Regulating Private Hospitals

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TOPIC: General Studies 2

• Government policies and interventions for development in various sectors and issues arising out of their design and implementation.
• Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

In News: The Delhi government’s Health Department will re-examine the draft policy framed by a committee to regularize the functioning of private hospitals in the capital, to understand the ‘rationale’ behind some of the suggestions.

Why the Panel: The draft advisory was prepared on the basis of recommendations by a nine-member expert panel, headed by Director-General of Health Services Kirti Bhushan. The panel was formed on December 13 last year, after a family alleged medical negligence a private hospital for wrongly declaring a baby dead.

Thoughts on the Draft Policy: Senior officials in the department are not satisfied with the draft policy and want the committee to work again on the entire report.

• On May 28, the Delhi government had proposed regulations restricting private hospitals and nursing homes from marking up prices of medicines and consumables over 50 percent of their procurement price.
• The draft was placed in the public domain for 30 days and suggestions were invited. The draft advisory suggested that private hospitals can charge patients the maximum retail price for medicines under the National List of Essential Medicines, 2015, as their prices have already been capped.
• The draft was ideally to be submitted by the end of June. It is already delayed by four months now.

Instances of suspected medical negligence and exorbitant bills are not unusual. Some make it to the headlines, others don’t. While the step taken by the Delhi Government could have important signalling value perhaps, the problem needs a systemic and sustained solution.

Basic tenets of regulating private healthcare:

• No payment at the point of service
• Governments as the primary spenders in healthcare
• Robust primary care system
• Regulation of prices of drugs and diagnostics
• Some health cover for every citizen

In India, this is probably the highest barrier currently — public spending on health is less than 1% of GDP, and per capita public health spend is about $15, less than in Bhutan, Indonesia, Thailand and the Philippines.

The National Medical Commission Bill, 2016 proposes to address the issue of medical ethics through some key features –

• Firstly, it emphasises the need for developing a competency-based dynamic curriculum in consultation with stakeholders such that medical graduates not only have appropriate knowledge and skills, but also values and ethics for providing health care.
• Secondly, it proposes to establish the Board for Medical Registration which will also be responsible for prescribing the standards of professional conduct and framing a Code of Ethics for medical practitioners.

Need to understand the dynamics of the game

Address Information Asymmetry:

• Citizens need to be empowered so that they understand their rights and the recourse available to them should something go wrong. It is important to appreciate that healthcare is in any case plagued by tremendous information asymmetry.
• Patients as buyers of healthcare services and doctors as providers are definitely not equal players. Patients and their families often have little choice but to assume that their doctor knows best. It is, therefore, imperative that citizens are educated about diseases, possible complications and approximate treatment costs.

Self-regulation: Best way froward

While we can put in place external checks and balances, the need for the medical profession to self-regulate and adhere to the highest ethical standards cannot be underscored enough.

States need to Step Up

While the Central government needs to relook at the Clinical Establishments Act of 2010, (that though adopted by 14 states stands unimplemented) state governments must seize the moment and bring in regulations along the lines of, or bettering upon, what West Bengal and Karnataka have recently done. Karnataka legislated the constitution of empowered grievance redressal mechanisms at district levels; mandated hospitals to display prices for procedures; and ensure observance of a patient’s charter. Such patient-centric laws are urgently required.

There is an equal urgency to building the institutional capacity to enforce them –

• Setting of protocols
• Computerisation of every patient interaction
• Supervision on real time basis
• An uncompromising approach to non-adherence of conditions need to go along with legal frameworks

Such an environment protects both doctors — of whom a majority want to do good — and patients, from the greed of hospital investors and managers.

We need to focus on building a strong public health system. It is not an either/or but given India’s dual disease burden and the fact that 50 per cent of deaths are now due to non-communicable diseases, we need to do more to keep people healthy and reduce the need for costly hospital treatment.

Connecting the Dots:

Suspending hospital licences is not a sustainable solution to a complex problem. Do you agree? Justify