When Mahesh* collapsed at a neighbourhood grocery shop, his friends rushed him to a well-known hospital in Mumbai.

A preliminary examination indicated he needed to be admitted for medical supervision and tests. But, to get Mahesh admitted --- lying on a stretcher at the emergency ward --- his friends had to either make an upfront payment of ₹60,000 or get the doctor treating him to recommend his admission.

A similar incident, involving the death of a 38-year-old woman, is posted on Medileaks.in --- an online platform where one can share information on unethical medical practices. She couldn’t be admitted to a charitable hospital in Mumbai for want of a ₹30,000- deposit.

While such incidents are not aberrations across the country, one of the saddest involves a family in Kolkata that had to pay money for a relative’s body to undergo post-mortem in the right manner.

Hospitals and clinics account for over 50 per cent of the Indian healthcare market ($78 billion–₹4,68,000 crore). So isn’t it time they are brought under a regulatory authority in the interest of patients?

Neutral body

It is “desperately required,” says Dr Devi Shetty, cardiac surgeon and Founder, Narayana Health hospitals. He adds that there are three groups involved — the patient, hospitals and the Government. A neutral body is required to sort out problems faced by any of them. When there is a difference of opinion on treatment tariffs, the Government cannot be an arbiter as well as an interested party, he points out.

Discussions for a regulatory authority involve two aspects, says Dr Alexander Thomas, Executive Director of the Association of Healthcare Providers of India (AHPI). Karnataka is considering a State regulatory authority, while AHPI member-hospitals have been encouraged to have a neutral person in each hospital to sort out patients’ problems.

There are unethical practices, commissions, etc, and it is in the interest of patients and hospitals to put a stop to it, he observes.

In an attempt to bring in minimum healthcare standards and services and to ensure emergency care to all, the Centre had enacted the Clinical Establishments (Registration and Regulation) Act, 2010 (CEA). However, though the Act covers facilities down to single doctor clinics, it has not seen universal adoption, since health is a State subject.

Mismatched expectations

Besides, the Act comes with its own issues of mismatched expectations. Blood banks, for example, are required to have blood bank officers, says Dr Shetty. But, this requirement has had an adverse impact on healthcare services in regions like the North East, he says, since there are not many blood bank officers in the country.

So charitable institutions in the NE have had to shut down blood banks and they are nervous to handle pregnancies in apprehension of a crisis in case there is need for blood, he explains. Also, huge manpower shortages exist when it comes to para-medical staff, anaesthetists, etc. The idea is not to run unsafe facilities but to have a realistic mapping of requirements and guidelines on safe practices and standard operating procedures so that patients get safe treatment, he says.

Outcome audits

Amit Mookim, Head of South Asia Consulting at IMS Health, a global number-crunching organisation, observes that the CEA has helped create benchmarks, but its success lies in its adoption.

Creating a regulator for healthcare providers would ensure enforcement, he says, adding the lack of enforcement has resulted in “unchecked frauds, unethical practices and unjustified prices of healthcare services putting our people at health and financial risks.” In Maharashtra too, steps are underway to adopt the CEA, with public consultations scheduled to discuss treatment rates, says Anant Phadke with Jan Aarogy Abhiyaan.

There is no grievance redressal mechanism, he agrees, adding that they were suggesting a regulatory authority in every district.

But Jan Swasthya Abhiyan’s Amit Sengupta points out that a regulator will not solve the problem, unless a robust Government-run hospital system is in place.

Suggesting a simple solution, Sunil Nandraj, co-founder of Medileaks, says, the outcome of labs and hospitals need to be audited. This would bring in accountability and transparency into the system, in the end, benefiting patients, he points out.

(*Names of patients have been changed to protect their identity)

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