Creating healthy hospital

INDIA ASPIRED, ON the eve of Independence, for a rights-based health system accessible to all regardless of economic status. However, what it has created over the decades is a framework dominated by high-cost private medical care. Contrary to the vision articulated by the Bhore Committee of 1946 to put in place a universal healthcare delivery apparatus, the present system forces citizens to spend significant funds out of pocket for healthcare, regardless of economic status.

International studies have shown nearly 80 per cent of patients in India resorting to private caregivers for major and minor ailments - despite the existence of a public health system of a sort. Such patronage and steadily increasing demand have resulted in a significant expansion of private hospital bed capacity, although this is concentrated largely in urban India and remains unaffordable to the overwhelming majority of the people. The strong growth of private healthcare has understandably led to the demand for a system of oversight in the interests of equity, credibility, and professional accountability.

The proposal of the Union Health Minister, Dr. Anbumani Ramadoss, to make it mandatory for private hospitals and diagnostic laboratories to register with the Central Government acknowledges this social imperative. It also serves the valuable purpose of encouraging a debate within the medical fraternity on forming a transparent and professional regulatory structure.

Regulation of private healthcare providers has been a contentious issue in India. Early attempts were made in Delhi, Maharashtra, and Karnataka to register private hospitals and nursing homes using local laws, and some States have tried to adopt the model. Such progressive intent has not been matched by political will. Research studies show that ordinary citizens have been unable to enjoy guaranteed levels of care or have recourse to actionable legal rights.

Very few private hospitals comply with the legal mandate to provide free medical services to a section of their patients. Scepticism over governmental regulatory efforts has strengthened after the Delhi administration discovered not long ago that some 1,600 hospitals and nursing homes in the national capital were not registered. This is not a phenomenon unique to Delhi. A way out of the confusion lies in inducting the more ethical and professional sections of the medical community in the regulatory effort. A scheme of self-regulation through peer accreditation of private health facilities will be a good starting point for the present registration initiative.

There are several controversial areas in private care delivery - such as a lack of protocols and the audit of medical procedures and the prescription of expensive and often unnecessary tests at for-profit diagnostic centres - but the importance of the sector in the Indian social context should not be underestimated. Regulatory structures that replace corrupt bureaucratic inspections with transparent professional standards will go a long way in winning the confidence of the medical fraternity. Patients are also bound to feel reassured if the exercise results in enforceable norms for hospital infrastructure, cost of care, financing, access to medical records, and dispute resolution.

There is considerable support for such measures among hospital administrators even now and a process of dialogue with the apex medical associations and consumer organisations can get the effort moving. In the absence of healthcare rights that are comprehensive and clear, patients and others have been resorting to consumer protection laws and even the penal code, often invoking unwarranted police action to handle hospital deaths that are alleged to be caused by negligence, rather than civil remedies.

Considerable work needs to be done to integrate the diverse benchmarks currently available for hospital standards, including the norms laid down by accreditation bodies in various countries. The prospect of a credible private hospital rating system emerging from the exercise should be grasped with both hands by all those who want to do something about health deprivation on a mass scale in India.

Courtesy- The Hindu