The Delhi government this week released an advisory aimed at capping profits of private healthcare providers in the city. The non-enforceable advisory would act as a draft for an amendment to the state’s Nursing Home Rules, giving government the power to cancel licences of erring hospitals.
“The draft will be put out in the public domain. And, after a 30-day period, during which people and even hospitals and nursing homes can suggest changes, we will make it legally binding,” said Delhi health minister Satyendar Jain.
The first part of this series looked at whether the policy would actually benefit patients.
Several hospitals and healthcare experts said the policy had not been thought through and could lead to patients shuttling from one hospital to another. This gives rise to the question of implementation of measures laid out in the policy.
“In this case, the government has no legal standing,” said social jurist Ashok Agarwal, who has been engaging with the Delhi government and private hospitals to help poor patients avail of free beds reserved for economically weaker sections in corporate hospitals.
The Nursing Homes Act, currently in operation, gives power to the government to cancel the licence of facilities that do not adhere to minimum standards such as floor area for every bed, proportion of doctors, nurses and staff with the bed strength.
“The government can cancel the licence of a healthcare facility under the Nursing Home Act only if they do not fulfil the conditions on which they had been granted approval. Even if the government amends the rules, can they say that you can open a hospital in Delhi only if you do not make profits?” said Agarwal.
“The hospitals can easily take any amendment that the government tries to make to court as the hospitals have a right to make profits. Commercialisation of healthcare is permissible under law. Only education is considered to be philanthropy or community service and schools are not allowed to profiteer,” he added.
That’s not all, the government’s own agreement with several hospitals allows for them to make profit.
“When the government provides subsidised land, the agreement states that hospital has to provide free treatment to a certain percentage of poor patients coming to clinics and for admission. Everything including medicines and diagnostics are free for these patients and the bill runs into lakhs. The hospitals are allowed to make profits from the others to accommodate these expenditure. How can the government then say that they shouldn’t make profit?” said Agarwal.
Where are the definitions?
“The government will have to put out a document in the public domain which has been drafted in a proper format, in proper legal language clearly stating which sections of the rules are being amended. The document that has been currently released is just a list of suggestions of the committee,” said Agarwal.
A proper legal document should also have definitions, and many experts say that the current document is somewhat “vague”.
“The policy says that hospitals should come up with normal packages and high-risk packages, but nowhere does it mention what procedure or what services. These would be highly variable,” said an administrator from All India Institute of Medical Sciences, requesting anonymity.
What about the hidden costs?
“When they say the packages should clearly mention what it includes, should the hospital start mentioning hidden costs like ‘this is my EMI for the new CT scan machine I purchased, this is for the air condition, this is for housekeeping’. The hospitals might have to resort to these impractical things because the draft says there should be no arbitrary charges without mentioning what is arbitrary,” the administrator said.
To give the advisory some teeth, the government will have to introduce it in the cabinet and then present it to the L-G. Even if all the necessary changes are made and the government is allowed to make the proposed amendments, it may be years before patients actually benefit.
Projects like remodelling of hospitals that had been announced by the government in the first year were cleared by the cabinet this year. Apart from that, the government is at loggerheads with the lieutenant governor for almost all their key projects.
Who will enforce it?
The “draft” does not mention anywhere how the government plans to check whether the hospitals actually follow the norms.
“Even now we come to know if there is any wrongdoing, people come in with complaints. But, we will come up with a helpline when it becomes a law,” the health minister had said at the press conference while announcing the draft policy.
“Right now, we are trying to gauge the public reaction; we will talk about implementation when we amend the rules. We are thinking of taking help of the 11 chief district medical officers and the 11 additional chief district medical officers, who can visit the hospitals in their area and check whether hospitals are following the norms,” said Dr Kirti Bhushan, Delhi’s director general of health services.
“All of this needs to be included in the draft before it is put out for public consultation. I am not against the AAP government, in fact, they have done a lot in the healthcare sector. But, the government needs to follow proper procedure if they are serious about bringing in the change,” said Agarwal.