#dnaEdit: While patients suffer

The Delhi government’s plans to implement the Clinical Establishments (Registration and Regulation) Act, 2010, to regulate private hospitals and clinical laboratories, and lay down maximum costs and minimum standards for medical procedures, is a welcome decision. Only six other states and four Union territories have implemented the Act and framed rules to permit public health authorities to inspect clinical establishments. Besides imposing penalties or cancelling licences of institutions exploiting patient vulnerability, the Act mandates a clinical establishment to maintain records of patients, operation theatres, labour rooms, medical termination of pregnancies, laboratory registers, discharge summaries, complaint registers, occupancy, and rates of services offered. Implementing the Act makes eminent sense in Delhi — and across India — despite the protests by doctors’ associations like the Indian Medical Association, which are functioning as pressure groups, simply to stall the implementation of this important piece of legislation. Regulation of the private sector is a tricky terrain for most governments, especially in view of the criticism that regulation hampers individual enterprise and discourages private investment. 

However, the medical sector, with its huge implications for public health and household budgets, cannot be allowed to run amok. The private sector provides nearly 80 per cent of out-patient and 60 per cent of in-patient care.

Incidents of medical malpractices from overpricing medical equipment and devices like stents, indiscriminate prescription of laboratory tests and medicines, and skyrocketing charges of hospitalisation, are today the norm rather than the exception. The prospect of ill-health presents daunting financial challenges for the average citizen — more because of the fear of the massive treatment expenses rather than the illness itself. Rampant corruption, red tape and unhygienic surroundings make government hospitals an option only for those who cannot afford private health care. Private medical insurance is yet to reach the poor and the insurance premiums are unaffordable, even for large sections of middle classes.  

Against this bleak backdrop, the newly elected Delhi government’s focus on health care — no doubt — is an important intervention. Recall that the Kejriwal dispensation recently intervened to fix a ceiling of Rs4,000 on H1N1 tests, for which private labs were charging nearly Rs10,000 per sample. Delhi health minister, Satyendra Jain, who is fast earning a reputation for identifying public interest issues, has promised to ensure that private hospitals provide mandatory free treatment to economically weaker sections. Nearly, half of the 623 EWS beds in these hospitals were kept vacant helping the hospitals save nearly Rs75 crore. 

It is another matter that stringent legislations are already in place. Yet, the malpractices they are meant to tackle continue to flourish. The Clinical Establishment Act provides for a District Registering Authority (DRA), including the district collector, district health officer, and three members, invested with the powers to visit private clinics/hospitals and inspect the facilities they offer. However, one major shortcoming in rules framing the Act is that the powers to enter clinics mandate the authority to first intimate the clinic of the date of the official visit; whereas impromptu visits are known to be more effective in revealing organisational lacunae. The political will to empower and monitor the functioning of the DRA is another important element if such initiatives are to succeed. The Aam Aadmi Party government will be fulfilling an important component of its election promise if it can force the powerful health establishment to follow the rule-book. Rajasthan, at present, is grappling with a powerful agitation by doctors against the implementation of this Act. The stonewalling of the Act is happening even as the Centre promises legislation making health a fundamental right, denial of which will be justiciable. The bottom line is that unless public health infrastructure and its delivery mechanisms improve, both citizens and state will be held hostage to the whims of private players. Laws can hold up against the might of private enterprise only when an enlightened citizenry demand their due. The AAP government’s intent is promising. Sustaining this resolve will be more difficult.