India’s Health Sector Needs More Government, Not Less

The conventional wisdom is that the less government we have, the better. In fact, that was precisely what Mr. Modi had promised us in 2014 with his rousing “Maximum governance, minimum government.” Of course, he confused governance with intrusion into our private lives, but that is the subject of another column some other day. My assertion here is that there is one sector in India to which this policy should not apply – the Health sector. If proof were needed to validate it, it has been provided by two shocking incidents in just the last month, both in Delhi. The first was the case of the little girl who was treated for dengue in Fortis Hospital, Gurgaon; she could not be saved but her parents were nonetheless presented with a bill for Rs. 16 lakhs: this was after the parents had turned down a preposterous suggestion to do a whole body plasma transfusion at a further cost of Rs. 45 – 50 lakhs (on a patient who was already 80% brain dead!). An “inquiry” has been ordered (the classic cover up) but the affair is a good as closed: we shall hear no more about it. The second case occurred on the 30th of November: twins born to a mother in the Max Hospital in Shalimar Bagh were declared dead immediately, packed up nicely like an Amazon prime parcel and handed over to the parents. On the way to the cremation ground, one of them was found to be moving – he was alive! (This baby also died subsequently a week later). The AAP government has now cancelled the hospital’s licence after an inquiry (the order will probably be stayed and the matter will drag on in the courts for years). The callous insensitivity of the medical fraternity was revealed on prime time TV when the President of the Indian Medical Council put the onus on the patient/relatives – he advised us that we should not assume death if the patient has a low body temperature or hypothermia! Why should WE assume anything, Doctor Aggarwal ? Isn’t it for the people like you and the hospital to do all the assuming, specially when you charge us hundreds of thousands for it ?

These are just cases that found their way to the news: similar stories are playing out in their hundreds everyday, in hospitals and nursing homes all over India. A sting last week by CNN-TV18 exposed how doctors and path labs collude to fleece patients and share the spoils.. Profiting has now degenerated into profiteering. The list of malpractices indulged in by the medical profession is menacingly imposing, and has been revealed by whistleblowers and NGOs such as SATHI (Support for Advocacy and Training in Health Initiatives): commissions, failure to prescribe generic drugs, “sink tests” by path labs where all the samples are thrown into the sink without testing and false reports generated, corporate hospitals’ unwritten rule that 40% of OPD cases should be converted into admissions, unnecessary and expensive tests. Even diagnoses are deliberately distorted in order to milk a patient for all he is worth: a report by Medi-Angels, a Mumbai medical centre that offers second opinions has reported that 44% of 12500 patients advised surgery for stents, joint replacements, cancer etc. were advised against it by the second consultants. (Most of us have our own personal horror stories about this.)

There are reportedly 4.50 million cases of medical negligence in India every year. But the citizen has little recourse to justice, except to go the Consumer Courts which is both expensive and time consuming. Government policy, till now, had visualised that the medical profession would regulate itself and had established the Medical Council of India for the purpose by statute. This body, however, like most internal regulatory bodies, has been a spectacular failure; it has become the protector of the practitioners that it was supposed to regulate and monitor. I have googled incessantly to find out how many doctors it has disbarred or deregistered for negligence or malpractices – I have been unable to get any information, because in all probability it hardly ever does so. All it does is lay down ethical guidelines, conveniently forgetting that it has legal obligations to the patients too. In contrast, in the USA about 450-500 doctors lose their licence EVERY YEAR, and in the UK the figure is between 150 and 200 (incidentally, most of them are of Indian and Pakistan origin !- not an export we should be proud of).

The medical profession has consistently resisted any attempt by the government to discipline them or to cap their exorbitant charges/fees. But (after the Kunal Shah case in 2013 where Rs. 13.00 crore was awarded as compensation to a patient) they have been demanding a cap on the compensation award! So far they have managed to get away every time by arm twisting the government, their strength lying in the fact that the private sector provides 80% of health care in the country. Successive governments, both at the centre and the states, are responsible for this dismal state of affairs: the state spends barely 2% of GDP on health, whereas the WHO recommendation is a minimum 5%: he who pays the piper calls the tune, and that is why doctors and corporate hospitals are humming all the way to the bank. But this has to change. Governments have to drastically increase outlays of the health sector: the 2.50- 3.00 % promised by the Union Health Minister by 2022 is just not good enough. Self regulation has failed, the cupidity of doctors shows no sign of abating, and corporate hospitals are medical vampires who suck your blood and make you pay for it! This is one sector that requires maximum government. It is high time that the National Clinical Establishments (Registration and Regulation) Act 2010 and the Clinical Establishment (Central Govt.) Rules 2012 are implemented and enforced by the Center and all states . Currently only a handful of states and UTs have done so, and that too for mere registration purposes only. If implemented sincerely the Act empowers governments to deregister clinical establishments, entertain complaints, award compensation, initiate criminal cases where needed, cancel licences of doctors, hospitals and other health related commercial facilities, fix the rates of various medical procedures (as it already does for CGHS and EGHS members), lay down minimum standards of treatments. The MCI’s mandate should be limited to advising on medical education issues, and issuing ethical guidelines (the only thing it is good at). The health consumer has been betrayed by the medical profession and the goverment must now step up to the plate and do the right thing. It must protect the ordinary citizen and not be seen to be siding with, or succumbing to the blackmail of, these corporate profiteers. As the poet lamented:

Inquilab-e-aasman se kyon na ho uljhan mujhe,
Main pukaru dost ko, awaaz de dushman mujhe

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