AAP Manifesto

AAP’s vision for healthcare reform will saddle India with a sclerotic, expensive, exchequer funded healthcare system that will be unaccountable to the public and take India’s outcomes from bad to worse.

In its recently released vision document, the Aam Aadmi Party (AAP) has outlined its vision for healthcare transformation in India. Summarized into six pithy points, the vision should be a cause for significant concern for healthcare leaders and professionals.

The brief section begins with a strong assertion: to substantially increase spending, which by itself seems a laudable goal.

However the devil is in the details; or the lack of it. Across the agenda items, in true babu-style, the focus is singularly on throwing money at the problem or on creating employment. Never once do healthcare goals, outcomes such as quality of care, patient safety, efficiency and economy find any mention.

By the time you read the second point the goal becomes clear: creating a massive socialised healthcare system, planned (from ‘commanding heights’) by the government, built using taxpayer money and run using taxpayer funds. Never mind that after 70 years of independence, public hospitals have universally becomes symbols of decay and apathy, the message is clear: while socialised healthcare may have failed in India, the AAP will not stop trying with the same model – with our money.

The reasons for the failure of India’s public hospitals (in general) are many: public hospitals are governed using management principles and employment norms that are designed to provide employment, not deliver patient care. As a result, they are grossly inefficient and employ far more people than they need to – typically, over 60% of staff at public hospitals do little in terms of patient care. Public hospitals also consistently struggle to obtain equipment and services at anything resembling good prices; they struggle to achieve basic standards in management and are fighting a losing battle in retaining talent. Finally, due to these and other conditions, public sector hospitals of all standards struggle to employ physicians. Several studies have shown that vacancy rates for physicians in public hospitals across the country can be as high as 60%. Even a national leader like AIIMS struggles to fill its teaching posts!

Despite these known shortcomings, the AAP manifesto does not talk about fixing any of them. Though a perfunctory nod to increasing accountability has been made, concrete steps – such as fixing rotten labour laws, bringing in a semblance of a meritocracy, fixing accountability levels, bringing in independent regulation in public healthcare, enabling public hospitals to adopt modern management principles for employment — find no mention anywhere in the entire document. In the absence of these reforms, the AAP’s bold plans for aggressively investing in healthcare are likely to end up wasting public money in constructing empty buildings with no care givers – and hence no care.

The AAP continues in its bureaucratic, input obsessed ’employment generation’ frame of reference – for example with reference to health workers. Despite this heart-warming focus on employment and empowerment of women, nowhere in the vision does the AAP conceptualize unshackling education from the clutches of the license Raj.

Finally, however, the AAP does note that cuts and questionable economic practices should not be tolerated. But, the document at least, does not show any understanding of the root causes of these practices: namely information asymmetry between doctors and patients, a total lack of focus on outcomes and virtually no real legal protection to customers.

Since it does not outline any solutions to fix these real, painful, substantive issues, one can only assume a resort to Delhi-style vigilantism; a solution worse than the crime.

In sum, the AAP’s healthcare vision is a scaled up version of the current socialised, license Raj in healthcare. A choice for which India has paid a terrible price.

In the author’s view, the current vision is unfortunate.

Real game changing reforms — such as moving the government from running hospitals to paying for care against prescribed norms and standards; mandating declaration of outcomes (clinical and financial); enabling patients to choose their providers by making funding follow the individual; unshackling the sector from red tape; and enabling technology and innovation to transforming healthcare — have been given a miss.

What we have is just more of the same. The AAP, it would seem, would like people to believe that its ‘good’ version of socialised license raj will outperform the ‘bad’ socialised license raj we have lived with.

Given what is possible; indeed given what is necessary, the AAP’s lacklustre healthcare vision earns it a D minus.

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Adheet Gogate

Dr. Adheet is a fellow of Harvard Medical School and an entrepreneur in the area of healthcare consulting.

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