Supreme Court directive on hospital rates welcome

The Supreme Court’s directive to the central government to ensure enforcement of the 14-year-old Clinical Establishment (Central Government) Rules underlines the need for affordable medical care for all those who need it. The rules mandate notification of a standard rate for various medical treatments and procedures, subject to certain conditions and in keeping with the living standards of different regions. But the mandate is hardly followed by medical establishments. There is considerable discrepancy in the prices of medical treatments across private medical facilities. Treatment at private hospitals is beyond the reach of many. The central government told the court it had received no response from the state governments in the matter though it had taken up the matter with them. The court has warned that it would consider implementation of the standardised rates prescribed by the Central Government Health Scheme (CGHS) if the government failed to find a solution. It has asked the Union Health Secretary to convene a meeting of state health secretaries to ensure that standard rates are notified within a month. 

The court’s initiative was in response to a PIL that sought regulation of fee structure for patients. The court was urged to direct the government to notify the CGHS rates as an interim measure. There is no doubt that the cost of medical treatment should be brought down. Healthcare inflation has been very high in the country and it is estimated to have risen by 9.6% in 2023 and is expected to rise by 11% this year. This is much higher than the overall inflation rate. The National Health Accounts have reported that over 47% of the total medical spending has been done from people’s pockets. Health insurance coverage is very low. The Ayushman Bharat scheme has many flaws and does not benefit even some very deserving people. The general insurance industry has recently launched the ‘Cashless Everywhere’ scheme, which entitles a policy-holder to receive treatment from any hospital in the country. But it is facing problems because hospitals do not have standardised rates for similar treatments and there is resistance to it.

The private healthcare industry is very strong, and it is entrenched everywhere as a vested interest. The industry has strong links with politics and government. Many politicians are directly involved in the medical education and hospital sectors. The fact that the rules were not implemented for 14 years and that the government expressed helplessness about it is proof of that. The private medical establishment attributes the high costs to better infrastructure and services that they provide, but that is not always true. It is anybody’s guess whether the court’s directive now will help to make a difference.