- Overcharging by hospitals: <\/strong>There\nis enough cases against the private players in health services for\novercharging. The Fortis\nhospital charged Jayant Singh nearly Rs 16 lakh for the treatment of his\nseven-year-old daughter, who died of dengue.[2]<\/sup><\/a><\/li>
- Reduction in inequality (Decrease in OOPE, gender, class,\nsocial stigma and caste gaps ) : <\/strong>To save\npeople from poverty by decreasing OOPE which has also some intrinsic value like\ndiscrimination and empowerment. Out-of-pocket (OOP) health expenses drove 55 million Indians \u2013 more than\nthe population of South Korea, Spain or Kenya \u2013 into poverty in 2017, and of\nthese, 38 million (69 percent) were impoverished by expenditure on medicines\nalone.[3]<\/sup><\/a><\/li><\/ul>\n\n\n\n
- Organ transplant scams: \n<\/strong>This has become a millionaire\nbusiness in the India.Several\nprivate hospitals in Tamil Nadu\u2019s Chennai may be unfairly favouring foreign\ntransplant recipients over Indian patients on waiting lists for organs.In 2017,\ninternational patients underwent 25% of all heart transplants in the state and\n33% of lung transplants in Chennai.[4]<\/sup><\/a><\/li>
- Referral commissions to Physicians: <\/strong>The physicians\/doctors are paid the commissions for the\nreferrals to the diagnostics or any specific medicine.<\/li>
- To get lands from government at concessional\/low rates in\nlieu of free or low cost services for BPL: \n<\/strong>The Delhi High Court has indicted a\nprivate hospital for not following the rules (High Court of Delhi ruling no\n2866\/2002). Because there are violations found at many places.<\/li>
- Late in providing cash maternity benefits: <\/strong>The maternity benefit scheme in Delhi called MAMTA scheme\ninstituted by Delhi government for institutional deliveries in private sector\nalso was a failure ostensibly for the reason that the private providers found\nit to be not very ‘remunerative’ (Nandan et al 2009). In Karnataka there is\nenough evidence to show that PPP based health care system use to provide late\nmaternity benefits. <\/li><\/ul>\n\n\n\n
- Untrained or unqualified doctors:<\/strong>\nUnqualified medics,\npopularly known as quacks, are routinely arrested in India for posing as\ndoctors. But a charity is now trying to train them in primary medical care.\n[5]<\/sup><\/a> But in\nother cases they are responsible for many deaths in India because of the work\nwhich they are not supposed to do.<\/li><\/ul>\n\n\n\n
6. Regulatory Architecture and gaps\nin healthcare in India <\/strong><\/p>\n\n\n\n
Health\nis a subject of state in India. Therefore, states use to play vital role in\nshaping the delivery of health services. Therefore, states can bring in\nspecific regulatory mechanisms to influence private\/public sector behavior. The\nunion governments and states governments use to bring in monitoring and\nregulatory mechanisms time to time. For instance, Clinical Establishments (CE)\nAct and its earlier variants the various state nursing home (NH) acts for\nlicensing and registrations of CE; Medical council Act for the licensing of\nmedical practitioners; Medical termination of Pregnancy Act (MTP) and so on.<\/p>\n\n\n\n
Clinical\nEstablishment (Registration and Regulation) Act(CEA) was passed in 2012. The\nunion government passed this act as prototype which each state has to customize\naccordingly. In this act there is provision of making national and state level\nhealth council. Various inspections of the facility for adherence of the\nstandard set by NHPS.Another provision was the penalties for\nnon-compliance. But only 16 states\nadopted it. Some other states have their own previous NHP act or acts with some\namendment subsequently. But Gujarat state does not have any regulation act.\nOnly Chhattisgarh state adopted CEA which includes patient\u2019s right and\ngrievance redressal mechanism. Whereas Bihar has adopted it without any change,\nas we know that every state\/region have its own cultural, social and political\nscenario and they should change it accordingly so that it can be make\nimplementable. It mean health is the subject of decentralization for effective\nand better outcome.<\/p>\n\n\n\n
Another\nact is Medical council of India Act which was passed in 1956 but revised in\n1964, 1993 and 2001. This act prohibits physicians from taking any gifts. By\nthe provisions of this act physicians should only provide prescribed generic\nmedicines. They should declare all fee before the procedures being started.\nThey should follow proper referral procedures. Endorsement of any drug from the\nindustry is not permitted. Any professional misconduct would be taken into the\nconcern of state medical councils for appropriate disciplinary action. <\/p>\n\n\n\n
In\nthe Medical Termination of Pregnancy Act provides legal termination of\npregnancy by a registered medical practitioner and there should not be any sex\nselection test. In the Transplantation of Human Organ Act, 1994 there is the\nprovision that organ transplantation can be done only by legal completing legal\nformalities among blood related persons.<\/p>\n\n\n\n
7. Recommendations: Proposed\nRegulatory Architecture for regulation of private sector<\/strong><\/p>\n\n\n\n
One\nof the most important command and control mechanism is through judicial process\nlike consumer courts. \u201cContracting-out of non-clinical services could be\nconsidered in a Universal health system, where non-clinical services such as\nlaundry, security, maintenance, kitchen and dietary services are given to\nprivate contractors under well-defined legal agreements that uphold<\/p>\n\n\n\n
quality,\nplace restriction charges with penalties if violated, and are accountable\nwithin a universal access framework. A small evaluation study in Bihar found\nthat hospital upkeep had improved post outsourcing\u201d (Gupta M,S. Prasanna\nundated). Right to health should be in the mind of policy makers while framing\nregulatory mechanism for healthcare services. Intersectoral approach would be\nmore beneficial for integrated public health model for good, efficient and\neffective outcome. Establishment of quasi-judicial-authoritative regulatory\nbody is necessary to be form for grievance redressal, it should have ample\nstaffs, finance and infrastructure. Public health systems should bring\n‘monopsony’ power to endure on the private players to drive for both high\nquality and low costs.<\/p>\n\n\n\n
Way Forward<\/strong><\/p>\n\n\n\n
In\nIndia there is the strong need of \u2018Right to Health Care Legislation\u2019. There\nshould also be an autonomous quasi-judicial authoritative regulatory body. This\nproposed body should be well financed and good number of staffs. Under the\nministry of health. There is also strong need to strengthen the public health\nsystem by financing, integrating some other institutions, universal , signal\nsystem. Markets usually function optimally where public system is strong. \u201cThe\nPFHI (Publicly Financed Health Insurance) schemes at present are not universal\nbut targeted, fragmented and sometimes multiple schemes catering to the same\npopulation run by different ministries resulting in efficiency losses\u201d\n(S.Prasanna, 2018). There is also need of strong and reasonable standard.\nBecause the the process by which regulation use to be introduced may be the\nsubject of potential root cause for corruption, red tape, harassment in the\ncountry like India where judicial processes are very slow.<\/p>\n\n\n\n
Hence\nit becomes very important that reasonable standards with the involvement of all\nstakeholders are set; information disseminated; facilitating compliance and\nminimizing the scope for corruption (Das Gupta M, et. al. 2009).<\/p>\n\n\n\n
So, the proposed regulatory mechanism would be in four sector at three levels of nation, state and district.<\/p>\n\n\n\n
<\/p>\n\n\n\n
![\"\"](\"https:\/\/thepubliceconomist.com\/wp-content\/uploads\/2019\/11\/image.png\")
<\/figure>\n\n\n\n
<\/p>\n\n\n\n
\n\n\n\n[1]<\/sup><\/a> <\/sup>https:\/\/www.indiatimes.com\/news\/india\/horrible-negligence-4-month-old-baby-given-painkillers-dies-within-an-hour-at-delhi-hospital-338039.html<\/sup><\/strong><\/a><\/sup><\/strong><\/p>\n\n\n\n
[2]<\/sup><\/a> <\/sup>https:\/\/economictimes.indiatimes.com\/industry\/healthcare\/biotech\/fortis-healthcare-refutes-charges-of-over-pricing-drugs\/articleshow\/62095787.cms<\/sup><\/a><\/sup><\/p>\n\n\n\n
https:\/\/www.news18.com\/news\/india\/httpwww-news18-comnewsindiagurugram-hospital-charges-rs-18-lakh-for-15-day-dengue-treatment-girl-dies-1582807-html-1582807.html<\/a><\/p>\n\n\n\n
[3]<\/sup><\/a> <\/sup>https:\/\/www.firstpost.com\/india\/indias-healthcare-woes-out-of-pocket-medical-expenses-pushed-55-million-into-poverty-in-2017-says-phfi-study-4773741.html<\/sup><\/a><\/sup><\/p>\n\n\n\n
[4]<\/sup><\/a> <\/sup>https:\/\/scroll.in\/latest\/882307\/chennai-private-hospitals-favour-foreigners-over-indian-patients-for-organ-transplants-says-report<\/sup><\/a><\/sup><\/p>\n\n\n\n
[5]<\/sup><\/a> <\/sup>https:\/\/www.bbc.com\/news\/world-asia-india-37571259<\/sup><\/a><\/p>\n\n\n\n
References:-<\/strong><\/p>\n\n\n\n
- Samb, B.,\nDesai, N., Nishtar, S., Mendis, S., Bekedam, H., Wright, A., … & Adshead,\nF. (2010). Prevention and management of chronic disease: a litmus test for\nhealth-systems strengthening in low-income and middle-income countries. The\nLancet, 376(9754), 1785-1797.<\/li><\/ul>\n\n\n\n
- Horng, J.\nS., Liu, C. H., Chou, H. Y., & Tsai, C. Y. (2012). Understanding the impact\nof culinary brand equity and destination familiarity on travel intentions.\nTourism management, 33(4), 815-824.<\/li><\/ul>\n\n\n\n
- (National Health Accounts,\nhttps:\/\/mohfw.gov.in\/sites\/default\/files\/National%20Health%20Accounts%20Estimates%20R<\/li>
- eport%202014-15.pdf ) <\/li><\/ul>\n\n\n\n
- Reddy, K.\nS., Selvaraj, S., Rao, K. D., Chokshi, M., Kumar, P., Arora, V., … &\nGanguly, I. (2011). A critical assessment of the existing health insurance\nmodels in India. Public Health Foundation of India, 4, 1-15.<\/li><\/ul>\n\n\n\n
- Sheikh,\nK., Saligram, P. S., & Hort, K. (2013). What explains regulatory failure?\nAnalysing the architecture of health care regulation in two Indian states.\nHealth policy and planning, 30(1), 39-55.<\/li><\/ul>\n\n\n\n
- V\u00e4lil\u00e4,\nT. (2005). How expensive are cost savings? On the economics of public-private\npartnerships. EIB papers, 10(1), 95-119.<\/li><\/ul>\n\n\n\n
- http:\/\/www.who.int\/global_health_histories\/seminars\/Raman_presentation.pdf<\/a><\/li><\/ul>\n\n\n\n
- Hay, D.\nA., & Morris, D. J. (1991). Industrial economics and organization: theory\nand evidence. Oxford University Press, USA. <\/li><\/ul>\n\n\n\n
- Nundy,\nSamiran, Keshav Desiraju, and Sanjay Nagral. Healers or Predators?: Healthcare\nCorruption in India. Oxford University Press, 2018.<\/li><\/ul>\n\n\n\n
- Laurell,\nA. C. (2007). Health system reform in Mexico: a critical review. International\nJournal of Health Services, 37(3), 515-535.<\/li><\/ul>\n\n\n\n
- Martens,\nJ. (2007). Multistakeholder partnerships-future models of multilateralism?\n(Vol. 29). Berlin: Friedrich-Ebert-Stiftung.<\/li><\/ul>\n\n\n\n
- Gilson, L.,\nDoherty, J., Loewenson, R., & Francis, V. (2007). Challenging inequity\nthrough health systems. Final report of the Knowledge Network on health\nsystems.<\/li><\/ul>\n\n\n\n
- McPake,\nB., & Mills, A. (2000). What can we learn from international comparisons of\nhealth systems and health system reform?. Bulletin of the World Health\nOrganization, 78, 811-820.<\/li><\/ul>\n\n\n\n
- Baru, R.\nV. (2013). Challenges for regulating the private health services in India for\nachieving universal health care. Indian journal of public health, 57(4), 208.<\/li><\/ul>\n\n\n\n
- Bhat, R.\n(1996). Regulation of the private health sector in India. The International\njournal of health planning and management, 11(3), 253-274.<\/li><\/ul>\n\n\n\n
- https:\/\/www.indiatimes.com\/news\/india\/horrible-negligence-4-month-old-baby-given-painkillers-dies-within-an-hour-at-delhi-hospital-338039.html<\/a><\/li><\/ul>\n\n\n\n
- https:\/\/economictimes.indiatimes.com\/industry\/healthcare\/biotech\/fortis-healthcare-refutes-charges-of-over-pricing-drugs\/articleshow\/62095787.cms<\/a><\/li>
- https:\/\/www.news18.com\/news\/india\/httpwww-news18-comnewsindiagurugram-hospital-charges-rs-18-lakh-for-15-day-dengue-treatment-girl-dies-1582807-html-1582807.html<\/a><\/li>
- https:\/\/www.firstpost.com\/india\/indias-healthcare-woes-out-of-pocket-medical-expenses-pushed-55-million-into-poverty-in-2017-says-phfi-study-4773741.html<\/a><\/li><\/ul>\n\n\n\n
- https:\/\/scroll.in\/latest\/882307\/chennai-private-hospitals-favour-foreigners-over-indian-patients-for-organ-transplants-says-report<\/a><\/li>
- https:\/\/www.bbc.com\/news\/world-asia-india-37571259<\/a><\/li><\/ul>\n\n\n\n
- Gupta, M.\nS. (2000). Corruption and the provision of health care and education services.\nInternational Monetary Fund.<\/li><\/ul>\n\n\n\n
- Varghese,\nJ., Blankenhorn, A., Saligram, P., Porter, J., & Sheikh, K. (2018). Setting\nthe agenda for nurse leadership in India: what is missing. International\njournal for equity in health, 17(1), 98.<\/li><\/ul>\n\n\n\n
- Gupta, M.\nD., Chung, W., & Shuzhuo, L. (2009). Evidence for an incipient decline in\nnumbers of missing girls in China and India. Population and Development Review,\n35(2), 401-416.<\/li><\/ul>\n\n\n\n
<\/p>\n","protected":false},"excerpt":{"rendered":"
Health is understood as a subject of \u2018Market Failure\u2019. But because it is the subject of social welfare there is need of an intermediary mechanism for active intervention. One such important mechanism would be regulation. <\/p>\n","protected":false},"author":39,"featured_media":64089,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_mo_disable_npp":"","footnotes":""},"categories":[6,3],"tags":[207,208,209],"class_list":["post-64082","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-healthcare","category-indian-economy","tag-ayushman-bharat","tag-private-healthcare-sector","tag-regulation-in-healthcare-sector"],"yoast_head":"\n
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- Varghese,\nJ., Blankenhorn, A., Saligram, P., Porter, J., & Sheikh, K. (2018). Setting\nthe agenda for nurse leadership in India: what is missing. International\njournal for equity in health, 17(1), 98.<\/li><\/ul>\n\n\n\n
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- Baru, R.\nV. (2013). Challenges for regulating the private health services in India for\nachieving universal health care. Indian journal of public health, 57(4), 208.<\/li><\/ul>\n\n\n\n
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- Reduction in inequality (Decrease in OOPE, gender, class,\nsocial stigma and caste gaps ) : <\/strong>To save\npeople from poverty by decreasing OOPE which has also some intrinsic value like\ndiscrimination and empowerment. Out-of-pocket (OOP) health expenses drove 55 million Indians \u2013 more than\nthe population of South Korea, Spain or Kenya \u2013 into poverty in 2017, and of\nthese, 38 million (69 percent) were impoverished by expenditure on medicines\nalone.[3]<\/sup><\/a><\/li><\/ul>\n\n\n\n