Regulate private healthcare

The fire that took so many lives at a Kolkata hospital raises a seminal question about health care in India. Why is it that we are unable to regulate medical services in this country? The authorities turn a blind eye or profess helplessness when it comes to addressing the unregulated mushrooming of private clinics and private hospitals. There are no mechanisms to regulate the quality of services offered or regulate the fees charged by private sector doctors and hospitals. Hospitals can charge whatever they like and stories of patients being fleeced by doctors and hospitals are wide spread. There has been no attempt to create a graded service-based fee structure within the private medical sector. This means that for a hospital offering a certain set of services, there should be a fixed range of costs across the state.

Being medically illiterate, patients are often not in a position to question hospitals or doctors on why a test is being ordered or why a certain number of drugs need to be taken, even if the common sense of the patient signals that these may be unnecessary. With a gradual erosion of ethics within large hospitals, families are frequently trapped into a financial ploy once they develop an illness. If the educated class in cities can at least voice an opinion, it is the poor and the vulnerable in cities and rural areas that bear the brunt of the lack of regulation of private medical practice. Without the ability to pay for services, these families have no option but to turn to quacks who may cause more harm than good.

We may criticise government hospitals for poor quality of services, but come what may, they are constantly under public and internal scrutiny. The media and the NGO sector keep a hawk eye on government hospitals, highlighting negligence wherever it is reported. This constant scrutiny has at least resulted in creation of the Indian Public Health Standards that ensures that certain facilities must be available at government hospitals. Whether these standards are achieving their goals or not is another story. But the point is that, as much as we love to hate it, the government sector has some standard that it has to abide by. It is therefore baffling as to why the government turns a blind eye when it comes to the private sector.

Most people are unaware that the complete lack of regulation of the private medical sector begins with the fact that we only have an approximate idea on the number of private doctors or clinics that are established in a city. These clinics are registered under the shops and establishments Act and most often, the corporation or the municipal health authorities do not have a complete list of such clinics. There is no rule that makes it mandatory for private practitioners to inform the corporation when they shut shop. Health authorities may be aware of small or large hospitals as they come under the hospitals Act. While these hospitals have to fulfil certain criteria, regular quality monitoring is not done.

Seventy per cent of India’s 1.2 billion population turns to the private sector for healthcare. Unable to afford out of pocket payment for treatment, the remaining turn to the public sector. If government hospital services are good (and there are examples of such hospitals scattered across the country), patients need not use the services of the private sector. This was the dream in 1947, when the country’s health system blueprint was developed. Universal health coverage, that is subsidised, routine care for all Indians through government health services was the vision. As we lacked doctors after Independence, medical colleges were set up to produce trained manpower to serve the nation. Rather than enriching health services, we now have a scenario where government health services do not have doctors whilst private doctors and hospitals proliferate in huge numbers, mostly in urban areas. This failure to provide universal healthcare should itself be a reason for the authorities to ensure that the private sector medical services are regulated so that people get a fair deal when accessing health services.

A set of guidelines for private sector medical practice is needed. The key points that this policy needs to address are standards of service, fees and ethics of medical practice. The policy should include what the government sector has done for itself — the establishment of patient welfare committees for all hospitals. Patient welfare committees at government hospitals have members of the public who can ensure that the user’s needs are addressed. Perhaps private sector hospitals could design equivalent committees of rational members, who could assist the hospital management in ensuring that the hospital keeps in mind the financial and social realities of patients using their services. Included in these committees should be the doctors that all of us know — those good men and women who have looked after our parents and grandparents and have moved on from being a doctor to a person who the family trusts and turns to for advice. Such doctors would keep the concerns of the patient at heart whilst understanding the needs and concerns of the hospital management.

The glamorous life that is possible when a doctor has a proliferating practice seems to have pushed to the background the Hippocratic values of social service that was the hallmark of the medical practitioner of an earlier generation. These values do exist somewhere within the medical profession, but the impact of globalisation on the medical sector seems to have placed these doctors far into the background together with the ethics of medical practice.

Whilst authorities create a policy to regulate private medical services, the Kolkata incident should be a time for introspection by all. Patients and family members should understand the challenges faced by doctors as they try to restore health in a diseased body. The authorities should remember that without private medical services, India would not have the health indicators that it has currently achieved. The private medical sector needs to reflect on the ethics underlying the delivery of medical care. But above all, the onus falls on the government to quickly develop a strategy for ensuring a regulated and ethical private medical service in this country.

(Views expressed in the column are the author’s own)

Anita Kar is Director, School of Public Health & Health Science, University of Pune, Pune. E-mail:  dranitakar@gmail.com