viability Gap Funding Scheme.

However, the experience reveals that private companies want freedom in fee structure, and in the present state regulated they are willing to invest only on those cities where they believe they have good prospects of wealth generation at the cost of health of the common people. Insiders say, that the government is working on removing all impediments on the path of selling the government hospitals to private hospitals who have earned notoriety in overcharging people on their healthcare services.