The decline in public investment in health and absence of credible social insurance have caused a precarious situation in medicare. The unpredictability of illness requiring substantial money at short notice is impoverishing an estimated 3.3% of India’s population every year. Government’s share of total health care expenditure is only 21.3 percent. With health insurance yet to make significant strides, substantial part of health care expenditure is out of pocket. Seventy-five percent of specialists and 85% of technology are in private sector, which takes care of 75% of dental health, mental health, orthopaedics and vascular disease.
The frustaration of young MBBS graduates is very real and palpable. No fresh MBBS graduate is opting for family practice. He or she doesnot fit in with any tier of healthcare. An average citizen prefers to consult a neurosurgeon for headache and a cardiologist for non-cardiac chest pain. This is creating a top heavy healthcare delivery system with all fresh medical graduates going for specialization and super specialization. In comparison, the entire healthcare need of UK is provided by the National Health Services manned by thousands of general practitioners with MBBS. Corporatisation of tertiary healthcare has brought cutting edge technology to our shore. Now the only way it seems to be going is largescale private health insurance taking over the healthcare in another couple of decades. We will land up with the American model which they themselves are finding grossly inadequate. The best model for us will be the NHS model of UK or the similar one in Australia. This will establish a 3-tier system of referral where basic medical graduates would find a decent place, healthcare costs could be managed and the burden on common man will reduce substantially.
Unfortunately, private healthcare institutions have never been given the due recognition they richly deserve. The attitude of the Government is to classify them as ‘for profit’ commercial establishments. This has harmed the situation no end. These institutions are governed by multiple laws and regulations. In fact, there are 51 of them on the statute (listed below). Hospitals have to do multiple registrations, including under the Shops and Commercial Establishments Act and the Dangerous Trade and Offensive Practices Act. Electricity and water are supplied at prohibitively expensive commercial rates. Governments have brought them under VAT and Luxury Tax. The cost of biomedical and liquid waste treatment and disposal is borne by these instituitions as well. Even the application fee for these licences run into five-digit figures. The labour laws for the hospitals are most unfriendly and are not sensitive to their special needs. The strangest aspect is that hospitals are considered service providers under certain laws, shops under certain others and industries under yet some other sets. Nowhere they are considered professional institutions which they really are.There is a strong case to consider hospitals as professional health care institutions and accord special status. All laws regulating hospitals have to be chanalised through a single institution.Accreditation with fixing of standards at every level should be mandatory. Public health duties should be assigned to private clinics and hospitals under private public partnership schemes .Individual private practitioners and private hospitals may be retained for a fee or tax concessions. Govt instead of trying to be a provider of health care could be a purchaser of health care. This would avoid duplication of capital cost and infrastructure.
The whole scenario in health care is maddening. Governments have neither provided a vision nor leadership in healthcare.The cacophony and chaos will only result in pushing more and more people below poverty line. Who cares?
Here is the list of 51 laws:
Laws regarding service delivery:
1. The Drugs and Cosmetics Act,1940 (Central Act of 23 of 1940) and Rules 1945
2. The Bio –Medical Waste (Management and Handling) Rules,1998
3. The Standards of Weights & Measures Act,1976 (Central Act 60 of 1976) & The Standards of Weights & Measures(Enforcement) Act,1985 (Central Act 54 of 1985)
4. The Pre-Conception and pre-Natal Diagnostic Techniques(Prohibition of sex selection)Act ,1994 and Rules,1996
5. The Drugs and Magic Remedies (Objectionable Advertisements)Act 1954 and Rules,1955
6. The Medical Termination of Pregnancy Act,1971 and Rules ,2003
7. The Transplantation of Human Organs Act,1994 and Rules 1955
8. The Air Act,1981
9. The Water Act,1974
10. The Clinical Thermometers(Quality Control)Order,2001
11. The Poison Act,1919(central Act XII of 1919)&the Kerala Poison Rules ,1960
12. Atomic Energy Act 1962
13. The Epidemic Disease Act of 1897
14. The Drugs (Prices Control)Order ,1995
15. The Mental Health Act,1987
16. The Central Mental Health Authority Rules,1990
17. The State Mental health Rules,1990
18. The Creation of Eye –Bank Rules ,1970
19. The Kerala Narcotic Drugs and Psychotropic Substances Rules,1985
20. The Kerala Intoxicating Drugs(Control)Rules,1983
21. The Kerala Corneal Grafting Act ,1963 and Rules 1963
Laws regarding the Institutions:
22. The Kerala Shops&Commercial Establishmrnt s Act,1960 and Rules 1961
23. The Kerala General Sales Tax Act,1963/KVAT
24. The Kerala Municipality (Registration of Private Hospitals and Private Paramedical Institutions)Rules 1997
25. The Kerala Panchayat Raj (Registration of private Hospitals and Private paramedical institutions)Rules,1997
26. The Kerala Building Tax Act 1975 Act 7 of 1975
27. The Kerala Tax on luxuries Acts 1976
28. Dangerous trade &offensive practices Act
Laws regarding the professionals:
29. The Indian Medical Council Act ,1956
30. The Medical Council of India Regulations,2000 and The Indian Medical Council(Professional Conduct ,Etiquette and Ethics )Regulations ,2002
31. The T.C. Medical Practitioner Act ,1953
32. The Indian Nursing Council Act,1947
33. The Nurses and Midwives Act,1953
34. The Kerala Nurses and Midwives Rules,1972
35. The Pharmacy Act,1948 ,The Pharmacy Council of India Regulations,1952
36. The Kerala State Pharmacy Council Rules,1961
37. The Consumer Protection Act,1986(Central act 68 of 1986 )and Rules,1987(Central Rules of 1987)
Laws regarding Labour:
38. The Minimum Wages Act,1948(Central Act 11 of 1940)& Rules,1950
39. Payment of Wages Act 1936
40. The Maternity Benefit Act ,1961
41. The National and Festival Holidays Act
42. The Gratuity Act 1972
43. Weekly Holidays Act ,1942(Central Act 18 of 1942)
44. The Employees Provident Fund and Miscellaneous Provisions Act ,1952 (Central Act 19 of 1952)
45. The Employees State Insurance Act 1948
46. The Payment of Bonus Act,1965 (Central Act 21 of 1965 )&Rules,1975
47. The Kerala Labour Welfare Fund Act ,1975 (Act II of 1977)
48. The Industrial Employment (Standing Orders)Act 1946
49. The Industrial Disputes Act 1947
50. The Kerala Payment of subsistence Act ,1972 (Act 27 of 1973)
51. The employment exchanges (Compulsory notification of vacancies) Act 1959