In the BJP Regime, Healthcare is Business
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THE BJP has already started its campaign for the 2024 General Election with PM Modi making a "guarantee" in healthcare. However, what is happening is a gradual transformation of the healthcare system into a 'commodity' and its corporatisation.
India adopted the Alma Atta Declaration of 1978, aiming for "Health for All by 2000 AD" through a free universal public healthcare system. The National Health Policy of 1983 outlined four key components: free and comprehensive primary healthcare service linked with health education, engagement of 'health volunteers', free referral system for secondary and tertiary treatment in government hospitals, and an integrated network for specialty services, accessible free of cost to those in need.
When the Modi government came to power in 2014, they decided to abandon the planning process, which included the abandonment of health planning. This has led to a lack of direction in the public healthcare system. As a result, the groundwork has been laid for the market to assume control of the healthcare sector.
By March 2015, the public healthcare network consisted of more than 153,000 sub centres, 25,308 primary health centres, 5,396 community health centres, district hospitals, and medical colleges. In urban areas, there are also hospitals/dispensaries in subdivisions and under municipal local bodies. However, despite these advancements, the free universal public healthcare goal was still far from being achieved. In response to the neoliberal push of international finance capital, the Modi government implemented a new National Health Policy (NHP) in 2017.
The NHP-2017 serves as the basis for the privatisation of the public healthcare system. Its main objective is to align the growth of the private healthcare sector with public health goals and facilitate the private sector's contribution.
In 2018, the introduction of Ayushman Bharat – PM-JAY marked a significant shift in the government's role in public healthcare. Former union health secretary Sujatha Rao described this shift as a transition from being a 'service provider' to a 'financier'. AB-PMJAY (Ayushman Bharat - Pradhan Mantri Jan Arogya Yojna) is an insurance-scheme-based healthcare initiative that provides secondary and tertiary treatment for the marginalised sections of our population. It replaces the responsibility of healthcare services from the central and state governments, which were previously responsible for free universal public healthcare.
Corporate insurance companies have designed treatment schemes in collaboration with private hospitals, diagnostic centers, doctors, medicine companies, and suppliers. However, these schemes are primarily focused on maximising their own profits rather than ensuring the best possible treatment for patients. As a result, the free universal public healthcare network and services, which were meant to provide care to the underprivileged population, have been replaced by insurance companies' schemes. Additionally, both the central government and state governments have completely withdrawn from administering the healthcare system, only contributing to insurance premiums at a ratio of 60:40 for all registered individuals.
The administrative responsibility at the national level has been transferred to an independent public entity called the National Health Authority (NHA). The NHA has a full-time CEO and is registered under the Society's Act. Similarly, in the states, the administrative responsibility has been given to entities registered under the Society's Act or to trusts registered under the Indian Trusts Act.
The detrimental consequences of governments gradually withdrawing from public healthcare services have become apparent in the testing and treatment of the Covid-19 pandemic.
In India, the healthcare sector has experienced a foreign takeover due to the neoliberal push. According to data from the Department for Promotion of Industry and Internal Trade (DPIIT), hospitals and diagnostic centres have attracted foreign direct investment (FDI) amounting to US$ 6.72 billion between April 2000 and March 2020. The value of mergers and acquisitions in the hospital sector saw a significant increase of 155 per cent in 2019 compared to the previous year. It is projected that the healthcare market will triple in size to reach Rs 8.6 lakh crores by 2022.
The next step towards healthcare privatisation occurred when Prime Minister Modi made a significant announcement during his Independence Day speech in 2020. He introduced the National Digital Healthcare Mission (NDHM), which he referred to as a major initiative.
Previously, the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) had focused on providing insurance-based healthcare to the poor through government funding. In contrast, the NDHM aimed to provide healthcare services to the remainder of the population, who were not covered by PMJAY, at their own expense. Both programmes would be overseen by the independent entity known as the National Health Authority (NHA).
EXPOSING PATIENTS' INFORMATION FOR EXPLOITATION BY MARKETS
In the health market, the patient cannot make choices and control expenses like other commodities and services. They must depend on various entities such as doctors, diagnostic centres, hospitals, and medicine suppliers. NHDM, a digital platform created by NHA, aims to bring together the patient, service providers, and material suppliers in a shared health market. This development has been labelled as 'major' by the prime minister, and the union health minister is advocating it as a means to achieve 'health for all' in India.
The National Digital Health Mission (NDHM) consists of two major components: the customers and the sellers. The customers are all citizens who have registered nationally with their health-IDs, which include their personal health records and other sensitive data. The sellers include service providers such as doctors, who are registered in the national e-register known as 'digidoctor', as well as private hospitals and diagnostic centres listed in the health facility registry. Additionally, there is a telemedicine facility for online medical consultation, diagnosis, and e-prescription, as well as an e-pharmacy for online medicine suppliers.
NDHM poses a threat to the privacy of personal medical records, as they can be accessed by the private sector and made available to the public, potentially leading to misuse and blackmail. Additionally, it raises concerns about Indian citizens being used as guinea pigs for medical trials by multinational drug companies, who may find it challenging to conduct such trials under the laws of more economically developed countries.
The draft of the National Digital Health Blueprint (NDHB) was made public by NITI Aayog on July 15, 2020, before the announcement of NDHM by the prime minister. The draft includes various types of "sensitive personal data" such as financial information (like bank account, credit card, debit card details), physical, physiological, and mental health data, sex life, sexual orientation, medical records and history, biometric data, genetic data, transgender status, intersex status, caste or tribe, and religious or political beliefs or affiliations.
This fascistic method is used by the present government to identify citizens based on sensitive data such as caste and religion. It raises concerns about its potential implications in the future.
In response to current conditions, a nationwide movement is imperative, advocating for, immediate withdrawal of the National Digital Health Mission (NDHM) opposition to privatisation of public healthcare, strengthening of free universal public healthcare services and allocation of 3 percent of the GDP to public healthcare in the budget.
POLITICAL SHIFTS IN JAN AUSHADHI: A RENAMING JOURNEY
The 'Jan Aushadhi' scheme, introduced in 2008, aimed to revive pharmaceutical PSUs to provide government-subsidised, low-priced, quality generic medicines to vulnerable sections of society. The scheme was to be implemented by the Bureau of Pharma CPSUs of India (BPPI), under the direct control of the Department of Pharmaceuticals (DoP) of the Government of India (GoI), with funding from the government. BPPI was responsible for procuring Jan Aushadhi medicines from the five drug CPSUs, setting prices, and selling them through Jan Aushadhi Stores (JAS).
However, when the BJP's Modi government came to power, they decided to sell all five pharma CPSUs and appointed Ethics Infinity Pvt. Ltd. to supply Jan Aushadhi medicines to 1000 Jan Aushadhi stores established by the National Yuva Cooperative Society (NYCS) of RSS.
The 'Jan Aushadhi' scheme was renamed by the Modi government in 2015 as "Pradhan Mantri Jan Aushadhi Yojna" (PM-JAY), and again in 2016 as the "Pradhan Mantri Bhartiya Janaushadhi Pariyojana" (PM-BJP). The Jan Aushadhi stores were renamed as "PM-BJP Kendras." Each pack of Jan Aushadhi medicines now bears the brand name "Pradhan Mantri Bhartiya Janaushadhi Pariyojana" (PM-BJP), with 'BJP' highlighted in saffron in Hindi.
MARKET-BASED PRICING
Over time, the Drug Prices (Control) Order (DPCO) from the early 1970s, originally encompassing all medicines, gradually narrowed down to regulate only 378 drugs listed in the National List of Essential Medicines (NLEM). The DPCO 2013 marked a fundamental shift from cost-based to market-based pricing, setting upper limits on the average retail price for companies with over 1 per cent market share for a given medicine.
The high prices of medicines can be attributed to two main factors. Firstly, there has been a significant increase in taxes on all medicines, including essential ones. Previously, the excise duty was levied based on the production cost, while the sales tax was applied at the retail level, amounting to 100-500 per cent of the production cost. However, with the implementation of the combined tax system GST, the taxes are now calculated based on the retail price. This has resulted in a significant increase in the prices of medicines.
Secondly, prior to the introduction of GST, many essential medicines were exempt from sales tax in several states. However, with the implementation of GST, this exemption has been revoked, leading to another substantial increase in medicine prices.
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