Court’s nudge on hospital charges, a reform opportunity

The Clinical Establishments (Central Government) Rules, 2012 were crafted by the Central Government pursuant to the authority bestowed by the Clinical Establishments (Registration and Regulation) Act, 2010. These regulations serve as a framework for overseeing and registering clinical establishments nationwide. The Act and its accompanying rules are designed to guarantee that clinical establishments meet specific minimum standards concerning facilities, services, and pricing.

An integral aspect of these rules involves the designation of a Secretary of the National Council, typically a Joint Secretary within the Ministry of Health and Family Welfare. This official supervises the functions of the National Council, tasked with categorizing and classifying clinical establishments based on recognized systems of medicine. Moreover, the rules mandate the establishment of sub-committees to address particular tasks within the domain of clinical establishment regulation, ensuring representation from diverse sectors and regions.

Furthermore, the rules delineate minimum standards for medical diagnostic laboratories, stressing the importance of upholding quality and consistency in diagnostic services. Clinical establishments are also obligated to conspicuously display their service rates and adhere to pricing guidelines set by the Central Government, fostering transparency and affordability for patients. Additionally, compliance with standard treatment guidelines and the maintenance of electronic medical records are pivotal components of these regulations, aimed at enhancing the overall quality and efficiency of healthcare provision.

Turning to the factors contributing to escalating healthcare costs in India, several elements play a role in this phenomenon. The prevalence of a profit-oriented private healthcare sector often results in market-driven pricing, leading to inefficiencies and disparities in healthcare provision. Elevated out-of-pocket expenditures further compound the issue, with a substantial portion of healthcare expenses being directly shouldered by patients. Weak enforcement of laws, inadequate investments in public healthcare infrastructure, and the corporatization of healthcare also contribute to the upward trajectory of costs. Additionally, issues such as opacity in rate standardization and the proliferation of irrational healthcare interventions exacerbate the challenge of cost control.

To address these challenges, various measures can be undertaken to stem the tide of escalating healthcare costs in India. Formulating standard treatment guidelines can serve as a cornerstone for establishing benchmarks for price determination and ensuring uniformity in the quality of care dispensed. Additionally, comprehensive health financing reform strategies are imperative to align stakeholders' interests and tackle underlying systemic issues. Emulating successful models from states like Tamil Nadu and Rajasthan, implementing transparent rate standardization measures, and promoting rational treatment practices can also aid in mitigating rising costs. Furthermore, bolstering patients' rights and enhancing grievance redressal mechanisms are essential for safeguarding consumers and fostering accountability within the healthcare ecosystem.

Government Initiatives Related to Healthcare:
National Health Mission.
Ayushman Bharat.
Pradhan Mantri Jan Arogya Yojana (AB-PMJAY).
National Medical Commission.
PM National Dialysis Programme.
Janani Shishu Suraksha Karyakram (JSSK).
Rashtriya Bal Swasthya Karyakram (RBSK).
Increased Allocation for Health in Budget 2021.
PM Atmanirbhar Swasth Bharat Scheme.
National Digital Health Mission.
National Medical Commission (NMC) Act, 2019.
Pradhan Mantri Bhartiya Janaushadhi Pariyojana.

Conclusion:
The Supreme Court's recent observation highlights a significant opportunity to tackle a key issue within the healthcare system. It underscores the importance of implementing rate standardization policies that are not only practical and easy to execute but also adhere to established price discovery methods. These efforts should be built upon existing and ongoing health financing reforms, with a focus on engaging a wide range of stakeholders to ensure effective management of healthcare costs.

This editorial is inspired by 'Court’s nudge on hospital charges, a reform opportunity' published in The Hindu on 30/04/2024.