NEW DELHI: The Centre is set to announce a scheme for providing free diagnostic tests, including several blood tests, x-rays and advanced CT scans, for those visiting public health facilities. Private service providers will be roped in wherever required.While the idea of providing free diagnostics has been hailed by all those aware of it, health economists and public health experts expressed concern over outsourcing the tests to the private sector, arguing that it is an “expensive and inefficient” way to provide the services.Costs of drugs and diagnostics constitute about 70% of health expenditure in India and are estimated to push 5 crore people below the poverty line (BPL) annually. The proposed ‘national strategy for providing essential diagnostics facilities free for all’ is meant for anyone visiting a public health facility — from a village health post to a district hospital.A panel of experts are learnt to have provided the government with a list of diagnostic tests considered essential for all categories of health facilities. The health ministry has also consulted some of the biggest companies in the diagnostic sector, including SRL, Dr Lal PathLabs, Quest Diagnostics, Mahajan Imaging and Star Imaging to thrash out all service provider issues.Along with reducing people’s health expenditure, the initiative is expected to help promote the diagnostics and reagents sectors, which currently have just over 20% share in the medical technology market.Under the scheme, existing diagnostic infrastructure in government institutions is to be strengthened, and where there is no infrastructure, state governments would be supported to engage with private service providers for collection of blood samples, analysis and reporting. The scheme is meant to outsource only high-cost, low-volume tests. In government facilities with inadequate personnel, the scheme will be in-sourcing personnel through contracts with the private sector. X-rays are to be sent electronically to radiology centres for proper diagnosis as most physicians are not trained to read x-ray films. The Centre will also help states to have CT scan services at district level under public-private partnerships. The shares of outsourcing and use of the government’s own facilities are expected to vary between states depending on the robustness of their health infrastructure.Health economist Sakthivel Selvaraj expressed skepticism, saying “With a slashed health budget and no allocation in the budget for the scheme, where will they find additional resources for this? Tamil Nadu and Rajasthan are already providing diagnostic facilities more efficiently without outsourcing. Why not follow that model? Why follow a model of outsourcing that has failed in several states like Bihar and Chhattisgarh? Outsourcing only adds to the cost.”However, government sources pointed out that the scheme is meant to be implemented under the National Health Mission, which has always seen the allocated money remaining unspent. Sources added that instead of huge capital expenditure on procuring diagnostic machines, the government could provide services to more people for the same amount of money by outsourcing.“The fear is that such outsourcing without thinking through the consequences could lead to the private sector eventually blackmailing the government and raising costs for services. India spends less than some of the poorest countries on health and this unwillingness to spend on health is the reason for having to resort to outsourcing to the private sector. In a country with such weak monitoring mechanism how will it work?” asked Reetika Khera, associate professor of economics in IIT Delhi.Some public health technology experts, however, felt that selective outsourcing has been shown to work in certain other technology intensive areas such as ambulance care/108, currently in place across 25 states and UTs which they said would not have been possible for the government to provide without private engagement. Similar engagements for laboratory and CT are being used in many states including Himachal Pradesh, Uttarakhand and West Bengal, they pointed out. “Experience suggests that measured formula-based centralised outsourcing is recommended only for ancillary services that are technology intensive,” said one such expert.