Syllabus
GS Paper 2 – Social Justice – Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.
Context
The recent fire incident in a private neonatal care nursing home in New Delhi highlighted systemic failures in health-care regulations in India.
Source
The Hindu| Editorial dated 7th June 2024
Health regulations need a base to top approach
Health regulations play a critical role in ensuring public health and safety. In India, the implementation of these regulations must be nuanced and calibrated due to the country’s diverse demographics, socio-economic disparities, and varying levels of healthcare infrastructure. Effective implementation requires careful consideration of these factors to ensure that health policies are both practical and impactful.
India’s Healthcare system
India’s health-care system consists of both government and private sectors, with the latter delivering about 70% of outpatient and 50% of hospital-based services.
Preference for Private Care
- Variety of Providers: The private health sector includes single doctor clinics, small nursing homes, medium-sized hospitals, and large corporate hospitals.
- Cost-Effective Care: Smaller facilities often provide essential health services at a fraction of the cost of large hospitals, making health care more affordable and accessible.
- Quality and Accessibility: Despite the availability of free government health services, many people prefer private facilities due to perceived better quality and easier access.
Regulatory Challenges in Indian Health-Care System
- Excessive Regulations:
- Multiple Approvals: Many Indian States require health-care facilities to obtain over 50 approvals under various regulations. This creates a cumbersome process for compliance.
- Overregulation Perception: Despite the plethora of regulations, there is a belief among officials and the public that the private health sector is inadequately regulated.
- Unrealistic Standards:
- Clinical Establishments Act, 2010: Enacted 14 years ago, this act is often considered impractical, with many states not adopting it due to its unfeasible provisions.
- Indian Public Health Standards (IPHS): First released in 2007 and revised twice, only 15-18% of government primary health-care facilities meet these standards, indicating that the regulations are aspirational but difficult to implement.
- Bias in Enforcement
- Unequal Penalties: There is a perception of unfair enforcement, where private facilities face harsher penalties compared to government hospitals for similar infractions.
- Example: In 2017, a private hospital had its license temporarily suspended for declaring a newborn dead when alive, while a similar incident in a government hospital only led to an inquiry.
- Approval Delays
- Sluggish Process: Private health-care facilities often experience significant delays in the approval process for renewals, even when applications are submitted well in advance.
- Operational Impact: These delays hinder the smooth functioning of health-care providers and contribute to systemic inefficiencies.
Recommendations for Improved Health-Care Regulation
- Formulate Practical Guidelines
- Health regulations should be achievable and practical.
- Harmonize existing regulations to reduce complexity and simplify the application process.
- Time-Bound Processing:
- Ensure applications for approvals and renewals are processed within a defined timeframe to avoid delays.
- Differential Standards
- Tailored Regulations: Implement different standards for various types of health-care facilities.
- Smaller clinics and nursing homes should not be held to the same standards as large corporate hospitals to prevent excessive costs.
- Meeting high standards can increase costs for smaller facilities, which might be passed on to patients, making health care less affordable.
- Involve Stakeholders
- Engage representatives from doctors’ associations, different types of facilities, and community members in the regulation formulation process to ensure practical and relevant regulations.
- Avoid Sensationalism
- Responsible Reporting: Political rhetoric and sensational media coverage can erode public trust in health-care providers and lead to increased violence against them.
- Media should focus on constructive reporting rather than sensationalizing incidents.
- Promote Primary Care
- Support Small Facilities: Single doctor clinics and smaller nursing homes are crucial for providing primary care and keeping health-care costs low.
- They should be supported rather than burdened with excessive regulations.
- Bottom-Up Approach:
- Regulations should be drafted from the bottom up, considering the practical realities of different types of health-care providers for effective implementation.
Conclusion
A fair and nuanced approach to regulation, along with support for smaller health-care facilities, can help ensure accessible, affordable, and high-quality health services. Promoting primary care through single doctor clinics and smaller nursing homes, and addressing systemic failures rather than just symptoms, is crucial for achieving the goals of the National Health Policy, 2017.
Related PYQ
Public health system has limitations in providing universal health coverage. Do you think that the private sector could help in bridging the gap? What other viable alternatives would you suggest? [ UPSC Civil Services Exam – Mains 2015]
Practice Question
Critically analyze the systemic issues in health-care regulations in India. [250 words]