By Dr Ashwini Nadahalli and Dr Ananya Tupaki-Sreepurna
Nov 16: This is a fact-based practical analysis of the proposed amendments to the KPME (The Karnataka Private Medical Establishment) Act. The sole purpose is to let the non-medicos understand the implications of these amendments. Before going into the details, it is important to know that:
1) This Act has been in effect since 2007, comprising all the rules and regulations to contain the unrestrained undertakings of the private medical establishments (PMEs) and prevent quackery.
2) If the intention of the State Government is to provide grievance redressal for the patients who have been victims of medical negligence or harassment, there are already existing bodies such as the consumer court, civil court and criminal court for the very purpose.
3) If the purpose is to provide affordable healthcare of high standards, we need to note that the Centre and State Governments spent 1.3% of GDP on healthcare in 2015-16 while the global expenditure on health care is 8-10% GDP.
Coming to the amendments that have been introduced to the original 2007 bill this year,
1. Is a committee comprising of the CEO of zilla panchayat, a Superintendent of Police, a public prosecutor/lawyer, a District Surgeon and only one PME representative with no lawyer for the accused doctor fair Indian judiciary? Is there a precedent for such a committee? Does this mean that the Consumer Court has thus far been an utter failure?
2. Section 9A of the amended Act deals with “fixation of cost of each health service or treatment” by the State Government Expert Committee “and different rates may be proposed for different class of PMEs”. There is a danger that the hardest hit from this would be the smaller PMEs in remote areas with no nearby Government hospitals while the larger corporates in the city may remain unscathed. How is this good for universal health care?
3. Furthermore, there is no clarification regarding the rates fixed by the State Government, the key members of the Expert Committee and the criteria used to make these decisions.
4. Section 10 of the KPMEA bill (2007) already ensures transparency of charges payable for different medical treatment and other services in the form of brochures or booklets and their display on notice board.
5. Section 12 (2017) deals with amendment of Section 11 (2007) which states “Every PME shall hand over in the event of the death, the body of the deceased immediately without insisting on payment of the dues. The same may be recovered from the representative of the deceased in due course” Can the State Government ensure the payment of the unsettled bills in such circumstances?
6. There is no practical advantage of changing the period of renewal of registration of the PME to every 3 years (from 5 years). In fact, they may lead to impeding of smooth functioning of the PMEs as a result of undue paperwork. A better alternative is to conduct more frequent audits and inspections.
Looking at the long term implications of these amendments,
1) They would lead to the practice of "defensive medicine", that is, excessive and repeat investigations and over cautious management in fear of future legal action by the doctors.
2) The two-way street of the patient-doctor relationship would be ruined on both sides.
3) In fact, they can adversely affect smaller nursing homes, private clinics and deteriorate the existing quality and availability of advanced technology in the bigger PMEs.
To conclude, focusing on the strict implementation of the original 2007 KPMEA by the State Government would result in the accomplishment of their true purpose to contain the escalating costs in private healthcare.
The real and ultimate solution would be to improve the conditions of the existing healthcare facilities in the Government setup where it is not uncommon to find rats scampering in the OTs (operation theatres).
References
• KPME ACT 2007, Amended KPME ACT 2017 from the Govt. of Karnataka website
• WHO Statistics
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