Affordable health care is now becoming increasingly inaccessible to the poor and lower middle classes in India, given the drive to privatization in all parts of the social sector. Sally Ogun, a patient’s rights activist from America says, “The provision of health care … is part of a social contract, one that assures citizens access to the tools they need to remain as healthy and as well as possible. As our survey confirms, there is no uncertainty on the part of patients about what those tools must be. As lawmakers hash out the particulars of health legislation, they must break through the politics of the debate and look to patients as a guiding voice in order to build a.. plan that works for everyone.”
The Government of Karnataka had been attempting to regulate private medical practice since 1976, but stiff resistance from the private medical practitioners has succeeded in stalling it till 2007, when the passed the Karnataka Private Medical Establishment Act was passed. The rules under the Act were notified in 2009. Following this, the private hospitals were required to display a rate chart, and maintain minimum standards of staff, technical knowhow and infrastructure. Registration was made mandatory, and they had to ensure clean and hygienic surroundings, proper lighting, ventilation, adequate/hygienic sanitation facility, maintain proper medical records, install standard bio-medical waste disposal system, and ensure access to attending doctors and appoint qualified staff in proportion to the number of patients treated daily.
In 2016, the government set up a committee make recommendations to bring amendments to the KPME Act, headed by Retd Chief Justice Vikramajit Sen with wide representation from all stakeholders including public health activists, representatives of private medical establishments, and others. The committee in its recommendations proposed to drop the term ‘private’ from the act, in effect bringing the government medical establishments too under the act. This was strongly objected to by the health activists who withdrew from the committee in protest.
In the subsequent debates on the KPME, one of the main concerns has been the undue focus on the interests of the private medical establishments and doctors to the exclusion of the interests of the patients. Civil society activists insist on the need to keep the patient at the centre of the debate. The other concern is to protect the public health system which continues to be the main health care provider to the masses of poor and disadvantaged in the country. And which is in danger of being swept away in the wave of privatization and corporatisation of healthcare in the country.
Going back to Sally Okun, she conducted a survey of patient needs in America in the light of the public healthcare system in that country. The response of the users of America’s public health services – which are essentially underwritten by the government – was the following:
- Major medical expenses
- Preventive care
- Outpatient visits for chronic illnesses
- Treatment for Preexisting conditions
- Some of the costs of prescription medications
- Mental health conditions
- Some of the costs of medical equipment
At this point, these services are all being provided by the government hospitals in Karnataka either free or at a low, subsidized price. Bringing them into the ambit of legislation which treats them on par with hospitals run for profit will sound the death-knoll to affordable and accountable patient care in Karnataka.
Furthermore, the government has a system in place for the collection of robust data, provision of services and an existing and functioning – though it needs much improvement – system of accountability. In a context where even children are now being increasingly diagnosed with cancers and other lifestyle diseases due to polluted air, land and water, and the high prevalence of diabetes in the state, preventive health is surely a responsibility that the state cannot afford to abdicate. “Private medical establishments are not into health care”, declares a health activist. “They are treating diseases.”
Hence the need for the government to recognize its constitutional obligation to protect the health f the citizens to the best of its ability and reject the recommendations of the Vikramajit Sen committee to bring its own hospitals under the same ambit as profit-making institutions and keep the service to the citizen as its main focus. The government must resist the pressure from doctors to subject themselves to democratically formulated and technically sound systems of regulation.
Cynthia Stephen is an independent journalist and development and public policy analyst