Análisis de la política y la dimensión pública de las asociaciones público-privadas en el sector salud: estudios de caso en hospitales municipales del estado de Maharashtra, India

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Cover image volume 2 issue 1 2025
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Publicado: jul 23, 2025
DOI: https://doi.org/10.36368/jcsh.v2i1.1182
Palabras clave:
Atención sanitaria, privatización, público-privado, gobernanza, rendición de cuentas, India

Contenido principal del artículo

Shweta Marathe
Support for Advocacy and Training to Health Initiatives (SATHI), Pune, Maharashtra, India
https://orcid.org/0000-0002-8133-0460
Deepali Yakkundi
Support for Advocacy and Training to Health Initiatives (SATHI), Pune, Maharashtra, India
Abhijit More
Support for Advocacy and Training to Health Initiatives (SATHI), Pune, Maharashtra, India
Dhananjay Kakade
Support for Advocacy and Training to Health Initiatives (SATHI), Pune, Maharashtra, India

Resumen

Introducción: Las asociaciones público-privadas (APP) se han consolidado como una política preferida a nivel global en el sector salud. En India, las APP han ganado impulso en las últimas dos décadas, aunque siguen siendo objeto de debate. La mayoría de las investigaciones indias se centran en APP en la atención primaria rural. Este estudio examina APP clínicas y diagnósticas en hospitales públicos de segundo y tercer nivel en zonas urbanas del estado de Maharashtra, analizando las relaciones público-privadas, los procesos de toma de decisiones, su funcionamiento, los desafíos enfrentados y su impacto en la prestación de servicios de salud.


Métodos: Se utilizó un enfoque exploratorio cualitativo con diseño de estudio de casos múltiples. Se mapearon 40 proyectos hospitalarios de APP activos entre 2017 y 2023, de los cuales se seleccionaron seis proyectos diversos para estudios de caso en profundidad. La recolección de datos incluyó 25 entrevistas cualitativas con actores clave, revisión de documentos técnicos y comparación de tarifas de 20 servicios de salud entre APP y hospitales públicos. Para el análisis de las relaciones público-privadas se aplicó la teoría del agente-principal, y se evaluó el desempeño de las APP utilizando los criterios de “carácter público” propuestos por David MacDonald y Greg Ruiters.


Resultados: El estudio reveló desafíos significativos en las APP, incluyendo politización, falta de transparencia e ineficiencias en la gobernanza. La influencia política local a menudo priorizó intereses comerciales por encima de los objetivos de salud pública, mientras que el respaldo burocrático se centró en problemas como la escasez de médicos y restricciones presupuestarias. La toma de decisiones en hospitales públicos se limitó al ámbito municipal, sin participación del departamento estatal de salud. De los 40 proyectos analizados, 24 involucraban agencias con fines de lucro y contratos de entre 10 y 30 años. Los mecanismos de supervisión fueron insuficientes, lo que derivó en incumplimientos contractuales, personal no calificado y prestación irregular de servicios. A pesar de contar con recursos adecuados, muchos proyectos mostraron baja utilización. Aunque algunos mejoraron el acceso, sus servicios resultaron inaccesibles para poblaciones marginadas, con precios de 3 a 15 veces más altos que los de los hospitales públicos.


Conclusión: Este estudio llena un vacío crítico de conocimiento al ofrecer evidencia empírica sobre APP clínicas y diagnósticas en hospitales municipales en India. En teoría, las APP pueden mejorar el acceso a la atención mediante la participación del sector privado; sin embargo, para lograr un desempeño efectivo y alineado con el interés público, son necesarias reformas estructurales, marcos de gobernanza sólidos, mecanismos de monitoreo eficaces y una regulación más estricta. El estudio subraya la importancia de fortalecer el sistema público de salud para garantizar una atención integral y equitativa, y plantea dudas sobre la viabilidad a largo plazo de las APP frente a los complejos desafíos de la atención sanitaria urbana.

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Marathe S, Yakkundi D, More A, Kakade D. Análisis de la política y la dimensión pública de las asociaciones público-privadas en el sector salud: estudios de caso en hospitales municipales del estado de Maharashtra, India. J Community Syst Health [Internet]. 23 de julio de 2025 [citado 2 de abril de 2026];2(1). Disponible en: https://journals.ub.umu.se/index.php/jcsh/article/view/1182
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Vol. 2 Núm. 1 (2025)
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Investigación original
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Biografía del autor/a

Shweta Marathe, Support for Advocacy and Training to Health Initiatives (SATHI), Pune, Maharashtra, India

SM works as a health system with a considerable background of research on private sector, public-private sector interactions, regulation of private sector, and corporatisation of healthcare. Her research interests focus on the transformations in the private healthcare sector. Currently, she is a fellow of the India-HPSR fellowship-2022.

Deepali Yakkundi, Support for Advocacy and Training to Health Initiatives (SATHI), Pune, Maharashtra, India

DY is data analyst with epertise in quantitative data and has around 18 years experience in the public health sector. She currently works as a senior data analyst with SATHI. 

Abhijit More, Support for Advocacy and Training to Health Initiatives (SATHI), Pune, Maharashtra, India

AM is a public health researcher and practitioner. He has been associated with public health activism at sub national level and is associated with SATHI as a senior consultant. 

Dhananjay Kakade, Support for Advocacy and Training to Health Initiatives (SATHI), Pune, Maharashtra, India

DK is currently Director at SATHI and has 20 years of experience of working in public health sector with civil sociaty organisations as well as funding agencies.

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