The Clinical Establishments Act was passed in 2010, but only ten states have implemented it. What are the reasons behind this lag?
It was enacted by the government to provide a legislative framework for registration and regulation of clinical establishments in the country, and to improve the quality of health services by prescribing minimum standards of facilities and services which may be provided by them. However, health is a state subject. For the act to be applicable in a state, it has to be adopted by the states under Article 252 of the Constitution. Initially, the act came into force in Sikkim, Mizoram, Arunachal Pradesh and Himachal Pradesh and all Union Territories except Delhi [as on 1-3-2012]. Subsequently, six more states—Uttar Pradesh, Uttarakhand, Bihar, Jharkhand, Rajasthan and Assam—have adopted this act. Thus, as on date, the act is applicable in ten states and six Union territories.
How is the Centre planning to push for this regulation?
We have been repeatedly sending request letters to the states to adopt the act. A dedicated website has been made operational for initiating online registration and for dissemination of information. Nodal officers have been designated and there is a provision for posts of coordinators at state and district levels for the implementation of this act. We are providing all technical and financial support for the implementation of the law. Also, operational guidelines for implementation of the act have been drafted and are available on the website. We have also been involving stakeholders like IMA [Indian Medical Association], [ministry of] AYUSH, IDA [Indian Dental Association] and QCI [Quality Council of India] to dispel any concerns. State representatives are sensitised during the meetings of the national council, where advocacy and training workshops are also held.
To what extent does the Clinical Establishments Act regulate private hospitals and help patients such as in the Fortis case? Can you cite specific clauses that could prevent overcharging, especially when critical care units (where costs are high) are involved?
As per clause 11 of the act, registration of clinical establishments is mandatory. The grant of registration is subject to certain conditions, some of which have been prescribed under the act. These rules will help specifically to prevent overcharging. For instance, display of rates by the clinical establishments so that patients can know the rates of facilities and services available in advance and make an informed decision. Also, according to Rule 9(ii), clinical establishments are required to charge rates for each type of facility and service within the range of rates determined and issued by the Union government in consultation with the state government.
In this regard, the National Council for Clinical Establishments has approved a list of procedures and a costing template. States have been advised to define “standard procedure cost” using the template of costing and keep local factors in consideration. The information on standard procedure cost should be available to the stakeholders and general public. Also, clinical establishments are expected to ensure compliance with standard treatment guidelines, as may be determined and issued by the Union government, or state government, as the case may be, in due course of time. The Union government has prescribed standard treatment guidelines for proper health care for 227 diseases, and for 21 clinical allopathic specialties and ayurveda. By following these guidelines, unnecessary treatment and investigations can be avoided.
Apart from these, immediate/prompt redressal of grievances will increase the confidence and trust in health care facilities.
The Karnataka assembly has passed the Karnataka Private Medical Establishments (Amendment) Bill recently. Do you think this law could be a model for the rest of the country?
The Clinical Establishments Act has better regulatory provisions than the KPME, because the KPME is only for private clinical establishments. The Clinical Establishment Act is applicable to government and AYUSH facilities also and covers all categories of clinical establishments such as clinics, polyclinics, mobile clinics, hospitals, physiotherapy centres, health check-up centres, dental labs, integrated counselling centres, individual doctors' clinics, and big corporate hospitals as well as diagnostic centres like laboratories and imaging centres. It also provides for mandatory stabilisation in case of emergency medical conditions to save the life of the patient. KPME has made provisions only for first aid, which is not sufficient.
How can health care be made more affordable?
A proper implementation of the provisions of the Clinical Establishments Act, such as display of rates and compliance to range of rates of procedures and services, and [compliance to] standard treatment guidelines will stabilise the cost across the board and make health care more affordable. States which have not adopted the act should do so immediately. There is also a need to regulate the cost of medical devices, drugs and consumables. Here, the drug controller general of India and the NPPA [National Pharmaceutical Pricing Authority] have to play a proactive role. There are complaints against many private clinical establishments charging more than the MRP. There is an act to regulate MRP, which should be strictly implemented. At present, majority of the people are paying out of their own pocket. We need to enhance the role of insurance in the health care sector. Health care should be available cashless to the patients. The Union ministry of health and family welfare has been giving grants to states to develop infrastructure. New AIIMS-like institutions are also coming up in states.