A prescription that falls short of a cure

Preeti Mehra | Updated on April 18, 2021

Uncaring: A Bengaluru hospital that was penalised for not reserving beds for Covid-19 patients   -  SOMASHEKARA GRN

A 2010 Act to regulate the medical sector flounders in implementation, even as healthcare remains unaffordable for the masses

In the last two decades the private health sector has overtaken public health infrastructure in no uncertain terms.

While the former has an estimated 43,487 hospitals with 11,85,242 beds, the latter has substantially less — 25,778 hospitals and 7,13,986 beds. With overcrowding, and lack of amenities and staff in government hospitals, citizens have been knocking at the doors of private establishments even if they cannot afford them. And there are enough stories of how families have sold their assets for a major life-saving procedure. A situation that has only become more grim as the pandemic takes a high human toll on the country.

Despite health being a state subject, in 2010 a Central legislation — Clinical Establishments (Registration and Regulation) Act — was put in place. The new law was applicable to all systems of medicine and all public and private medical establishments including hospitals, maternity homes, nursing homes, clinics, dispensaries, laboratories, diagnostic imaging centres, and physiotherapy centres.

But implementation of the regulation has been slow, and fraught with delays. So what has led to the decade-long stalling? Dr Abhay Shukla, Dr Kanchan Pawar and Dr Abhijit More, with the Maharashtra-based ‘Support for Advocacy and Training to Health Initiatives’, outline the reasons in a recent paper brought out by Oxfam India.

In their assessment, the government’s clubbing together of the entire private sector and avoiding a differential approach to different kinds of clinical establishments have worked against the legislation.

The authors even argue that an ‘enforcement’-based approach to regulation should be dropped in favour of an ‘interventionist’ approach “which does not stand apart from the market, but actively intervenes in ways to reshape the market in the direction of greater equity and public interest”.

Leaning on private care

The 75th round of the National Sample Survey Office (2017-18) showed that 54.3 per cent patients in rural areas and 64.7 per cent in the urban were treated by private hospitals. And the major lament among patients has been the lack of regulation, with many private establishments duping patients by overcharging or advising a plethora of unnecessary tests or surgeries.

When the National Pharmaceutical Pricing Authority had analysed bills from four big hospitals in the Delhi-NCR region, it found that the profit margins ranged from 100 per cent to 1,737 per cent on drugs, consumables and diagnostics. These three components made up 46 per cent of a patient’s bill.

A National Council was formed to list minimum standards. In July 2019, the draft notification for minimum standards for 35 different categories of allopathy and AYUSH establishments were shared for public feedback. These still await a notification. In any case, only 11 states have adopted the legislation. Others have their own laws, some a diluted version of CEA 2010 and some, for all practical purposes, non-functional.

Political will

The authors point out that the Centre has not been proactive in building consensus around the Act. The report notes that, while sticking to the core principles of the legislation, some of the genuine concerns of smaller and individual providers could have been accommodated. States also have not been given the flexibility to customise the Act to suit their needs.

Further, the report cites the “lack of political will to allocate sufficient funding and resources for the regulatory apparatus”. The Act mandates national and state councils and a district registering authority but does not allocate dedicated staff or funding for it, defeating its own purpose.

Published on April 18, 2021

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