Health regulations need a base to top approach

• The subject of Health regulation has always been of interest to health programme managers but the challenge is unrealistic health-care quality standards.

KEY HIGHLIGHTS

• Governments at every level in India are known to draft policies which are near perfect.
  • The Clinical Establishments (Registration and Regulation) Act, 2010, enacted 14 years ago, was not fully adopted by States.
  • This is because State governments, in discussions with stakeholders, have realized that many provisions in the Act are impossible to implement.
• the Indian Public Health Standards, drafted by the government for its own health-care facilities in order to deliver quality health services.
  • Yet in 17 years of existence, only 15% to 18% of government primary health-care facilities in India meet the government’s own standards.

India has a mixed health-care system

• 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 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.
• Yet, when it comes to health-care regulation, there seems to be an unfair attempt to enforce the regulations in the private sector.
  • 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.

Affordable care is one need

• The private sector has various types 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 utilization 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.
• Clearly, there needs to be supportive and facilitatory regulations to serve the public purpose of keeping health-care costs low and affordable.
• In regulatory aspects, expecting smaller facilities to meet the same standard would make it expensive for the smaller facilities, a cost that is likely to be transferred to patients, making health services unaffordable.
• There is a need for a differential approach for different types of facilities.
• Representatives of doctors’ associations and the types of facilities for which regulations are being formed should be involved in the process of forming regulation.

Focus on the primary-caregivers

• India needs to promote single doctor clinics apart from smaller health-care facilities, and nursing homes.
• These are what deliver primary care and contribute to keeping the cost of health care low. Every such facility and its doctors need to be supported rather than burdened with excess regulations.
• There is a need for fairness in implementations, time-bound decisions and renewal of licenses, promoting smaller health-care facilities with subsidies, and support for increased quality and safety.
  • India’s health-care system is already becoming skewed towards admission based in-patient services.
  • Promoting 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.
• This requires health regulations being drafted from bottom up and not top down, and implemented in a nuanced and calibrated manner.