The new Karnataka Private Medical Establishments (Amendment) Bill has a bit of everything -- some things are good, some are bad and some completely missing.
First, let’s talk about the good things. The first major change is that price controls were dropped to bring price transparency in medical procedures at hospitals.
With a strict price control on stents, Indian patients have been losing out on the latest generation of stents with international companies like Abbot Pharmaceuticals pulling out of the business.
The big risk of good private hospitals withdrawing treatment has been averted.
In another step, hospitals and government will fix rates for medical procedures that are covered under government health schemes. The rates will only go up when the Karnataka government brings in a Universal Health Care system. It’s vital to note that a UHC will work in Karnataka only with the cooperation of private hospitals, clinics and diagnostic centres.
Now, let’s look at the negative aspects. The new amendment strengthens a ‘License Raj’ on private medical establishments in Karnataka. Before this, all medical establishments had to get registered via necessary authorities that included the district commissioner, district health & family officer, AYUSH representatives and others. Now, the registration authority is becoming a registration and grievance redressal authority to handle all non-clinical grievances of patients, including overcharging and denial of basic patient rights. While the government move to remove the imprisonment clause in case of price-related violations is welcome – it is not enough.
The all-powerful registration and grievance redressal authority now has the opportunity to extract bribes from hospitals not just during registration and renewal, but even after that, repeatedly. On paper, they may be helping patients obtain their rights, but giving government officials such control over private businesses can only lead to more corruption and compromise, eventually leading to worse and more expensive private healthcare in the state.
The KPME Amendment Bill misses a great opportunity to create multiple independent regulatory authorities for private healthcare. These independent authorities could register, license and audit private medical institutions apart from hearing patient grievances. Good governance, at a global scale means reforming various sectors to have independent regulators, rather than having government departments and officials function as regulators themselves. This 21st century law seems to be wanting to take the medical profession to pre-industrial licensing days.
Talking about missing aspects, everyone in the state appears to be focusing on redressing grievances and punishing hospitals for their excesses. Nobody wants to ask how grievances can be prevented in the first place. The KPME Amendment Bill mandates hospitals to disclose the prices of standard treatment and procedures on their own websites, a government website, physical booklets, etc.
Information is the fundamental problem that plagues healthcare across the world. Because doctors and hospitals have a lot more information than patients, they can certainly be taken for a ride by being given wrong treatment and being charged excessively.
The solution to this is to empower patients with actionable information.
Imagine a patient protection service, where independent officers are available in hospitals and a helpline and a web portal that complements them. This could make sure that the patients know their rights. Starting with getting a second opinion to serious interventions and exploring expenditures across different hospitals, it would get the patients all that they need. The service could also gather patient feedback and peer feedback from doctors and create a public ratings system of doctors and hospitals.
The public debate today is being shaped only by certain individual cases of alleged overcharging and medical negligence. While all cases of grievances must be examined thoroughly by the legal system, patients being successfully treated, do not make news. A comprehensive rating system could give us a better picture of which healthcare providers consistently have problems. With this the patients can make better and informed choices.
Karnataka’s private healthcare regulations will set the tone for India and may even set the stage for how other developing countries manage their own countries. There is an opportunity here for going beyond a compromise solution to a modern regulatory system that protects both the rights of patients and the economic freedoms of private hospitals. It must not be missed.
Author is a fellow and faculty at the Takshashila Institution, an independent school of public policy. He tweets at @zeusisdead