Unregulated sector

Print edition : October 16, 2015

IN Delhi, only those hospitals that have bought government land at subsidised rates are obliged to give free medical treatment to patients from the economically weaker sections (EWS)—25 per cent of the outpatients and 10 per cent of the inpatients. Poor patients taking treatment after these quotas are filled have to pay their medical bills. Only 51 private hospitals in Delhi have the quota provision. Even these hospitals are not obliged to admit critically ill patients. The migrant family from Odisha that lost its young son to dengue fever did not belong to the EWS category. Yet the hospitals refused to admit the boy, citing a shortage of beds.

The situation is far worse for poor patients who cannot afford expensive private health care. Government-run hospitals in Delhi are often overloaded with patients and find it difficult to cope when there is an outbreak of a disease. In view of the poor health infrastructure in most parts of northern India, poor patients even from faraway places wait outside the super-speciality government hospitals in Delhi for months on end seeking medical assistance. Private hospitals entertain only rich patients and foreign medical tourists.

Ashok Agarwal, a health care activist, said: “Regular budgetary cuts have impacted government-run hospitals in a big way. The State-run Hindurao Hospital did not have X-ray films for three months. Institutions such as the AIIMS offer free consultation but charge for tests and accessories used in surgical procedures. For instance, the medical bill for having a pacemaker implanted or for chemotherapy sessions in the AIIMS may cost up to Rs.6 lakh. The doctors there say they do not have enough money to facilitate expensive procedures. Where will the poor people go?”

The situation has led to a nexus between some government doctors and pharmacies that supply medicines and accessories to government hospitals. “Doctors get a lot of benefits from the pharmacies and laboratories they recommend,” Agarwal told Frontline.

Sometimes, at the instance of activists, courts order hospitals to provide treatment to critically ill patients. But the fact remains that Delhi, with inadequate public health infrastructure, cannot cater to the needs of entire northern India. In epidemic situations, “unless and until the preventive, curative and promotional responses of the State are organised, many more deaths are bound to happen in the years to come. Delhi has failed to have a comprehensive epidemic control programme in place despite being faced with epidemics in the last few years,” said Joe Verghese of Jan Swasthya Abhiyan (People’s Health Movement).

The Delhi Nursing Homes Registration Act, 1953, requires only a registration without any obligation to run a private hospital and, therefore, controlling epidemics is not within their scope. Similarly, The Clinical Establishments (Registration and Regulation) Act, 2010, enacted by the Central government prescribing the minimum standards of medical facilities, has not been adopted by the Delhi Assembly until now. The Act makes it mandatory for both public and private hospitals to provide emergency health care to critically ill patients. “In epidemic situations, private hospitals make a lot of profit. The almost 20 per cent cut in the Union health outlay has worsened the situation,” Verghese said.

Many private hospitals apparently insist on money being paid in advance for treatment. This amount varies from tens of thousands of rupees to a couple of lakhs. It is unethical to place such demands on a patient when the primary duty of the hospital is to provide the immediate treatment needed.

Ajoy Ashirwad Mahaprashasta

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