From sick-care for some to healthcare for all

The Clinical Establishments (Registration and Regulation) Act, 2010, coming into force from August last year takes the people of India several steps nearer towards the goal of Health Care for All.

An immediate benefit from the new enactment is that no one who comes, or is brought, in an “emergency medical condition” to any of the doctors, hospitals and clinical establishments in the country can be callously turned away or denied appropriate treatment on any kind of excuse whatsoever. The Act makes it mandatory for all clinical establishments belonging to any recognised systems of medicine, as well as single doctor establishments with or without beds, to register themselves with the National Council, which will maintain a National Register for the purpose.

It has been entrusted with the task of evolving and enforcing a proper grading system to govern the clinical establishments which will also be bound to adhere to a scheme of standards and safeguards aimed at guaranteeing prompt service of optimum quality.

It is proposed to vest the Council with the powers of a regulatory body overseeing the functioning of clinical establishments throughout the country so as to ensure uniformity in health-care delivery and total transparency in all their transactions.

The law has come into being not a day too soon. All that today passes for health care is nothing but sick-care, which means attending to a person after he becomes a patient afflicted with some ailment or the other, often after it has become acute or chronic due to lack of means or facilities, or ignorance or neglect.

Whereas healthcare, if it has to serve its true and intended purpose, should lay the utmost emphasis on prevention, early diagnosis and detection by advance screening, and timely advice to forestall its taking any unexpected or undesirable complexion.

Want of will

Healthcare in India had for long been a casualty of the combined onslaught of four factors: The first is the poor insurance coverage and the exorbitant cost of treatment. According to a report of the National Rural Health Mission (2005), only 10 per cent of Indians have some form of health insurance and around 40 per cent have to borrow money or sell their assets to meet their healthcare expenses. More than 25 per cent of the people slip below the poverty line because of hospitalisation due to a single bout of illness.

Second, the paltry facilities. India bears 20 per cent of the world's disease burden, but has only six per cent of the world's hospital beds. Hospital beds per 1,000 population in India are less than 50 per cent of that in developing countries such as Brazil and China and less than 35 per cent of the world average. The ratio of doctors to population is also measly.

Nothing better can be expected with the total expenditure on public health being a mere 0.9 per cent of the GDP.

Third, is the want of will on the part of both the Government and the Medical Council to enforce the laws and regulations that already exist. The Code of Conduct for doctors embodied in the Medical Council of India Act is a dead letter. There has not been a single instance that I can recall of a doctor being disciplined for violation of its provisions.

Fourth, there has been a general decline in fellow-feeling, consideration, compassion, empathy and humanity brought on by the pressures and tensions of daily life, and the members of the medical profession are equally affected by it.

Theirs is a noble, almost divine, calling, and just a little effort on their part to cultivate social conscience will mitigate the negative impact of all other factors.

Meanwhile, the Health Ministry should launch an intensive campaign to make all the clinical establishments aware of the provisions of the new law.