By Dr M Kamath Ammembal
MD, DGO, DNB, MRCOG
Mangaluru, Nov 14: The KPME (Karnataka Private Medical Establishments) Act amendments have been in the limelight for the last 2 weeks due to strong opposition from private medical practitioners. An open debate is essential to understand the issues both from public and doctor’s perspectives.
First of all, let us understand the background for the government’s purported intentions to amend the act which was originally enacted in 2007 with a view to regulate private medical establishments. It is supposed that there is a significant socio-economic disparity in the society preventing citizens from deprived backgrounds from accessing the highly advanced healthcare available in private hospitals. There is a suggestion that private medical establishments are charging exorbitantly and unscrupulously thereby causing severe hardships to the common man.
There is a perception that treatments are being recommended recklessly, resulting in complications and in some cases, death. Overall, the government suggests that private medical establishments have been insensitive to the plight of the poor. The amendments aim to set these problems right by imposing severe penalties and even imprisonment if the doctor concerned has been found negligent. The amendments provide for "capping" the rates for treatments, investigations and charges. An appellate will be formed at the district-level to provide "immediate justice" to aggrieved patients. This appellate will comprise members from local governing bodies as well as an AYUSH doctor.
The doctors in general and private medical practitioners in particular, are vehemently opposing the amendments for several reasons. Private medical establishments come in several categories starting from stand-alone clinics to high-end multi-speciality corporate hospitals. Vast majority of establishments are small to medium nursing homes and hospitals which cater to 70% to 80% healthcare in the state according to various estimates. Most of these establishments are owned by doctors themselves who would have taken huge loans to purchase land, construct the building, purchase equipment and install infrastructure. Many of them will have to pay EMIs for several decades. Simultaneously, they have to appoint and maintain staff as well as pay decent salaries to prevent attrition. In addition, healthcare sector is a rapidly progressing field with new developments coming up almost everyday. To keep oneself up-to-date, one has to subscribe to journals, attend (expensive) courses and conferences as well as regularly invest in new equipment. In other words, running a successful practice is an extremely expensive and intensive project for a professional from middle-class background. There is practically no help and support for these doctors-cum-entrepreneurs from the government.
For the above reasons, healthcare in the USA is completely dominated by the insurance industry. In the absence of insurance, one would not have access to any healthcare except for the most basic provision. In the UK where I worked for several years before returning to India, private healthcare is practically non-existent as the British Government takes almost complete responsibility for health of the country through National Health Service (NHS). NHS hospitals are some of the best in the world, equipped with ultra-modern equipment and skilled nurses and doctors. One would get excellent care irrespective of socio-economic background. However, it is important to bear in mind that the government has prioritised health over everything else. The situation in Scandinavian countries is even better. Private doctors in India are doing what NHS in UK is doing, albeit at a much smaller level. They may not always be doing an excellent job because they are after all ordinary humans and not governments with near-infinite resources at their disposal.
Human body is a mystery and it is often difficult to predict how it will react to a particular treatment even when a highly experienced clinician is treating the patient. In the event of complications or death, doctors in India have to often deal with physical violence, which is unheard of in the western world. Any death or complication in the UK is investigated and analysed by highly respected bodies such as the General Medical Council who have the necessary knowledge and experience to deal with same. Whilst it is absolutely essential that any negligence on the part of doctors has to be dealt with severely and appropriately, it should be done fairly and by a body which has the necessary understanding of the nuances of clinical science.
In summary, many of the concerns which the public and the government have are valid. They need to be addressed in a calm, systematic and dispassionate manner if we are really sincere about achieving health indices comparable to developed world. Blind and brutal legislation, that too targeting the very foot-soldiers who are providing 80% healthcare in the state will only lead to long-term deterioration of health of the state of Karnataka. In the next part, I shall address the possible long-term consequences of the proposed amendments and how to co-opt private entrepreneurship to overcome the serious health deficit suffered by the people of Karnataka.
About the author: Dr M Kamath Ammembal is a consultant gynaecologist with keen interest in public-private partnership in achieving health indices comparable to the developed world. He was a consultant at Hinchingbrooke NHS Trust, UK, before returning to Mangaluru and setting up Ammembal Women's Health.