Policy Context and Objectives
- Public policies reflect objectives through design, not stated intentions or symbolic development claims.
- PPP in medical education may prioritise profits, optics, or rent-seeking, not public welfare.
- Framework design indicates dilution of affordable, quality public medical education goals.
Expansion of Medical Colleges in Andhra Pradesh
- Government medical colleges increased to 17, with 19 private colleges already operational.
- Proposal to add 10 new colleges under PPP mode, raising total seats beyond 6,500.
- 835 acres acquired; colleges initiated during the previous government’s tenure.
- Estimated cost: ₹450 crore per college, totalling ₹4,500 crore.
- Financing planned via NABARD, State funds, and central schemes.
- Each college planned with 150 MBBS seats attached to 650-bed district hospitals.
Fee Structure and Revenue Model
- Three-tier fee system for fiscal sustainability:
- 50% seats at ₹15,000 annually.
- 35% seats at ₹12 lakh annually.
- 15% NRI seats at ₹20 lakh annually.
- Annual fee revenue estimated at ₹11 crore per batch.
- Cumulative recovery expected to reach ₹55 crore by fifth year.
- Additional postgraduate seats add significantly higher revenue potential.
PPP Model Proposed by New Government
- Entire land and district hospitals leased for 33+33 years at nominal rates.
- Government to provide 25% viability gap funding and statutory clearances.
- State guarantees 70% bed occupancy and insurance empanelment.
- Investor obligations include:
- Completing construction within two years.
- Providing free OPD and 70% free inpatient care at Ayushman Bharat rates.
- Government deputes engineers and provides free space for Jan Aushadhi and medico-legal work.
Risks, Inefficiencies, and Systemic Concerns
- Unequal risk-sharing favours private investors over the State.
- High risk of quality dilution, faculty shortages, informal fees, and service denial.
- Judiciary remains the only remedy if contracts fail, causing long delays.
- Handing over district hospitals for 66 years undermines public control.
- Evidence shows 30% hospitalisations avoidable through strong primary care.
- PPP fragments healthcare delivery, weakening referral systems and continuity of care.
Broader Structural Issues
- Chronic underfunding and vacancies, especially specialists in rural areas.
- Commercialisation discourages graduates from serving in public and rural health systems.
- State lacks institutional capacity to regulate privatised healthcare effectively.
- Previous fragmented contracts in primary care caused enforcement failures.
- Priority should be quality, faculty availability, and equitable access, not unchecked expansion.
- PPP as a welfare delivery mechanism fails to inspire confidence in public health.
