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If we dont self-regulate, then the govt. will |
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If we dont self-regulate, then the govt. will
Dr KK Aggarwal,  13 February 2018
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There has always been a dispute whether healthcare is a commercial business or a social business. The first step in regulation of the medical profession was taken when the medical profession was brought under the Consumer Protection Act (CPA). Consequently, any medical service provided to the patient in the form of consultation, diagnosis and treatment came to be under the ambit of ‘service’ as defined in the CPA.

In several of its judgements, the Hon’ble Supreme Court of India has stated that costs/charges in the medical profession must be reasonable. In the matter of Samira Kohli vs Dr. Prabha Manchanda & Anr on 16 January, 2008, the Apex Court said, “28. But unfortunately not all doctors in government hospitals are paragons of service, nor fortunately, all private hospitals/doctors are commercial minded. There are many a doctor in government hospitals who do not care about patients and unscrupulously insist upon unofficial payment for free treatment or insist upon private consultations. On the other hand, many private hospitals and Doctors give the best of treatment without exploitation, at a reasonable cost, charging a fee, which is reasonable recompense for the service rendered. Of course, some doctors, both in private practice or in government service, look at patients not as persons who should be relieved from pain and suffering by prompt and proper treatment at an affordable cost, but as potential income-providers/ customers who can be exploited by prolonged or radical diagnostic and treatment procedures. It is this minority who bring a bad name to the entire profession.”

The word to be taken note of here is “exploitation”. You cannot charge more in an emergency. If you do, this may mean that you are exploiting the patient.

Earning a profit is required for sustenance. But should this justify profiteering? A very fine line separates the two, which must never be crossed.

The word “reasonable” needs to be defined. The govt. always wanted to cap pricing in the medical profession. Towards this end, the govt. introduced the Clinical Establishments Act (CEA) to regulate prices in health care, which was opposed by the IMA.

The govt. is now trying to control prices via TPA, CGHS, state government health scheme and now through the newly launched “National Health Protection Scheme” under the Ayushman Bharat initiative announced in the Budget on Feb.1, 2018. The National Health Protection Scheme will provide coverage of Rs 5 lakh rupees per family per year for secondary and tertiary hospitalization, but only under the ‘general ward’ category to about 50 crore beneficiaries. This scheme may be taken advantage of or exploited.

This means that the govt. may cap the prices for each procedure as it did under the Rashtriya Swasthya Bima Yojana (RSBY), a health insurance scheme for the Below Poverty line (BPL) families, which provided a coverage of Rs 30, 000/- per annum to beneficiaries on a family floater basis. Under this scheme, the govt. has framed indicative package rates for several interventions or procedures.

The only way health sector can be controlled is by way of re-imbursement.   Just as the HMOs have controlled healthcare costs in the US, insurance companies in India too may control pricing in India.

Two types of costs may be worked out; one, a reasonable’ cost, one which could be covered under the ‘general ward’ category as directed by the govt. and the other a ‘private’ cost, which is not capped and allows charging as per the paying capacity of the patient.

If we don’t self-regulate, then the govt. will. Then we may have no choice but to comply with the price cap that has been put by the govt.

 

Dr KK Aggarwal

 Padma Shri Awardee Vice President CMAAO Group Editor-in-chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA


Comments

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  • Dr Rahul Singh 14 February - 18:18 hrs

    so kind of medical regulator will definitely come in near future. self regulation is not a practical idea.

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  • Dr Shivajirao Holkar 14 February - 08:19 hrs

    Self regulation will definitely be a better choice.

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  • Dr Ashok Sirohi 13 February - 19:07 hrs

    Reasonable changes with standards of set up and cities. Attending emergency at unreasonable hours for hours cant be compared to giving consultation at fixed hours. Fee of a 20yrs experienced surgeon cant be compared to fresher. Why not concept of reasonable fee or for that matter CPA to advocate. Its ok for a private set up to display its charges for various procedures, some times range of charges.

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  • Dr Anil Poddar 13 February - 15:44 hrs

    I would agree totally that we should self regulate these, but we should also regulate the hospital charges, i.e. bed charges, investigation cost, biochemistry and radiology, and pharmacy charges and all the consumables, then only the patient will get benefit.

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  • Dr Bhaskar Diwan 13 February - 13:47 hrs

    It is true that professional ethics should regulate the profession , otherwise law will takeover

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  • Dr RAKESH GUPTA 13 February - 12:59 hrs

    rightly said sir....

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  • Dr KRISHNENDU TASHA 13 February - 12:04 hrs

    Very good thought sir.Only I can change my self .The health care system should be free of cost for every citizen.There must be Indian Medical Services like IAS who will run the show.

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  • Dr Geeta Chaturvedi 13 February - 11:57 hrs

    thought provoking

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  • Dr Dr Pradip Kumar Dev Mahanta 13 February - 11:55 hrs

    I agree with your observations. The rates defined in the categories should be uniform in the country.At present there are different rates in different states which is unfair.

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  • Dr selvarajan selvarajan 13 February - 11:29 hrs

    Dr Kk sir well said. Streamlining of both Govt and private health care cost is essential. Establishment in public health sector by the must be Result, growth, Heal oriented investment without growth is set back to economy.. Private sector investment icesvy not only growth profit. Speedy result. Facility comfort oriented. Self regulation is must..

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  • Dr Kamla Sharma 13 February - 10:58 hrs

    I agree with views expressed by you DrAggarwl .

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  • Dr Prem Goyal 13 February - 10:48 hrs

    Dr Aggarwal I agree with you. This way everyone gets same medical treatment at reasonable expenses in hygienic condition. As cost increases luxury increases, may be up to five star. I suggest that same criteria should be adopted for govt Hospitals with ashare to doctors and staff.

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  • Dr Yugeswar Patel 13 February - 09:13 hrs

    This issue a big controversy and I would advise e medinexus to keep itself away,or else it will burn its finger. You cannot isolate medical profession and leave legal,CA,Sportspersons ,actors,hotels ,musicians,social lecturers astrologers and so many others,who are charging racklesslywithout doing as much,even one tenth of doctors,with sincerity and seriousness. So better you should analyse this issue as a whole.

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  • Dr Raj kumar Mani 13 February - 06:20 hrs

    If the price cap is unreasonable it may destroy healthcare industry and may even encourage unethical practices. Govt should base pricing on exact coating allowing sustainability. It should not be arbitrary and populist.

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  • Dr Kaushal Singh 13 February - 06:16 hrs

    We must regulate ourselves But healthcare is Gradually going in the hands of Corporate

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  • Dr Govindarajan Iyengar 12 February - 22:57 hrs

    For the very poor, Emergency medical care can be given at door step / speedy evacuation through NGOs. The onus of deciding the POVERTY should be left to the NGOs and no political interference should be there.

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  • Dr Govindarajan Iyengar 12 February - 22:48 hrs

    There shouldbe a TWO / THREE - TIER sysytem. One for the below poverty line - where charitable organizations/Govt can make it ABSOLUTELY FREE with food and shelter. Second for the common man , the main bulk of the population who are economically independent to the extent that they can pay for their treatment with some caps on the high value procedures. The ELITE class of course will be wiling to shell out for the five star facilities - they require NO subsidies. If the economic status can be pre determined health planning would be that much easier. ROB PETER to PAY PAUL may not be entirely out of place here.

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