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| Edited By: K Sujatha Rao |Source: DNA |Updated: Nov 28, 2017, 07:15 AM IST
In the din of the controversy surrounding the movie “Padmavati”, the media underplayed a major milestone in the health-care delivery system in India: the unanimous passage of the Karnataka Private Medical Establishment Act (KPMEA) by the Karnataka Legislative Assembly a few days ago. Why is this significant and what does it say?
Health systems are defined to consist of six pillars: governance, financing, payment systems, information, human resources, and regulation. Each of these pillars interacts on one another and impact upon the extent to which the health system is equitable, accessible, affordable, and fair.
Though India has one of the most privatised health systems in the world, with a public investment at an abysmal 1 per cent of GDP, the regulatory framework is weak. Laws cover only some aspects of the health system, are generally toothless and hardly enforced. Such a laissez-faire environment, in a sector, that unlike any other is fraught with market asymmetries, is seen as a major subsidy that the state seems to provide the private sector to thrive and prosper. And it does at 17 per cent CAGR per year.
Against this backdrop, the KPMEA, 2017, assumes a measure of importance. Though this Act brought in only some amendments to an existing act that was hardly being enforced, yet, the reaction of the doctors was hostile, with over 60,000 doctors going on a one-day strike. Threats of shutting down hospitals by local associations and a nationwide strike by the IMA were issued. One leading private hospital even circulated a letter stating how the bill was at the instance of leftist-oriented civil society organisations. Misinformation was galore.
The doctors’ associations wanted the government to roll back. There were four issues that troubled them but music for the patients: 1. The constitution of a District Registration and Grievance Redressal Authority; 2. Capping of prices; 3. Mandating the display of rates being charged by hospitals alongside a Patients Charter that empowers them with the right to be informed, access their medical records, dignity and privacy; and 4. Penalties for non-compliance with the Act or the patient’s charter.
The doctors’ apprehensions were not however unfounded. Afraid of being harassed by a corrupt, petty bureaucracy or blackmailed by patients’ families, there was some merit in their demands for a reconsideration. In a round of negotiations, the composition of the redressal committees was revised: replacing the Superintendent of police and public prosecutor etc with a 6-member board consisting of two generalists and four doctors; laying down and enforcing rates only for patients covered under government-sponsored insurance programmes; and penalising deviant behaviour through fines and cancellation of registration to practice rather than imprisonment.
The final bill approved by the legislative assembly was thus based on a consultative process. As the bill only empowers the government to fix rates for services provided under the government-sponsored insurance schemes, some have seen it as a dilution. In reality, it is not. With the government seeking to merge all its insurance programmes and if the GOI-funded CGHS and ESIS along with the public sector insurance companies also follow state government rates, that they ought to, it would have an immense impact on enhancing government’s market power resulting in reducing prices and also stabilising them. With government prices being fixed by expert committees based on protocols, nature and quality of services being provided by hospitals in different settings and on actuarial principles arrived at in a transparent manner, hospitals will find it difficult to justify excessive billing in complaints taken to the Grievance Redressal Authorities that have the powers of a civil court. In other words, this bill has intelligently combined price rating alongside the attendant institutional reform for fixing prices, as well as, ensuring compliance by having an oversight mechanism.
Finally, removal of the penal provisions leading to imprisonment and instead increasing the quantum of fines was wise. Doctors are active partners in health care. The majority like to play fair. Penalties are for the deviant: to control greed and bring back reason.
Exempting government doctors and hospitals from the provisions of the act, is a grouse felt by private doctors resulting in a feeling of victimhood. Undoubtedly provider regulations must cover government providers too. But then the functioning of the government hospitals need to be brought on a par with the private in terms of autonomy, flexibility, and standards in the first instance. Government hospitals and doctors work with their hands tied and their backs to the wall and under the scrutiny of over 7 agencies: CVC, CAG, CBI, Parliament, the Ministry, media, judiciary. Working conditions of public and private are not comparable.
A final word. The Minister of Health of Karnataka has provided exemplary leadership in this case. A similar alacrity needs to be shown in the implementation of the Act, with the Rules drafted in a time-bound manner. People are waiting and have hope. This time, breaking their trust will not be forgiven.
The author is a former Secretary, Ministry of Health and Family Welfare. Views expressed are personal.
