Say ' NO' to Privatization of Radiological Services in Government Medical Colleges in Maharashtra

To- Dr. Vijaykumar Gavit Minister, Medical Education and Research, Mantralaya, Mumbai Subject: Privatization of MRI and CT scan facilities in all the 14 Govt. Medical Colleges in Maharashtra Dear Dr. Vijaykumar Gavit, It is learnt that the Maharashtra Govt has decided to privatize MRI and CT scan facilities in all the Govt. Medical Colleges in Maharashtra. We are alarmed at this unprecedented move and demand that this decision be reversed since it is not in public interest. We briefly argue below that there is no economic, technical, managerial rationale for this decision. 1) This decision of privatization is contrary to the recommendations in the report of the High Level Expert Group (HLEG) which was appointed by the Planning Commission (with initiative from the Prime Minister’s office) with the mandate to suggest a ‘blue print’ for achieving by 2020, the goal of Universal Access to Health Care (UAHC). The HLEG has recommended abolition of all user fees in all public health services. (The Executive Summary of this report is available at http://www.phfi.org/images/what_we_do/HLEG UHC_Exec_Summary_Dec_2011_1.pdf. ). The recent draft report of of the Steering Committee on Health for the 12th FYP has clearly recommended cashless universal health care for all. The Planning Commission is set to double the public health expenditure in India from the current 1.2% of GDP to 2.5 % of GDP in the 12th Five Year Plan. This would mean an additional budgetary availability of Central Govt. funds of more than Rs. 50,000 crores annually, an amount many times the additional budgetary allocation for the NRHM during the 11th Five Year Plan. There would be thus no financial constraints in providing free health care services including MRI and CT scan services in all government college hospitals. However, instead of withdrawing user fees at the point of service, as per the recommendations of the High Level Expert Group (HLEG), the privatized MRI and CT scan facilities in all the Govt Medical Colleges, would charge fees for all patients. Patients below a certain level of annual income of say Rs. 1 lakh would be charged as per government rates and the rest would be charged commercial rates. The experience of the privatization of MRI and CT scan facilities in the GT hospital in Mumbai is not positive. Out of the total number of patients accessing this facility, only a small proportion of patients are referral cases from Public Health Facilities which are charged at government rates. Moreover, under some pretext or other, even such patients are made to spend beyond the official rate. It has been the general experience that after privatization of Public Health Services/ facilities, the private parties violate many of the terms of agreement; there being hardly any adequate mechanism to effectively monitor and ensure the observance of these terms of agreement. A systematic, independent and transparent review of the experience of privatization of CT scan and MRI services in GT hospital should be done before suggesting privatization of MRI and CT scan facilities in medical college hospitals. Through privatization, medical college hospital wards have been computerised and inter- linked. A systematic, independent and transparent review of this experience should also be done. 2) No company will be able to depute full time qualified radiologist in all medical college hospitals, especially in places like Ambejogai, Nanded etc to report CT scans and MRIs. It is much more likely that the reporting would by done by expert radiologists stationed in bigger cities by extensive use of tele-radiology. This can be very well done in the government sector with the help of existing highly qualified radiologists and by hiring part time services of highly qualified radiologists from the private sector. The experience of the Command hospitals and of Tata Memorial Hospital (TMH) in Mumbai shows that it is possible to retain expert doctors by offering adequate financial incentives within the framework of a full time professional commitment. For example, expert radiologists in medical college hospitals can be retained by paying them extra for doing the extra-work of tele-radiology and tele-conferencing (for training technicians and junior radiologists).Thus unavailability of expert radiologists to report MRI and CT scan in these fourteen medical college hospitals cannot be the reason for privatization of these facilities. Management of establishments like railways, atomic energy plants and centres like ISRO, not to speak of the string of Command Hospitals, are extremely complex task in terms of technical and managerial capacities. If all these can be managed well in the public sector, CT scan and MRI facilities can certainly be managed by the Public Health Services if there is a political will to do this. Whatever problems that may exist in the management of MRI and CT scan facilities in the medical college hospitals, must be solved by seeking active cooperation of the doctors and other staff in these centres. Privatization is no answer to these problems. Public Health Services currently account for a small proportion of health care in India and it is not possible to achieve the goal of health care for all as envisaged by the HLEG report mentioned above if there is further whittling down of Public Health Services. 3) The important specific function of medical college hospitals is to train new generation of doctors and this is crucially dependent upon hand on practical training. This function would be adversely affected by privatization. Secondly, once privatization of radiology is accepted, by the same logic, privatization of other facilities like the pathological laboratories would follow and the government medical colleges would remain so only on paper; greatly damaging the training of new generation of doctors. In the 21st century health care should be regarded as human right and in most developed countries as well as in many developing countries like Sri Lanka, Thailand, Brazil, Malaysia and Venezuela the goal of Health Care for All has been achieved. In this process, the Public Health Services have played the role of leadership, of trend setting and as a back-borne for the National Health Care System. India cannot be an exception. In any case, such a major decisions should not be carried out without a proper public debate as this decision would adversely affect millions of patients and medical education in Maharashtra. We urge you to convene a broad based meeting with participation of the staff and of civil society groups to explore the way forward to improve Public Health Services, including radiological services in medical college hospitals. Thanking you, Sincerely yours,