A young girl who is suffering from a relapse of cancer is administered a dose of chemotherapy, without her parents being informed that her chances of responding positively to the treatment are negligible and the heavy medication could in fact put her in an irreversible coma. The inevitable happens and her parents who belong to an underprivileged family are bewildered and desperate for answers. Instead, they are slapped with heavy dues by the hospital that they now need to clear.

 

 

Such cases of gross malpractice and sheer exploitation of patients in health facilities in both the public and private sectors have unfortunately been rampant for many years. The media has been replete with instances of negligence, overcharging, corruption and supply of spurious drugs, shattering the faith of citizens in a profession which is supposed to save their lives.

 

 

This anger and frustration, at times, manifests in the form of physical violence against healthcare providers and damaging of medical infrastructure.

 

 

The National Health Policy released in 2017 recommends the establishment of an empowered medical tribunal for ensuring the timely resolution of grievances related to medical negligence and excessive charges. Recognising the gravity of the challenge, the Government has taken several initiatives, especially in recent years, to minimise instances of medical malpractice in the country.

 

During the implementation of the Pradhan Mantri Jan Arogya Yojana (PM-JAY), the health insurance component of the Government’s flagship Ayushman Bharat program, considerable priority is being accorded to putting in place strong grievance redressal mechanisms, social audits as well as fraud prevention, detection and control.

 

In fact, a working group of the Insurance Regulatory and Development Authority of India and the National Health Authority (NHA), was set up to focus on issues of malpractice and fraud control. As of January 2020, it is estimated that the NHA had imposed punitive action on 171 hospitals by de-empanelling them as well as imposing monetary penalty to the tune more the INR 4.5 Crore on erring hospitals.

 

Health insurance schemes around the world are prone to fraud and malpractice which makes these measures being put in place by the Indian Government during the initial years of implementation of schemes like PM-JAY extremely important.

 

Another key step has been the passage of the National Medical Commission (NMC) Bill, 2019 by the Indian Parliament. Under the NMC Act, every hospital will be mandated to declare an individual in-charge who would be legally responsible, in addition to the practising doctor, for ensuring ethical conduct in the facility. This information would be fed in to the central database and would be made available to patients who are faced with instances of medical negligence or malpractice. The Act emphasises the need for medical graduates to not only possess the requisite knowledge and skills, but also values that will enable ethical conduct.

 

The Ethics Committee constituted under the aegis of the Board of Governors which replaced the Medical Council of India prior to the passage of the NMC Bill, has already made an attempt to spot errors and fix the liability of doctors, in addition to determining the type of punishment to be given depending on the nature of the offence.

 

This effort was initiated to ensure uniformity in action taken against offending doctors by medical councils in different States across India. The process of obtaining feedback on this draft is underway.

 

Efforts are also underway to leverage technology for ensuring that unnecessary medical procedures are not thrust upon patients and that outpatient care does not get converted into inpatient care, in an arbitrary fashion, by hospitals.

 

The National Health Stack (NHS), for instance, proposed by NITI Aayog in 2018 is designed to offer a range of advanced technologies which can be incorporated into overall digital health implementation in India, enabling policymakers to also detect fraud in health insurance schemes, among other benefits.

 

There are several good practices around the world and in many parts of India that should also be carefully examined and implemented, wherever possible.

 

In Bolivia, for instance, the involvement of citizens as ‘watchdogs’ greatly helped with detecting corruption in healthcare provider services. Local health directorates, comprising government officials and citizen representatives, were established to oversee health facilities. Similarly, it has been found that instances of fraud ca be significantly curtailed through institutional checks and balances like comparing actual and expected revenue as well as conducting regular internal and external audits.

 

It is, therefore, imperative that citizens are educated about diseases, possible complications and approximate treatment costs. In some parts of India, Jan Sunwais or citizen hearings are organised to enable patients to report their experiences in the presence of Government officials, civil society and community leaders.

 

While Government initiatives are key, the private sector too must follow principles of self-governance to cleanse the medical profession of instances of corruption and exploitation. Most importantly perhaps, all stakeholders, be it the Government, private players or civil society need to invest extensively in citizen education and empowerment.

 

Healthcare is a field plagued by information asymmetry. The doctor always knows more than the patient and this is what makes patients vulnerable to exploitation in many cases. It is therefore imperative that citizens are aware of possible unethical practices and the recourse available to them.

 

Disclaimer: Views expressed are personal.