How do we define an emergency? Why does the government not do its job? Why should private hospitals treat emergencies? Who will pay? Who will take responsibility to transfer patients? What if people demand emergency treatment
Why would they not support the global move towards standardising care? And the right to affordable healthcare? India has one of the world’s maximally privatised healthcare system. But there is something even more unique about this model. Doctors invest in hospitals (StockPic)
Medical associations are largely led by hospital owners. The conflict of interest is stark. The entanglement severe. Hence, attempts to push doctors to accept patients not on their terms or control face resistance
n 2014, the Maharashtra Government set up a committee with a mandate to formulate a state version of a Central Act called the ‘Clinical Establishment Act’. This act governs all healthcare institutions in India and sets standards. The then health minister and secretary were keen on a more comprehensive act than the central one. Among the tasks given to the committee was an interesting one. “To rationalise fee structure across healthcare institutions”. The committee had diverse representation. State government officials, professional medical organisations and representatives of NGOs working in public health and patient’s rights. I was a nominated member. One of my rare trysts with the corridors of
Mantralaya. It was an educative experience. On how government committees function and how policies are formed, the interests at work. But the biggest insight had nothing to do with government or bureaucracy The Clinical Establishment Act highlights emergency care and the issue came up in the very first meeting. As a surgeon, I pointed to the chaotic state of emergency care especially for accident victims and suggested that it was an opportunity for the state to setup an organised trauma care system. I presented a plan for hospitals with a certain capacity to be identified as emergency care centres and in turn link it to large hospitals and the ambulance system through a centralised control room with access to information on beds. I also proposed that all hospital staff should be compulsorily trained in Basic and Advanced Life support as is the case in most countries. The government was interested. But some of the committee members were not.
How do we define an emergency? Why does the government not do its job? Why should private hospitals treat emergencies? Who will pay? Who will take responsibility to transfer patients? What if people demand emergency treatment? Does the government have a right to force private hospitals to treat? Don’t doctors have a right to decide whom they want to treat and whom they don’t? The doctors representing the medical organisations in the committee kept raising these questions. Most of them were hospital owners.
Then came the issue of rationalisation of fees. Some of us suggested that we propose grading of fees and a range depending on the facility and geographical location. This created pandemonium. How can governments decide fees? Is it Constitutional? We were accused of creating conditions for closure of nursing homes. And serving the interests of large corporate hospitals. The IMA launched a campaign through WhatsApp calling for opposition to the committee. Several batchmates called me to say “Why are you doing this?” “Why are you against the medical profession?”
Finally, a watered-down version was presented to the health minister. Some of us presented a dissenting note. The government changed. The Act was shelved. Everybody lived happily thereafter. Almost. Till Covid. When Rajesh Tope, the health minister, lamented, “If we had a comprehensive Clinical Establishment Act we need not have invoked special Acts like the Epidemic Act.”
Why do doctors oppose such Acts? Why would they not support the global move towards standardising care? And the right to affordable healthcare? India has one of the world’s maximally privatised healthcare system. But there is something even more unique about this model. Doctors invest in hospitals. They own them. Their income is directly dependent on the hospital’s earnings. They are used to patients paying immediately out of pocket. The idea that healthcare costs are moving towards third party payment has still not sunk in.