It’s Friday evening and a ‘Jan Sunwai’, or public hearing, on patient experiences at private hospitals during the pandemic has just concluded in Pune.

“Despite the Government capping rates (of certain tests and treatment), there are instances of patients being overcharged. And there is no organised platform for patients to take their problems,” says public health expert Dr Abhay Shukla, emerging from the interaction.

Patient families are forced to borrow money at high interest rates to pay hospital bills, despite having documents that make them eligible for payment by the Government, says Dr Shukla, co-convenor, Jan Swasthya Abhiyan.

This problem is present across the country, he says, agreeing on the need for a healthcare regulator. But it should not be a top-down approach, he cautions, calling for an “accountable social regulation”. A “differential approach” that incorporates different ground realities (be it in South Mumbai or rural Nandurbar), while standardising parameters on patient rights and transparency, he explains.

The recent Economic Survey highlighted the concept: “A sectoral regulator to undertake regulation and supervision of the healthcare sector must be considered given the market failures stemming from information asymmetry.”

And while the concept finds favour, the task is easier said than done, say veteran healthcare voices. “It is not comparable to governing the telecom or insurance sector, where there are few players,” says Shukla. Healthcare has many institutions of varying shapes and sizes. The Central system needs to be present at the district level as healthcare issues are complex, varying from overcharging to medical negligence. More work needs to be done on the Clinical Establishments Act (2010) too, he adds.

Shukla suggests multi-stakeholder bodies to address patient issues, but “not in an inspection way”.

Even-handed approach

The call for a hospital regulator has been long in discussion, observes Vishal Bali, but such an agency should be even-handed in its approach to public and private healthcare institutions, big and small outfits, charitable trust-run institutions, nursing homes, and so on. Price and other regulatory issues should not be handled by the same body, he says, pointing to pharmaceuticals. Pricing is handled by the National Pharmaceutical Pricing Authority, while other regulatory issues are under the Drug Controller General of India and State Food and Drug Administration, says Bali, Executive Chairman, Asia Healthcare Holdings, who formerly helmed hospital networks Wockhardt and Fortis.

The NABH (National Accreditation Board for Hospitals and Healthcare Providers) looks at hospital accreditation and is required for empanelment on Government insurance schemes, he points out. It assesses civil and medical infrastructure, among other things. The Government needs to be clear on what it intends to achieve, he says, adding that the United Kingdom’s NHS (which the Government cites) is a public health system where everyone contributes.

Health is a State subject and, during the pandemic, many States collaborated with private hospitals for Covid-19 treatments and capped prices. But any discussion on pricing should consider input costs as well, he says. The regulatory system should involve an accredited quality system that is “universally applied, adopted and audited,” he adds.

Hinduja Hospital Chief Executive Gautam Khanna understands the rationale behind a regulator. A nodal agency will help standardise matters, but it should not be selective, he says. It should look at quality, infrastructure and pricing. Such a system will also require electronic records across the board — another difficult task, he points out.

Sidharrth Shankar, equity partner at law firm J Sagar Associates, observes that an autonomous regulator to inspect and audit independent healthcare service providers is important to improve overall care for patients. Especially so, he adds, since healthcare expenses are largely borne by the patient directly, unlike the case in developed economies.

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