Will the new proposals of the Parliamentary Standing Committee on Home Affairs help improve accountability in the private health sector while enhancing efficiencies, or will it end up giving the State overarching powers to arm-twist an emerging sector? Let’s find out.
During Covid-19, especially in the initial months of the pandemic outbreak, the absence of the private healthcare sector in the efforts to contain the coronavirus grabbed much press. Not many hospital chains were ready to offer their services for the public at large. Few were willing to cooperate with the governments in the fight against the deadly virus. Soon, when government facilities went chock a block with Covid patients, private players had to pitch in with support but allegations of overcharging and abuse of facilities were rife, suggest reports from across the country.
Evidently, this was a pointer on my counts. With the media abuzz with reports of rampant abuse of healthcare privileges by the private sector, policymakers and the public at large were raising concerns around the way private health players function in the country. It is in the context that the recent proposal by a Parliamentary panel to frame a comprehensive law to regulate private healthcare in India gains importance. The panel wants to introduce a legal provision under the National Public Health Act to have a check on private hospitals that charge exorbitant rates on beds during the pandemic period and engage in black marketing of medicines and products standardisation.
The new provision of the Act was mooted by the Standing Committee on Home Affairs, headed by Congress leader Anand Sharma. The proposal came as a part of a report on the management of Covid-19 pandemic and related issues, submitted to Rajya Sabha Chairman and Vice President Venkaiah Naidu on December 21. The panel notes several cases were reported recently where beds reserved for Covid-19 patients in private hospitals are sold at exorbitantly high prices.
Need of the hour?
According to the Shama panel, India’s spending on healthcare is comparably low and hence the government must increase its investments in public healthcare. According to the National Health Policy 2017, the government planned to increase healthcare spends up to 2.5% of GDP by 2025 from 1.15% in 2017. The Panel wants the government to walk the talk on this within two years, not exactly by the target year of 2025, which the panel feels is too far and the public health can’t afford the risks it faces now. The pandemic has exposed the chinks in the armour of public healthcare.
The absence of good facilities in government hospitals forces the public to choose private hospitals for treatment. But these hospitals overcharge the hapless patients, observes the panel. Some hospitals quote an amount before admitting patients and charge heft sums during discharge citing complex and bizarre reasons, such as the charges incurred on PPE (Personal protective equipment) kits, disinfection and other facilities. This must stop, feels the panel. It urges the government to introduce a sustainable price model to help Covid-19 patients. The panel also says the government must incentivise the private health care sector to move towards universal health coverage.
Black-marketing in healthcare
Overbilling has become rampant in private hospitals during the pandemic. Some hospitals charge Rs. 10,000-15,000 a day for just PPE facilities. Even though the PPE costs must be shared among the patients in a ward many hospitals force patients to bear the costs individually. Erratic charges such as admission charges, medical history assessment charges, RMO (Resident Medical Officer) charges, equipment use charges, biomedical waste disposal charges, universal precaution charges and even parking charges find a place in the final estimates to the patients.
At the initial phase of the pandemic, it was observed that the insurance coverage was not extended to people who suffered from Covid-19, thanks to which private hospitals were charging comparably higher fees. The Parliamentary panel report says there is a need to have regulatory oversight over all hospitals working in the country to prevent refusal to accept insurance claims. The committee also wants to make Covid-19 treatment cashless for all with insurance coverage.
Several government schemes exist with the aim of helping the vulnerable during the pandemic. Beneficiaries of Ayushman Bharat scheme can now avail Covid-19 treatment at a cost of Rs 4,000 in private hospitals. For the frontline health workers, engaged in the fight against Covid-19 facing the highest risk of the pandemic, the government in March had initiated an insurance coverage of Rs 50 lakh per person. This includes doctors, nurses, ASHA workers, paramedics and sanitation staff.
The National Health Policy and beyond
The Centre adopted the National Health Policy in March 2017 (which got a facelift in 2020) to strengthen the health sector. The target was to achieve ‘Health for All’ by 2025. To meet the target, the government had planned to open medical colleges in every 3-4 parliamentary constituencies. The NHP aims to inform, clarify, strengthen and prioritise the role of the Government in shaping health systems: the investment in health, organization and financing of healthcare services, prevention of diseases and promotion of good health through cross-sectoral action, access to technologies, developing human resources, etc.
In this context, the Parliamentary panel wants the government to take some measures so there won’t be a problem in handling such crises in the future. On vaccine trials and use, the committee says no emergency use authorisation has been given by the central drugs standard control organisation. “If given, it should be given under proper precautions and consideration by the government in rare cases”. It has also proposed detailed standard operating procedures (SOP) for the international passengers to India. The SOP includes proper screening, testing and quarantine in the cases of a pandemic break in the coming future. The panel says a uniform health care system should be created across the country to handle pandemics.
Meanwhile, the committee says it’s necessary to use campaigns to prevent people from panicking. This will also help them abstain from spending huge amounts of money on expensive drugs through campaigns. The panel has also asked the government to prepare Aadhaar-linked national databases. This, it says, can help the government reach people in times of future crises and provide rations and facilities. The panel has “strongly recommended” amendments to some laws. These include the Inter-State Migrant Workmen (Regulation of Employment and Conditions of Services) Act, 1979, Disaster Management Act, 2005 and Epidemic Diseases Act, 1897.