The draft rules of the Karnataka Private Medical Establishments (Amendment) Act have now been put on the public domain. This comes following a review meeting with the stakeholders.
Health activists strongly believe that the draft rules are highly watered down and serves little purpose, with no hold over private hospitals and its ways of functioning. They explain that these draft rules appear “like a collaboration with the private medical establishments.”
Speaking to TNM, Dr Sylvia Karpagam, a public health researcher and activist raises several concerns with the draft– from the lack of rules to check implementation to having representatives of the Public Health Foundation of India(PHFI) on the state committee that will look into regulation of private hospitals. The Foundation recently lost its Foreign Contribution Regulation Act license over allegations of lobbying with parliamentarians.
She points out that there is no mention of what happens if these rules are not implemented in the present draft.
Dr Silvia said that even as the state government had, in the past said that they would look into capping prices of treatment procedures at all hospitals. These draft rules, however do not mention the same
“It only says that ‘As far as possible, the committee shall use as reference the standard costing template formulated by the National Council constituted as under the Clinical establishment,’” she explains.
While the rules propose maintaining standards that are to meet specifications of the National Accreditation Board for Hospitals, not all smaller institutes would be able to live up to it. “There is no mention of charitable hospitals in any of these consultations. Bringing in NABH standards would adversely affect charitable hospitals in remote areas and could cause many of them to shut down giving a free unlimited playing field to the for-profit sector,” Dr Silvia argues.
Biased towards private establishments?
She also points to the possibility of the rules being biased given that a majority of representatives are from the private association of doctors.
“Technically, all non-official members of the grievance redressal committee could come from Indian Medical Association and Private Hospitals and Nursing Homes Association. The first member is from the Indian Medical Association. The second could come from PHANA (Private Hospitals and Nursing Homes Association) and the third (woman nominee) could again come from either of these bodies. The initial clause that not more than 1/3 representation will be from the private sector seems to have disappeared?” wonders Dr Silvia.
She also sought to know why the PHFI was a representative on the Expert Committee for classification, infrastructure and staffing and also to decide uniform package rates when in the past, several allegations have been made against them.
Package rates
The draft rules have mentioned that the Expert Committee constituted by the State Government for recommending uniform package rates for healthcare assurance schemes for participating private medical establishments shall consist of the director of the Suvarna Arogya Suraksha Trust. The Suvarna Arogya Suraksha Trust is the implementing agency for the schemes that are being implemented on public-private-partnership basis.
Dr Sylvia believes that having the SAST director to decide uniform package rates may tilt costs in favour of the private sector rather than patients.
Treatment rates
In November last year, private hospitals and the representatives of the Indian Medical Association went on a protest demanding several revisions to the Act. Primary among them, was the issue of price capping. The state government had initially proposed to cap prices of various treatment procedures so as to make it affordable to avail treatment in private establishments.
“The uniform package rates are only for healthcare assurance schemes for participating establishments. Is this for only BPL or APL as well? For APL only 30% costs will be borne by the government. Is the other 70% completely left to the whims of the private establishment? Will this also have to be displayed? There is no strong clarity on this.”
Even as the rules specify how the grievance redressal committee ought to be constituted she adds that there is no mention on the rules that they would be operating on.