The Emerging ‘Health Care Industry’ in India: A Public Health Perspective

Abstract

Corporate hospitals are becoming a significant presence within the ‘health care’ industry in India. There is strong advocacy and promotion by the industry, and the government, of the idea that health care infrastructure should not just be viewed as a social good but also as a viable economic venture with productivity. Yet, the discourse on privatisation, on the public–private divide in health systems does not pay attention to the spread of corporate sector activities and corporate financing in health care; to the increasing commercialisation of health services. This brief note highlights some recent trends and features of the hospitals sector of the ‘health care industry’ in India. There is a need to document and analyse the practices and behaviour of the hospital industry, and examine the impact of these changes for the public health systems, for policy and planning in public health, from a critical public health perspective.

The impacts of corporatisation of healthcare on medical practice and professionals in Maharashtra, India

“…Earlier models of either employment by government colleges and hospitals, or being a small or medium hospital owner or a solo practitioner are declining, while the trend of doctors working within corporate hospitals is increasing. This is borne out by other reports 14 41. Corporate hospitals have indeed become a favoured destination for doctors' employment.…”

“…Our respondents’ accounts suggest that corporate healthcare chains with aggressive marketing to develop client pools are operating as an explicitly commercial and socially disembedded enterprise and that their business practices exacerbate the risk of over-intervention. The corporate chains are part of a ‘medical-industrial complex’ that brings together the medical profession, politicians, religious organisations, financial capital, real estate, insurance and other non-health industries, and which is influential in public policy processes for pharmaceuticals, medical devices and healthcare provisioning 14 20 47…”

“…This reorientation of healthcare also has significant implications for the working lives of those in the workforce of healthcare organisations. Various writers on transformation in the private healthcare sector have recommended more research on its effects on doctors and on medical practice 11–14. The literature on the effects of healthcare corporatisation on employment practices in high income countries emerged in the 1970s and 1980s1 11 15 16 and has been subject to renewed interest in the last few years 17…”

Shrinking Spaces for the ‘Public’ in Contemporary Public Health

“…Hence, special attention is paid to new vaccines, drugs and equipment for tertiary care (Bhargava, 2013;Chakravarthi, 2013;Madhavi, 2013) to deal with maternal, neo-natal, reproductive and child health (MRNCH), infectious diseases, non-communicable diseases and injuries. Its lead authors are economists who were in the World Bank and provided leadership for the 1993 Report.…”

“…There are continuities in terms of vision and methodologies from the SPHC approach in the late 1970s to the LCGH, such as a selective approach to investment in health where selections are based on available technology and not on epidemiology. Hence, special attention is paid to new vaccines, drugs and equipment for tertiary care (Bhargava, 2013;Chakravarthi, 2013;Madhavi, 2013) to deal with maternal, neo-natal, reproductive and child health (MRNCH), infectious diseases, non-communicable diseases and injuries. As in the case of SPHC, public health metrics have become mere mathematical sophistry to support a techno-centric approach to priority setting.…”