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When can doctors charge fair rates?

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Dr Amandeep Aggarwal    04 April 2018

When there is no capping of compensation awarded by courts in cases of alleged medical negligence, how can there be capping over professional fees of doctors/ hospitals?

Dr Amandeep Aggarwal

Chairman, Action Committee-cum-Legal Cell, IMA-Punjab

Recently the statement of Punjab’s Health Minister that the state will soon adopt the Clinical Establishments (Registration and Regulation) Act to regulate private hospitals, on the lines of neighbouring Haryana has created consternation in the medical fraternity. While the Health Minister may have attracted appreciation from the general public, the doctors’ body -- the Indian Medical Association -- labels it as playing to gallery move by the ruling party.

On March 26, the Health Minister told the Punjab Assembly that the state government will soon adopt the Clinical Establishments (Registration and Regulation) Act in the state to regulate the private hospitals and their fees, on the lines of neighbouring Haryana. The Health Minister also said that he had discussed the matter with the Chief Minister and the state government would soon bring in the new law. The issue was raised by the Leader of Opposition in the Assembly.

Doctors are up in arms with their arguments and maintain that when the government is not doling out any subsidies or concessions to the individual doctors, it did not have the right to impose a cap on fees and other conditions. For individual hospitals, doctors purchase land at the market rate, pay electricity bills at commercial tariff, deposit all other local taxes and pay income tax without any special exemptions by Government. Moreover, there is no cap on compensations awarded by consumer courts against doctors and hospitals in case of alleged negligence. All other professionals such as advocates, architects, business and management consultants, plumbers, electricians, carpenters have the right to fix up their fees; how can the government do selected targeting of doctors alone? An advocate charges Rs. 5,000 as professional fees for the entire case, whereas another advocate with experience of similar number of years may charge in crores as engaging fees alongwith fees per appearance. And why not if people are ready to pay for his reputation and expertise? Health for all has been the unfulfilled aim of the government. As successive governments have miserably failed to build a decent medical infrastructure, the private sector began catering to healthcare demands of more than 80 per cent of the population. Through this Act, the government is trying to shift its responsibility on private doctors without extending any facility to them. Our Constitution enshrines right to life in its Article 21 that includes the right to livelihood too. How can government encroach upon the same? Corporate hospitals which enjoy the patronage of respective governments and also some subsidies in terms of concessional land allotments are most commonly the cause of embarrassment to the profession. Individual doctors and small size hospitals are already providing world class medical services at peanuts cost. This Clinical Establishment Act will only crush the small sized private sector whereas corporate hospitals will flourish and prosper. In the last 71 years of Independence, the government has not been able to check quackery which is one of the biggest challenges in modern day healthcare. Medical profession and doctors are already regulated by numerous acts and laws.

The previous Punjab governmnet had discussed the issue and decided not to implement it in Punjab as health is a state subject. So far, only nine states and UTs out of 29 states and seven UTs have adopted the Act. West Bengal recently introduced its own even more stringent Clinical Establishment act.

The Government maintains that except for the defence forces’ clinical establishments, the Act provides for registration and regulation of all other clinical set ups whether in the field of diagnostics or medical services such as hospitals. The idea is standardisation of protocols for treatment, fixation of the range of costs which hospitals can charge from a patient; regulation of standards of medical services and facilities. But clinics which enjoy political clout continue to violate the law and have convinced several states that the law is intrusive which it is not. In the absence of the law, hospitals and diagnostic centres continue to charge what they want for the same treatment or test.

If the government does not involve doctors’ body into its decision making process for health, the state may soon find doctors at the barricades as their tempers are already flared up due to contemplation of a National Medical Commission. Rather than encroaching upon private hospitals, the government has to set its own house in order by improving the standards of healthcare in its hospitals and set an example before private sector to emulate or compete.

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