“A Stitch in Time Saves Nine”-Regulating KPME Act, 2007
The Indian Government has a constitutional obligation to provide health facilities, as settled by law, which makes the right to health integral to the right to life.
Healthcare is a matter of the states. However, there has been a constant corrode in the healthcare systems across the country. This largely arises due to differences in availability, accessibility, insurance coverage, and service delivery models among Private and Public health systems. These inadvertent issues have put the nation into a state of acute medical malfunction!
Karnataka is among a long list of states with outdated legislation and inadequate implementation in terms of laws pertaining to healthcare. The Karnataka Private Medical Establishments Act was passed in 2007 “to bring comprehensive legislation in place of the Karnataka Private Nursing Home (Regulation) Act, 1976”. This was an effort to register private healthcare providers and identify genuine medical practitioners and make the legislation more patient-centric. The repeated efforts at proposing key amendments to the KPME Act, 2007, were directed at keeping tabs on the functioning of the private sector healthcare establishments and personnel.
Though it is the patient’s interests that need to be prioritised over those of the medical providers, suggested amendments caused widespread upheaval through the Karnataka medical fraternity. Strong resistance came from the private sector against the amendments because of price capping, imprisonment terms and raised fines, grievance redressal, and other things that were deemed controversial.
A steady waning in the number of people availing healthcare service at government hospitals has given precedence to private players, who in turn derive bigger profits by exploiting the bleeding situation and pushing larger numbers into further poverty. Intended transformations and regulations are thus meant to contain emerging trends and provide better access and quality healthcare for all people, irrespective of economic and social statuses. The state’s vision for its healthcare system must determine what is possible and propose workable solutions to its identified problems.
The sole legislation that Karnataka has in terms of the health sector doesn’t have enough to demand complete accountability. With the exponential growth in the private sector, ranging from multitudes of one-room clinics, dispensaries, and small nursing homes to large corporate hospitals, there lies an innate tendency for these revisions to be biased to this sector. The public sector is still critically underfunded and its facilities are mostly weighed down by long waiting lists, scarce medical supplies, and out-of-date technologies. This makes for an unintended drift towards private providers. With maximising gains here the hollowness of this revision glares through multiple deficiencies.
The Sen Committee’s report recommended a structure that included all streams of healthcare provision, from allopathy to Ayurveda, Yoga, and Homeopathy, in order to simplify the registration process. This meant the adoption of a Patient’s Charter on the lines of the WHO and QCI-NABH guidelines while addressing grievance redressal through state and district authorities. This Report, however, came under scrutiny in terms of it leaving out government hospitals and coming across as discriminatory.
Following the West Bengal model, implementation of legislation in Karnataka probably requires a committed authority to regulate healthcare provisions. In fact, the amendments can also take a note out of the Maharashtra Government’s move of framing a law to prohibit and make the “cuts and commission” practice by PMEs an offence.
In an attempt to make the legislation more stringent in order to check on bossism by the private providers there are a few things that can be considered straightforward benefits to those who seek medical care. As a saving grace, the Ayushman Bharat Scheme brings relief on disastrous expenses that shove patients and their families towards poverty. It also takes the edge off the terrible risk that is caused due to these expenses.
Even though the private sector has mostly enjoyed the comfort of the legislative cushion here, the public sector is waking up to appropriate upgrades to infrastructure in terms of tertiary care hospitals and medical colleges under Pradhan Mantri Swasthya Suraksha Yojana (PMSSY).
An overview of Cuba’s system reveals that its healthcare outcomes are those of a developed country, although it has the economy of a developing country. Its current model of nationalized healthcare was achieved post the revolution and provides an excellent example.
The status of India’s healthcare is a complicated fact to discuss. A healthier nation depends largely on an empowered public health system. Therefore, every state’s legislation needs to equip this sector and give it primary status making the private sector a complementary asset to achieve broader healthcare goals. We need to take a step back and realise that healthcare means the difference between life and death. Whether the system is private based or public based, power needs to be derived from the community in order to ensure that the people have the right care at the right time.