Dr Sudarshan Ballal’s article on June 28, 2017 in these columns expressing concern about the controversy and mistrust being generated between the medical fraternity and the state government by the introduction of the Karnataka Private Medical Establishments (Amendment) Bill, 2017, ironically leaves patients and their rights completely out of the equation.
His point about the unusual situation of doctors taking to the streets in protest against the amendment makes one wonder why doctors do not similarly protest when patients’ rights are violated by exorbitant costs or negligence and when empanelled hospitals fleece the government and refuse to be accountable. Lack of information cannot be a reason because there is research pouring in from every state about practices that violate the very core principle of medical ethics, which is “first, do no harm”.
The idea being promoted in Dr Ballal’s article of healthcare as a free market economy that should not come under any form of “control raj” is highly problematic. If a person wants to buy a commodity like a fridge or a television, he or she can make the choice based on budget and even choose not to buy it, unlike healthcare, where people have no ‘choice’ but to undergo treatment.
It is this choicelessness, vulnerability and extreme asymmetry in power between a doctor and a patient that makes it dangerous to bring health under the purview of market logic – the recent issue of patients being charged anywhere from 1,000 to 2,000% more for cardiac stents being a case in point.
The regulatory bodies that Dr Ballal says are already in existence, are a maze deliberately set up to protect the doctors while patients seeking redressal struggle to get medical opinions from expert doctors who are unwilling to testify against their colleagues even in cases of gross violations.
His concern that the small hospitals and mission hospitals in Tier 2 and Tier 3 cities will be subsumed under this Act, in fact, would actually hold true in the context of the National Accreditation Board of Hospitals’ (NABH) standards.It is these standards which the corporate private sector is attempting to force even on government hospitals, knowing fully well that it would be the death knell of government hospitals (and smaller hospitals) that work on different standards and principles.
The statement that the private sector is filling a vacuum created by lack of facilities in the public sector only means that the public sector has to be strengthened with investment in human resources, training, drugs, infrastructure, residential facilities etc, and a strong regulatory mechanism. How this then goes on to mean that the private sector should not be regulated is unclear.
Dr Ballal’s point that tax payers pay for public healthcare is true even for private empanelled and other hospitals which are receiving huge subsidies, land grants, loans, tax exemptions, import duty exemptions etc, but these benefits don’t go to patients.
One way of strengthening the public sector has to be pre-empted by reigning in the private sector so that it functions as an integral part of a larger health system and not as a law unto itself.
The private hospitals’ poor record of sharing data with the government is a documented reason for antibiotic resistance, multi-drug resistant tuberculosis and HIV, not to mention irrational surgeries and unnecessary investigations.
It is also interesting that the doctor says that there are some rotten apples in the medical community and it is unjust to label the entire community as corrupt and dishonest. This a clever play of words. At no point has the argument in favour of the amendments been to label doctors as corrupt or dishonest but only to bring the so called ‘rotten apples’ under rule of law so that patient’s rights are not violated on a day to day basis.
The government in the role of insurer is a fancy way of saying that on the one hand the government should ensure that an endless supply of money and ‘lucrative’ patients are directed to the private sector but on the other, it should not impose any kind of regulatory strictures on costs or intervene where there are violation of patient’s rights.
This would however make it a government for the private sector rather than a government for the very last citizen of the state – irrespective of their religion, caste, language, class or paying ability.
(The writer is a public health doctor and researcher)