The Hindu Business Line : Regulating medical clinics

CONSIDERING THE LIST of economic activities now subject to a regulatory regime, the case for such a framework for clinical establishments is indeed very strong. It is a well-accepted principle of governance that activities having a strong public interface need to be regulated. Eligibility norms need to be laid down for firms entering the business, and the minimum quality standards set for their output. Thus, for instance, there exists a licensing procedure for regulating entry of players into insurance or banking industries and, once licensed, they are subject to regulations that lay down how they shall conduct their business.

Viewed by this yardstick, issues of public health deserve to be placed on an even higher footing in the context of a regulatory regime. There can be no dispute that an independent professional assessment is required of the infrastructure appropriate for patients and of the clinical procedures that are performed in an establishment. Equally, few would question the rationale for laying down standards of patient safety and service quality or for a monitoring mechanism that ensures these are followed, to name just two important aspects of regulation in this context. If the cases coming up before the judicial forum for consumer disputes are anything to go by, there exists a vast gulf between the minimum desirable norms and those currently available in these establishments. There are other positive spin-offs too. As the regulatory environment evolves and acquires a certain level of sophistication it should logically lead to agencies warranting levels of service quality just as a credit rating industry evolves side-by-side with the oversight function performed by regulators such as the Reserve Bank of India. As rating agencies gain credibility, the phenomenon should result in India being recognised internationally as a source of quality healthcare service.

While the concept itself may be unexceptionable, a lot however depends on how it is implemented in practice. There are two potential pitfalls. The Centre can only formulate the law. The actual implementation may have to be left to the State Governments if not the authorities responsible for provincial administration. Over the years, the quality of governance at the sub-national level has deteriorated with corruption creeping into all facets of administration. There is a real danger, therefore, of regulation being cynically exploited by the powers that be, for self-aggrandisement with no perceptible improvement in the quality of healthcare delivered to the public. Then there is also the cost aspect. If the accreditation and supervisory infrastructure are to be paid for by the consumers, that is bound to raise the cost of healthcare service in the country at a time when the public healthcare system is woefully inadequate. The Health Ministry faces the daunting challenge of reconciling the long-term benefits of quality service with rising costs of administration in the short term.