In Karnataka, all healthcare roads lead to private hospitals

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Bengaluru: Karnataka chief minister Basavaraj Bommai on Tuesday visited Manipal Hospital, one of Bengaluru’s biggest private medical establishments, for a checkup after testing positive for Covid-19 a day before.

Bommai is not the first Karnataka chief minister to get treatment at a private centre. Former chief ministers BS Yediyurappa, Siddaramaiah and HD Kumaraswamy also received treatment at a private healthcare centre earlier when they had tested positive for Covid-19 or for other treatments.

“He had just gone there for a check-up after he tested (Covid) positive on Monday,” said an official from the chief minister’s office (CMO), requesting anonymity.

At a time when the state is witnessing a surge in Covid-19 cases, activists and experts pointed out that the head of government’s visit to a private hospital does not help in gaining people’s trust in the public health care facilities.

To be sure, Karnataka’s gross allocation (total demand +IEBR ( Internal & Extra Budgetary Resources) ) for health and family welfare is 4% of the total budget or 11,908 crore, according to the 2021-22 budget presented by former chief minister BS Yediyurappa in March last year.

“This points to the fact that private hospitals are ubiquitous in cities while government hospitals are difficult to find,” said Adithya Pradyumna, faculty at the Azim Premji University (AZU), who also works in the areas of environment and health, public health and health impact assessment.

He added that there is some sense of confidence that private hospitals will do a “better job” than government facilities.

Experts also pointed at the declining real expenditure on public health.

A 2021 study by AZU, ‘Urban Healthcare at Crossroads: Assessing Healthcare Vulnerabilities for Urban Poor in India’, highlighted those complexities in defining urban boundaries in the urbanisation process and the multiplicity of health care providers both within and outside the government are challenges to urban health governance. It added that overlapping administrative jurisdictions and lack of coordination result in chaos in urban health.

“Our evidence from Bengaluru shows that 30% of even the poorest quintile seeks delivery care from private sources. Since there is a 10-fold difference in cost between public and private facilities, this significantly adds to their financial burden,” the report added.

Treatment for covid-19 is free in public hospitals while private medical establishments were capped prices for treatment in covid-19 hospitals at 5200- 11500 depending on the type of ward and if on ventilator. Private hospitals also protested that 50% of their total capacities were asked to be set aside for free treatment for government-allocated patients while it had very little room to treat their walk-in patients as well as those with other ailments.

This has been done away with as the number of cases came down in the later half of 2021.

Prasanna Saligram, a public health and community health researcher with Jana Swasthya Abhiyan Karnataka, pointed to a deep “class system” within the society, saying inequality is a big determinant of health.

“Evidence globally shows that if you invest in public health systems, then you have better health outcomes,” Saligram said, adding, “Glorification of the private sector in Karnataka is phenomenal.”

He added, “Because of inequalities, the ruling, upper and elite class get what they want and naturally the have-nots or poorer sections have to make do with the poorer services.”

There were allegations that people in public hospitals or those patients allocated by the government to private hospitals were made to find life-saving drugs like Remdesivir on their own while keeping their stocks for higher paying walk-in patients. Even when most public hospitals ran out of vaccines, large private hospitals with direct agreements with vaccine makers, had steady supply of doses which was paid for.

Private or paid inoculation accounted for more than half of all inoculations in Bengaluru alone, according to senior government officials, leaving those dependent on public medical establishments in a state of despair.

Interestingly, the Siddaramaiah-led Congress government brought in the Karnataka Private Medical Establishments (Amendment) Bill, 2017 to regulate the cost of treatment in private establishments. However, the bill hit a stone wall after doctors from private hospitals protested for several days. More than 22,000 doctors in Bengaluru participated in the protests.

Later, a diluted version of the same bill in November 2017 that sought to ensure that elected representatives and government employees, who are eligible for medical treatment reimbursement, get treated in government hospitals.

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