The Karnataka Private Medical Establishment (Amendment) Bill has been a source of protest and disruption of medical care in the state. The Karnataka government and the doctors' association appear to have come to an understanding over the weekend, with counterproductive price controls and a problematic grievance redress cell likely getting removed or reduced in scope.
While this is a welcome move, unfortunately, the challenges of private healthcare have not gone away. Karnataka and Bengaluru are fortunate to have a private healthcare industry that is comparable to the best in the world. While there is seemingly endless demand for healthcare, the state seems to have a competitive market of hospitals, diagnostic centres and other medical establishments that need to continue to grow in number.
However, the key market imperfection with healthcare across the world - be it public or private - is contestability and information asymmetry. Doctors and hospitals know more about treatment options and costs than patients do, and during times of emergency and duress patients and their attendants are not always in a position to make informed decisions.
Sometimes doctors and hospitals can suggest unnecessary treatment or get billed excessively. When such cases occur, patients can feel helpless, and at present, they have no recourse but a grievance redressal system that includes consumer court, the Karnataka Medical Council (KMC) and other legal remedies.
The big question in healthcare regulation is how to reduce patient grievances. The key to this is empowering patients with actionable information. The Amendment Bill makes a good start by bringing in a robust Patient's Charter of rights and duties but the charter is not followed up with implementation details.
The most important right mentioned is the right to seek a second opinion for any serious medical intervention. This is the best way to reduce overtreatment or unnecessary surgeries. We do not yet have a culture of taking second opinions, and currently, if you're admitted at a hospital, it is very inconvenient to go for a second opinion from a doctor in a different hospital.
The Bill also mandates transparency on prices for procedures, asking hospitals to publish prices of standard procedures. However, these measures do not go far enough. Minutes of a Department of Health and Family Welfare meeting from last year describe how there are over 4,000 listed medical procedures - no patient will be empowered even if each hospital lists the prices of these procedures in print and online.
We propose a strong Patient Protection Service. This is the missing link that can enforce patients' rights, help achieve transparency and allow patients to make an informed choice. Patients and their attendants can be lost, confused and afraid while making big decisions - and need a human touch.
The core of the Patient Protection Service is instituting Patient Protection Officers in all hospitals. These officers are independently employed by the service, can be hospital administration graduates and also MSW workers with special training.
The officers will have four broad functions. First, they must be accessible to all patients and make patients aware of all their rights, including that of seeking a second opinion and provide the right information. Second, the officers shall also provide cost information at the hospital and of competing places nearby. Third, the officers must collect and aggregate ratings and feedback on hospitals and doctors - from patients and doctors. They must also share ratings with patients so that they are made aware of their options. Fourth, the officers shall help patients file a grievance before the appropriate authorities in cases of overcharging, mistreatment, negligence or fraud. One officer is needed for every 150-300 beds in a hospital.
A 24/7 Patient Protection helpline on phone and social media must complement the in-hospital Patient Protection Officers. The helpline is necessary to serve outpatients and patients at smaller clinics and diagnostic centres, as well as patients who are looking to see where to go. In addition, a helpline is available as a substitute for patient protection officers, in case they are not dispensing useful advice and support.
Patient Protection Officers can reduce patient grievances and thus make hospitals a better working place by defusing conflicts before they arise. The officers can not only inform patients of their rights, but also of their duties. With a functional protection service, hospitals could face less litigation and fewer prolonged fights with irate patients and families, as these officers nipping the problem in the bud.
While independent officers may initially feel intrusive for hospitals, they can actually help hospitals become safer, happier and more effective places.
For the Patient Protection Service to work, it needs the KMC, private hospitals' association and the Karnataka government to work together closely, to develop information systems, software and training for the officers and staff. To finance the venture, the hospitals association and the government could share the costs and independently pay the staff involved. The Patient Protection Service can be an instituted as an independent trust that is co-managed by all stakeholders mentioned, as well as have patient representatives.
The officers can also be rotated frequently between hospitals in a city such that they do not become compromised by individual hospitals. The Bill will also need to be amended to mandate strong price disclosure standards for private medical establishments. Hospitals need to electronically share price ranges of standard procedures and tests, update them every quarter, and the Patient Protection Service can aggregate the prices.
In all, the focus of any private healthcare regulation in Karnataka will have to focus on empowering patients to be able to take good decisions and reduce the ability of hospitals to mistreat patients. A strong patient protection service can achieve both.
(The writers are researchers at Takshashila Institution)