Suddenly doctors have become the new victims. They feel that they are justified in shutting down shop and getting onto the streets for what they perceive to be a good cause – the cause being none other than the Karnataka Private Medical Establishments (Amendment) Bill, 2017, currently being tabled in the Karnataka Assembly, which private doctors are opposing in large numbers. They are keen to have the Vikramjit Sen (VS) committee recommendations rather than the current Amendment. They fail to mention that the VS committee had deliberately excluded patient/citizen rights groups from their final decision making group, and there was a complete takeover of decision making by private sector, which not surprisingly, is entirely in favour of promoting private medical establishment interest.
Karnataka has seen a massive growth of the private sector which has neither self-regulated nor allowed any form of government control. This has led to rampart overcharging, denial of patients’ rights, negligence, unnecessary procedures and tests. Patients have been over-charged and held to ransom. The cost to life and the burden that private healthcare has imposed on patients has been well documented in India as well as other countries. Government health services, on the other hand, have systems of monitoring and oversight, even if the implementation has generally been poor. The criticism that government hospitals are not accountable is an untrue statement. They are much more accountable than the private sector when it comes to training guidelines, standard treatment protocols, reporting morbidity/mortality and referrals. While no one in their sane mind would claim that government hospitals are perfect, they are much more within the ambit of regulation and control because of their intrinsic system of operation and their underlying principles of equity, accessibility, affordability and comprehensiveness. The clamour by private hospitals to bring in government hospitals into the VS committee regulation is not borne out of concern for the patient, but to ensure that there is a weapon to shut down even the existing government hospitals so that people are completely and absolutely at the mercy of unscrupulous and unregulated market.
It is well known that private hospitals have no mechanism of reporting data on morbidity, mortality, caesarean sections, hysterectomies and other surgeries. There is poor documentation and maintenance of records for the rationale (if any) behind investigations and treatment, referral patterns and cause of death, if it occurs. Patients therefore have very little access to information if they would like to have a second opinion, which they are entitled to, or if they suspect negligence and would like to pursue the case legally. The public health system has a more rigorous system of data collection and transmission, which helps to understand disease and mortality, as well as diseases of public health concern.
The amount of power that a doctor exerts over a patient is not small. This power begins right from when a patient comes with a symptom, to deciding what tests have to be done, what procedures, what drugs, for how long. It continues even when patients feel that there has been negligence and files a complaint against the doctor. It is also well known that in cases of negligence and denial of care by private hospitals, expert doctors very rarely testify against colleagues even in obvious cases. This makes patients and their relatives extremely vulnerable and puts them completely at the mercy of medical establishments, with doctors as experts. Why aren’t any so called ‘ethical’ doctors protesting this gross violation of patient rights?
With the Vajpayee Arogyashree scheme (VAS), private empanelled hospitals have demonstrated how they are quite ready to manipulate the government for economic gains, pick and choose lucrative patients, while closing the door on patients who are terminally ill or requiring protracted care. They have also been shown to bring on several added costs for patients over and above the money received through VAS. This has created a burden on patients, with out of pocket expenditure under the scheme ranging between Rs. 10,000 to more than Rs. 1 lakh. One has never seen doctors out on the street protesting this violation of patient rights and misuse of public money.
Where were the protesting doctors when pharma was buying them plane tickets, international cruises, international conference sponsorships, drink and dinner parties and other such cozy memorabilia? When stents were being billed to patients at 500% to 1000% the original cost, no doctors were seen protesting the burden on patients.
Health has been known to improve when the government health system is strong, easily measured by maternal and child mortality rates. The government health system, apart from its curative role, plays an important role in prevention, promotion of health and rehabilitation. The private sector has never taken up preventive roles because it has low economic value. While the public sector undergoes rigorous training on management of diseases of public health importance such as tuberculosis, HIV, non-communicable diseases, dengue etc., the private sector has often initiated treatments that not only lead to bad outcomes for the patient, but create major public health problems such as antibiotic resistance, multi-drug resistance and other complications which are then left for the public health system to manage. Rather than working on prevention of public health diseases like dengue, the private sector often capitalises on the fear syndrome for its own private gain.
The government’s decision of regulating private medical establishments, introducing a Charter of patients right’s, creating a grievance redressal committee and fixing a cap on rates should be strongly applauded and supported. The government should not give in to the pressure exerted by the private sector lobby and instead do whatever is required to ensure that all patients, irrespective of their ability to pay, are offered access to comprehensive preventive, promotive, curative and rehabilitative health care.
This would go a long way in making the government people centric instead of market centric, and make Karnataka a model of comprehensive health care for other states to follow.