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| Last Updated:01/02/2019

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States sense public anger, crack whip in pvt healthcare

It started off with the Valentine's Day announcement capping stent prices. Prime Minister Narendra Modi talked about it in his campaign speeches in Uttar Pradesh the next day. Advertisements with his pictures reiterating his resolve to cap stent prices appeared in national dailies and billboards across the country. Healthcare was finally being acknowledged as a possible vote-getter at the highest level.




The year 2017 may well go down as the year regulation of private healthcare became the Big Issue in response to growing public anger with rising costs and unnecessary treatment for profit. West Bengal (Trinamool), Kerala (Left), Karnataka (Congress) and Maharashtra (BJP-Sena) have all moved to regulate private healthcare.


Barely a fortnight after stent price capping, on February 22, West Bengal chief minister Mamata Banerjee held a televised meeting with heads of private hospitalsin Kolkata where she lashed out at them for overcharging patients and shoddy service, the two most common complaints.

The fact that Banerjee chose to hold the health portfolio herself shows she realised its significance early on.


On March 3, the West Bengal Clinical Establishments (Registration, Regulation and transparency) Bill, 2017 was passed unanimously in the assembly, a recognition of the public mood. Banerjee thundered: "Some hospitals are overcharging patients, making exaggerated bills. The greed is crossing all limits. When the limits of patience are broken, steps have to be taken."


The Indian Medical Association (IMA) and local doctors associations bitterly criticised the new law. They petitioned the governor and high court to repeal the act. Neither was in a mood to oblige. The governor gave his assent and the bill became law on March 17. The high court dismissed the petition on August 21.


This is a recurring pattern across states -- repeated and determined efforts by governments to enact a law to regulate the private sector in the face of stiff opposition from doctors' associations. While doctors' strikes and demonstrations forced governments to back off on previous occasions, there is now little or no public sympathy for doctors and private hospitals. Sensing this, governments too are unwilling to be cowed down by the pressure tactics of corporate hospitals and doctors' associations.


"Anger against the medical profession and the private healthcare system has been building up since a decade. It is evident in the rising incidents of violence against doctors and hospitals. But in Karnataka, the medical fraternity has been putting relentless pressure on the government to restrict regulation. Hats off to the government for taking a tough stance," said Dr N Devadasan of the Institute of Public Health in Bangalore.


The Karnataka Private Medical Establishments (Amendment) Bill 2017 to regulate the private sector was tabled in the assembly in June. The IMA and local hospital associations went to court against the bill. They launched an indefinite strike, but had to call it off after the high court asked them to hold talks with the government. "The doctors expected a lot of anger against politicians, especially the government. But common people are congratulating the government," added Dr Devadasan.


In Mumbai, a hospital hoarding saying "No Commission only honest opinion" kicked off a row about doctors taking commissions from hospitals and diagnostic labs for referring patients. Responding to the outrage, in September, the state government released the draft Prevention of Cut Practice in Health Care Services Bill, 2017, the first in India to formally recognise the menace of cut practice. The bill proposes up to five years of imprisonment for demanding or accepting commissions. The 40,000-member strong IMA in Maharashtra protested vehemently but the government is moving ahead.


In Kerala, with the highest per capita expenditure on health in the country, the drafting of the Kerala Clinical Establishments (Registration & Regulation) Bill 2017 started last year. Several cases of negligence or callousness in private hospitals leading to deaths this year fuelled public anger. Hospitals refusing to reduce their treatment expenses despite stent prices falling added to it. 


The state government in August introduced a bill to regulate all hospitals and diagnostic centres. The bill was sent to the subject committee on health and not the select committee. "The subject committee means public hearings and a quicker process. Choosing this is a recognition of public support for the bill," said Dr B Iqbal, neurosurgeon and former vice chancellor of the University of Kerala.


"Clearly, the costs and the malpractices in private healthcare have become impossible to defend. This is just a one-shot attempt to contain costs, a knee jerk political response to the vocal dissatisfaction of the middle class and the elite with high costs. However, it is mostly about tertiary care, to which the poor have little access anyway. 


In reality, instead of improving and expanding the public sector, this is shifting the debate to how to improve access to private facilities. Allocation for public health facilities remains the same, showing just how serious governments actually are about addressing people's lack of access to affordable healthcare," said Dr Amit Sengupta of the Jan Swasthya Abhiyan, a network of organisations working on healthcare issues.