In Keralam, ‘affordable’ private health care is easier said than done

The Keralam government’s announcement that it will make private health care more “affordable” through consultations with the private health sector, and that a Bill in this regard was in the offing, should be seen against the State’s seven-year legal battle before the Kerala High Court upheld the Kerala Clinical Establishments (Registration and Regulations) Act 2018, throwing out all objections raised by private hospitals.

The KCE Act was the first ever attempt made in the State to bring the entire health sector, public and private, under a regulatory framework.

But the Act was systematically opposed and its implementation stalled at every turn by the private health sector in the State.

It was in November last year that the Kerala High Court threw out all objections raised by the Kerala Private Hospitals’ Association (KPHA) and the Indian Medical Association (IMA) and upheld the validity of the Act.

Contentious area

Unlike the Clinical Establishments (Registration and Regulation) Act, 2010 (Central Act 23 of 2010), which attempted to cap the treatment/procedure/diagnostic rates charged by the private health sector by fixing a price range, the KCE Act had not touched this contentious area at all.

The KCE Act just insisted on mandatory registration of all clinical establishments under all systems of medicines (including hospitals, clinics and laboratories) and that every establishment maintain certain minimum standards based on the category in which they fall. It also said that hospitals display their rates for various procedures openly so that there is transparency.

However, the private health sector argued that it violated rights under Article 14 and Article 19(1)(g) of the Constitution.

Appeal in SC

Even after the High Court specifically held that KCE Act’s Section 16 (mandatory registration of clinical establishments), Section 39 (display of fee rates and package rates for services) and Section 47 (obligations concerning life-saving treatment/emergency care and safe transfer of patients) were constitutionally valid and gave directives to the government to implement the Act without delay, KPHA went in appeal to the Supreme Court.

The Supreme Court has not stayed the KCE Act, but granted members of the petitioning associations interim protection against coercive action by the government.

Yet to register

Kerala Clinical Establishments Council, which is responsible for the implementation of the Act, maintains that the registration process is continuing and that even now, many clinical establishments are yet to register themselves under the council.

Small hospitals with up to 15 beds have been given some concessions by the council, trimming down the checklist for assessment to just basic and essential points, so that at least the basic registration brings these establishments too within the regulatory framework.

The government’s efforts to draft a new Bill to bring in a regulatory framework that “protects patients’ interests while taking into account the operating costs and practical difficulties of private hospitals” is well-intentioned, but the fact remains that the private health sector is still holding out against the KCE Act at the Supreme Court.

Questions are also being raised whether a new legislation is in order or if the costing regulations can be incorporated into the KCE Act itself.

‘Entirely welcome’

Meanwhile, public health activists like B. Ekbal have stated that any attempt by the government to regulate the treatment expenditure in the private sector and save people from catastrophic health expenditure is entirely welcome.

Dr. Ekbal said that though private hospitals are an essential component of the health system, health care cannot be left entirely to market logic. It is the government’s responsibility to regulate the sector adequately so that patients are not exploited.

In a statement here, Dr. Ekbal said that the Standard Treatment Guidelines (STGs) should be insisted on and that the government initiate a scientific cost evaluation of various medical and diagnostic procedures and treatments so that a rational and transparent rate list suited to the State can be evolved.