A top notch health tourism destination, complicated surgeries and “star” doctors many of whom are the pioneers in their respective fields – India’s private healthcare system enjoys a glorious international reputation. It is in short a stark contrast to the state of the public health sector. A 2007 paper published in the Economic and Political Weekly notes, “…high absenteeism, low quality in clinical care, low satisfaction levels with care (clinical and with regards to courtesy and amenities) and rampant corruption plague the [public health] system.” It is something that the private sector never fails to remind us about in times such as now when its business model is facing countless questions after Fortis Gurugram billed the family of 7-year-old Aadya Singh – who eventually died of dengue – Rs 15 lakh plus for a fortnight’s stay in the hospital.
Since the 1990s India has pursued a policy of privatisation – especially of the health and pharmaceutical sectors with the public sector all but handing over the baton to the private.
It is important to understand that India’s persistent push towards privatisation in healthcare since the 90s isn’t as much a testimony to the efficiency of the private sector, as it is a compensation for the lack of a robust public health system.
This despite the fact that Articles 14, 15 and 21 of the Indian Constitution that enshrine respectively the rights to life, equality and non-discrimination are additively interpreted to arrive at a Right to Health. The Constitution lays down in Article 47 of the Directive Principles of State Policy; “Duty of the State to raise the level of nutrition and the standard of living and to improve public health.—The State shall regard the raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties and, in particular, the State shall endeavour to bring about prohibition of the consumption except for medicinal purposes of intoxicating drinks and of drugs which are injurious to health.”
To that extent right to health is at least as much enshrined in the Constitution as the state’s duty to prevent cow slaughter – the very next article.
Nevertheless conditions have been created for not just the thriving of the private sector but its unregulated profiteering – as opposed to a for profit business model – as Aadya’s tragic case has brought to light once more. In a fantastic convergence of minds, Centre and the states often ranged at opposite ends of the political spectrum have somehow or the other put off regulation of the private sector. There are some exceptions, admittedly. West Bengal government’s stringent Clinical Establishments Act happened after a comparable incident in the state earlier this year and now the Karnataka government is attempting to bring its own law much to the chagrin of big names in the private sector including Dr Devi Shetty’s Narayana Hrudayalaya. On the whole though, seven years after the Centre passed a model law, The Clinical Establishments (Registration and Regulation) Act, 2010 precisely for the purpose of regulating the private sector, states’ uptake has been very poor.
The functioning of the medical profession has been kept deliberately vague – there are standard treatment guidelines available now for many medical conditions and diseases but implementation is non-existent. Regulation has been kept in the hands of a handful of politically connected doctors whose sole purpose is to preserve the smokescreen and perpetuate their own interests rather than cleanse the system. Government whose job it is to regulate has or years been making the right noises about public private partnerships in healthcare but has been remarkably sloth in getting regulations and regulators in place which has to be the first step if government whose stated policy is transparency is to work with the private sector at any level. Poor penetration of health insurance that could have been a de facto regulator in its own interest has made even that filter ineffective.
In short that the private hospital business model is opaque and exorbitant is actually a gift government of India has decided to give them. It is a small detail that we pay the price of.