Medicare : Towards Regulation

Historically, the private sector in India remained invisible to the state. Not until the mid-1980s did the state planners sit up and start taking notice of the rapidly growing health care infrastructure in the private sector. While public health services came under state regulations, private nursing homes and hospitals were expected to be registered under legislation specially enacted to cover them. Unfortunately, few states passed such laws and as a result private institutions were only registered as services places with little or no regulatory obligations. Even in the state which did pass the necessary law, such as Maharashtra, because of the absence of accompanying rules they could not be implemented. And if all these conditions were extant, there are no monitoring mechanisms to even check that all health cares institutions have indeed registered under the act. As a result even an estimation of the private sector, remains even today a good guesstimate combining the results of a variety of surveys and studies and the 'official' registers. How in this undefined environment can any agency assure quality of care? Poor, indifferent medicare, unethical practices, gross negligence have all been features of private care, at least as much as it is in the public hospitals. But while the latter could be held accountable at some level, private institutions are a law unto themselves.

On paper there is a regulatory body of sorts – the Medical Council of India. It is charged with ensuring ethical behaviour and practice of medical professionals whom it licenses , renewing them regularly. Complaints of negligence may then be brought before the state councils and the doctor may be debarred from practice. Not a single such action has been taken by the MCI on grounds of negligence in its 44-year old existence.