Health regulations need a base to top approach (GS Paper 3, Health)
Context
- Health regulations are essential but their implementation in India needs to be nuanced and calibrated.
Health care regulations
- The subject of regulation has always been of interest to health programme managers but, arguably, is one of the weakest points in India’s health-care system.
- It is not as if there are not enough health regulations in Indian States. Rather, it is a problem of excess.
- Some States have over 50 approvals under multiple regulations, which need to be followed and complied with by every health-care facility.
- The other challenge is unrealistic health-care quality standards. Governments at every level in India — national and States — are known to draft policies which are near perfect.
- One such case is the Clinical Establishments (Registration and Regulation) Act, 2010, enacted 14 years ago, but not adopted by States.
- This is because State governments, in discussions with stakeholders, have realised that many provisions in the Act are impossible to implement.
- Another example is the Indian Public Health Standards, or IPHS, drafted by the government for its own health-care facilities and proposed as essential in order to deliver quality health services.
- The IPHS were first released in 2007 and have been revised twice since then.
- Yet, in 17 years of existence, only 15% to 18% of government primary health-care facilities in India meet the government’s own standards.
- Clearly, in the efforts to be aspirational, health-care regulations and standards in India have drifted towards unrealistic standards, and are difficult to implement.
India has a mixed health-care system
- There is a binary perception that when it comes to adhering to the rules, the government health sector always does better, and that the private sector always violates them.
- The fact is that India has a mixed health-care system, where private health-care facilities and providers deliver nearly 70% of outpatient and 50% of hospital-based services.
- In most States such as Maharashtra or Kerala, the health indicators are better not because these States have outstanding government facilities but because the facilities and clinics in the private sector are fulfilling the health needs of the people.
- Clearly, for effective regulation and adherence, the stakeholder should not feel they are being targeted.
- In health-care regulation, in the current scheme of things, the burden of responsibility is more on providers and facility owners.
- Most private nursing homes and clinics have often flagged the issue of approvals being delayed by the authorities for months even when these facilities apply for renewal well in advance.
- The sluggish approval process is a main concern as far as facility owners are concerned.
Affordable care is one need
- The private sector is also not a homogenous entity as there is everything from single doctor clinics, small nursing homes and medium-sized hospitals to large corporate hospitals.
- Single doctor clinics and small nursing homes are often the first point of contact for access and utilisation of health services in India by middle-income and low-income populations, and are the real lifeline of health services.
- They deliver a large share of health services at a fraction of cost of that of the big corporate hospitals.
- The single doctor clinics and nursing homes play a key role in health service delivery in India and make services accessible and affordable.
- Clearly, there needs to be supportive and facilitatory regulations to serve the public purpose of keeping health-care costs low and affordable.
Suggestions
- First, ensuring quality of health services is essential and the joint responsibility of all stakeholders.
- Second, in regulatory aspects, what is possible for large corporate hospitals may not be feasible for smaller clinics and nursing homes, without escalated cost.
- Third, representatives of doctors’ associations and the types of facilities for which regulations are being formed as well as community members should be involved in the process of the formulation of such regulation.
- Fourth, political loose talk and sensational media headlines might worsen the mistrust of the common man about doctors and nursing homes and may result in increased violence against health-care providers.
- Fifth, and most importantly, India needs to promote single doctor clinics apart from smaller health-care facilities, and nursing homes.
Conclusion
- India’s health-care system is already becoming skewed towards admission based in-patient services. It needs to promote providers and facilities that deliver out-patient care at lower costs.
- This would contribute to the goal of the National Health Policy, 2017 — to deliver health services that should be people-centric, accessible, available, affordable, and have quality.
