Treating private healthcare excesses

Private hospitals have been in the news lately for all the wrong reasons. The Delhi Government has cancelled the license of the Max Hospital in Shalimar Bagh finding the hospital administration guilty of medical negligence. Also in the line of fire is Fortis Gurugram that presented a bill of ₹16 lakh for the 15-day dengue treatment of seven-year old Adya who lost her life subsequently.

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.

The Clinical Establishments Act, 2010 was enacted by the Centre for registering and regulating all types of public and private clinical establishments in the country, including single-doctor clinics. Thus far, the Act has been adopted by Uttar Pradesh, Rajasthan, Bihar, Jharkhand and Assam; however, it has taken effect only in four states, namely Arunachal Pradesh, Himachal Pradesh, Mizoram and Sikkim.

The Act provides for the creation of a regulatory authority at the State and district levels. Other key elements include the grading of clinical establishments, adoption of standard treatment guidelines and protection of patient rights. In the same vein, the National Health Policy, 2017 recommends the setting up of an empowered medical tribunal for the timely resolution of complaints pertaining to medical negligence, excessively high cost of treatment and unfair practices.

There is no doubt that the adoption and implementation of this Act in letter and spirit will be a significant step towards curbing malpractices such as overcharging and minimising instances of negligence.

However, citizens also need to be empowered so that the 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. In some parts of the country Jan Sunwais are organised during which citizens have the opportunity to report their experiences with health providers in the presence of government officials, NGOs and community leaders.

Such interventions should be replicated as they not only increase citizen participation but also make health governance more accountable and responsive to local communities. 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.

In this regard, the role of the Medical Council of India (MCI) has been grossly inadequate. 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.

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. Never before has the proverb prevention is better than cure been more relevant for the country.

Take for example the case of seven-year-old Adya who lost her battle with dengue at Gurgaon’s Fortis Hospital. Adya might never have needed a hospital in the first place if we had systematic measures in place for preventing mosquito breeding.

The National Health Policy, 2017 and NITI Aayog’s Three-Year Action Agenda make several important recommendations for strengthening public health, including the creation of a focal point in the Union Health Ministry and a dedicated public health cadre, among others. These need to be implemented on a war footing.

When it comes to tackling medical negligence or profiteering, one-off actions are unlikely to have a lasting positive impact. We need to attack the roots instead of just hacking at the leaves.

The writer is Public Policy Specialist, Office of Vice Chairman, NITI Aayog. The views are personal