Several central laws prohibit medical treatment
by anyone except a doctor. Paradoxically, all studies have shown that it is qualified doctors who pay handsome commissions (30 per cent of the fees) to unqualified practitioners for making referrals to them; they have in fact employed and trained these helpers to administer injections, IV fluids, antibiotics and steroids. A WHO (2016) analysis reveals that India has more unqualified practitioners than qualified doctors. In the absence of enforcement, UMPs stock and treat with strong medicine often as demanded by the patient. As a result of incompetence and commercialisation here and elsewhere, multi-drug resistant TB, failed antibiotic treatment
and the irrational use of fourth generation drugs have become a reality.
In India the citizen — rich or poor — has virtually no protection against medical exploitation or malpractice. Regulators like the Medical Council of India and the State Medical Councils rarely react to medical malpractice.The Consumer Protection Act 1986 deals with the failure of service contracts — the focus being on compensation and not medical malpractice which is the crying need. Incidentally public sector doctors are not covered even by such controls.
In 2010 the Central Government enacted the Clinical Establishment Act 2010 to register and regulate all health establishments, their standards, the qualifications of the workforce with the stated aim of ending quackery. Not a single state has actually adopted the Act by establishing a regulatory structure capable of enforcing either standards or quality. More than half the states do not even have a legislation requiring private establishments to be licensed. Those that do have some kind of legislation like the Delhi Nursing Homes Act 1953 still retain a token penalty of Rs 100 for a transgression.
Technological and regulatory oversight have controlled the private sector in telecommunications, electricity, civil aviation and corporate enterprise. A host of Authorities, Boards, Commissions, Tribunals and Appellate bodies have exercised the power to supervise and enforce. Treating and saving human lives is obviously a larger imperative by far. Needed is a regulatory system to oversee the health sector at all levels –public and private. It is now a matter of compulsion.
The writer is a former secretary in the health ministry
via Regulate the private health sector | Business Standard Column