Health Policy Issues and Health Programmes in ... - Amazon S3

Public–Private Interaction in Health: Policy Issuesinformation base. Governments must assume the responsibility of collecting information. Medicalcouncils, medical associations, and local governments can play important roles in this process. InIndia, various agencies are supposed to collect and update information on private providers.However, this is not being done systematically and regularly, and the roles, responsibilities, andaccountability are not clear. For example, the Medical Council of India (MCI) is supposed toprovide information about the number of doctors registered with it. Information from 1992 is theonly kind available from secondary sources. No data is available concerning the number ofproviders working in the private sector; there are only some estimates. Similarly, localgovernments are supposed to have information about the private hospitals registered with them.These data are also difficult to obtain. Governments need to take quick action to fix theresponsibilities of various agencies, ensuring basic data and information on the private sector.Agencies need to be sensitized about the importance of this information, a situation that becameevident to the local government during the plague epidemic in Surat, India. Information on thenumber of providers in the private sector was needed to design a strategy to handle the epidemic.Similar case studies can help policy-makers highlight the importance of such information.Strengthen the Capacities of Governments to RegulateRegulating private providers will be a new role to many health departments in the states, sincethey lack experience in this area. Studies must be initiated to find out what regulatorymechanisms are available in what places, whether they are sufficient to handle the problems ofmarket failure. International experiences in this area would be useful in discerning what worksand what does not. Experiences in development and implementation of regulations exist; forexample, the Consumer Protection Act, which was implemented with reasonable success butperhaps needs further strengthening. However, at the same time, there are cases inimplementing some regulations, such as the Medical Council of India Act and Nursing HomeAct, which need further strengthening. How to strengthen existing regulations? Which newregulations are required? Do the health departments have the capacity to develop andimplement the new regulations? How to strengthen these capacities?106Develop Capacity of Health Departments to Handle Public–Private CollaborationPublic–private collaboration may assume various forms; for example, collaboration through thedirect provision of the private provider, contracting out of services, informal cooperation,technology, and facility sharing, and so forth. There are a number of legal and managerial issuesinvolved with these collaborations. Handling them are new tasks for the health departments, andthey need to develop capacity in these areas. Governments can provide resources to variousprivate collaborators in the form of land and other assets. The implicit understanding betweenpublic-private partnerships would be to contribute toward equity (for example, by allocating 40%of facilities to the poor) along with know-how. In most cases, the health departments would bebanking on private capital. Since investments will be large (if it is specialty and tertiary care), whoowns the facility and what its revenue-generating model will be are of critical importance.Involvement of private financing in these collaborations needs to be worked out carefully.Investments compete with other opportunities, and departments need to handle private initiativesensuring that they earn reasonable returns, which requires some financial analysis capacity withindepartments. Thus, developing health economics and financing capacities would be critical.