THIRUVANANTHAPURAM: The new Government is pushing through the proposed Kerala Secondary Health System Project as part of its 100-day action plan. However, a controversy is in the making over the public-private mix, user service charge and social insurance schemes being insisted upon by the World Bank that is to fund the Rs. 500-crore project.

The Chief Minister, Oommen Chandy, was one of the leaders who had suggested introduction of service charge in hospitals and educational institutions as early as the Nineties when he was the Finance Minister. However, the present political climate appears not quite favourable for the move proposed by the World Bank. If the Cabinet rejects its conditions, it is to be seen whether the World Bank would be keen to provide the loan.

Apart from policy and institutional reforms, the project proposes prevention and control of non-communicable diseases and trauma, considering the increasing morbidity and mortality rate on account of diseases such as hypertension, cardiovascular diseases and cancer. It suggests that local self-governments be entrusted with the responsibility of collecting user service charge for institutional development and novel social insurance schemes.

Private participation
The private sector is to be brought into the fold of health services with the public sector outsourcing services from it. ``With reciprocity, their value-added services like CT scan and other lab tests can be subsidised to the public sector leading to a win-win situation,'' says the concept paper on the project.

It observes that the role of Government as a welfare agency is increasingly becoming that of a coordinating and regulatory agency. Cost sharing and risk pooling are to be undertaken through the insurance system with the Government support for cover to the poor. Resources mobilisation is to be done through hospital development committees or other set ups or through pay clinics, user fee and health cess.

Disadvantageous
According to critics of the proposal, such a system would be disadvantageous to the poor who depend on Government hospitals for free healthcare. There is even reason to fear that silent deaths, similar to the suicide by farmers, would occur even among those just above the poverty line once the Government withdraws free services. Insurance could become a costly affair as has happened in the United States itself. In Kerala, the situation could turn worse on account of corruption as is evident in the motor vehicle insurance sector.