Healthcare activists and patient advocacy groups in the Capital have given a cautious welcome to the Delhi government’s long-awaited move to regulate the functioning of private hospitals and restrict their profit margins though many remain sceptical of its effective implementation citing legal hurdles.

According to a draft advisory issued by the state government on May 29, the profits on medicines and consumables at private hospitals and nursing homes in the National Capital Territory is proposed to be capped. Such products could maximum cost 50 per cent more than the purchase price or equal to the MRP, whichever is lower. Though State Health Minister Satyendar Jain has hinted at amendments to the Delhi Nursing Homes Registration Act of 1953 to incorporate these clauses, the legal issues involved in such statutory changes leave many in doubt.

The Delhi government had formed a nine-member panel, which included members from the Indian Medical Association and the Delhi Medical Council, in December 2017 to look into profiteering by private hospitals and the draft guidelines are prepared on the basis of its recommendations. The authorities have put the draft advisory in the public domain to invite objections and suggestions within 30 days. A final set of norms will be crafted on the basis of these inputs.

“It is a step in the right direction. But we have to wait and see how much of these guidelines are applicable. They can expect a slew of lawsuits from hospital promoters. The Delhi Nursing Homes Act is toothless. They have to make numerous amendments to implement these guidelines. It is going to be an uphill task,” Birender Sangwan, the activist lawyer who filed the public interest litigation in the Delhi High Court that led to price capping of key medical devices, told Pharmabiz.  

The Delhi government has been promising to implement Clinical Establishment Act (CEA) which will apply to registration and regulation of all clinical establishments. Recently, in a letter to the chief ministers of all states and Union Territories, the Union Health Minister JP Nadda had said that effective implementation of the CEA would deter clinical establishments from indulging in unethical practices. “It would have helped the government act tough on scores of diagnostic centres and pathology labs in the city. The Act has taken effect in Arunachal Pradesh, Himachal Pradesh, Mizoram, Sikkim and all Union Territories except the NCT of Delhi,” Sangwan opined.

While accepting that the Delhi Nursing Homes Act is ineffective, some healthcare activists point out that the CEA is equally ineffectual as it also lacks provisions to check hospital rates. “Even if the state government adopts the CEA, they would need to amend it to introduce these kinds of measures, which won’t be cleared by the Lt Governor. So the state government will issue an advisory but none will need to comply with it,” Malini Aisola of All India Drug Action Network (Aidan) pointed out.

Aidan, a consortium of NGOs in the health sector, has cheered the Delhi government’s “progressive” step stating that it signals a “paradigmatic shift in governmental thinking”.

“We welcome the proposed measures to lower the costs of treatment and bring more transparency and accountability to private healthcare services in the NCT. But we are afraid that the measures need further careful consideration and legal vetting to ensure they do not get stuck in courts. This kind of reform requires a statutory mandate, which could come through substantial modifications to the Delhi Nursing Homes Registration Act 1953, the Act under which these measures are sought to be brought into force. Failing that, an entirely new Act would be required in order to accommodate the measures proposed. In the absence of such legal cover, we are afraid the Delhi government's good intentions will be of little or no avail,” Aidan said in a statement.

“But because of the evident difficulty that the Delhi government has in passing legislation due to the Centre's drive to frustrate any initiative of the state government, it appears to have had no choice other than to go through a route which is unlikely to succeed. It is unfortunate that a state government that is interested in acting to the benefit of patients is forced to intervene in an ineffective manner, even while the Centre refuses to take any meaningful steps towards regulating private hospitals or lowering the prices of medicines and consumables,” Aidan added.

The draft advisory also proposes a 50 per cent waiver on the total bill if a patient dies within six hours of being admitted to a hospital’s emergency or casualty wards. And if a patient dies within 24 hours of admission, 20 per cent of the bill should be reduced. Hospitals won’t be allowed to refuse releasing a deceased patient’s body if the bill has not been paid the protect ‘dignity of the dead’. The guidelines also moot increased transparency in the way hospitals offer packages. If a patient requires additional procedures after being admitted for one surgery, the second surgery should have a 50 per cent discount.