Why small hospitals in Kerala are opposing the Kerala Clinical Establishments Act

Pvt hospitals are required to display their treatment charges, ensure uniformity across establishments.
Why small hospitals in Kerala are opposing the Kerala Clinical Establishments Act
Why small hospitals in Kerala are opposing the Kerala Clinical Establishments Act

The Kerala government has sought to make private hospitals display their rates for their treatments, expanding upon the Kerala Clinical Establishments Act of 2017.

On Wednesday, State Health Minister K K Shylaja addressed the Assembly and stated that private hospitals would be required to display rates for treatments offered in a step to prevent exploitation of patients.

The bill which was passed earlier this year in February was welcomed by many who felt that it would help regulate the private healthcare sector, making hospital functions more transparent.

Some of the features which were listed by the Act include defining a minimum basic standard to ‘ensure uniformity’ across different establishments. In addition, it would require each establishment to display details of the charges and rates for treatments, in a visible manner. Furthermore, it has been stated that a registry will be maintained of all clinical establishments to help allocate resources and develop new policies. Registration will be undertaken as per guidelines established by the Act.

However, some members of the medical fraternity have spoken out about certain aspects of the Act which they feel would negatively impact smaller clinics and establishments.

Dr Sreejith N Kumar, founder Secretary of the Kerala Association of Small Hospitals and Clinics (KASC), spoke to TNM, “Kerala has achieved remarkable health status at a very small cost. The roles played by the clinical establishments in this is significant. Unfortunately, the small clinics and establishments are vanishing since last few years. On one side they are not receiving any patronage and on the other side more rules and regulations are coming which are strangulating them.”

He explained that at present, the National Accreditation Board for Hospitals and Healthcare Providers (NABH) set the grounds for what is considered a ‘gold standard’ in healthcare. “But NABH calls for clerical standards, it is not clinical standards. Clinical standards are determined by the health indices and Kerala has been giving excellent indices since last few decades because of these small institutions,” he said.

A healthcare institution is deemed to be NABH accredited if it meets the criteria set by the NABH, however smaller clinics which may not necessarily meet these criteria are still capable of providing quality healthcare.

“Kerala is known for its health model which is signified by good health care at low cost. This has been made possible due to various resource factors but the most important one is the huge network of small clinical establishments scattered throughout the length and the breadth of the state which are run by qualified MBBS doctors. They provide scientific quality care,” added Dr Sreejith.

The Act aims to introduce a minimum standard for all healthcare institutions, which will be classified into categories based on its size (number of beds) and the services and facilities rendered. The standards will vary according to the hospital’s assigned category. According to the Act permanent registration is offered to those institutions which have already gotten accreditations from National Accreditation Board for Hospitals (NABH) or the National Accreditation Board for Laboratories (NABL).

Dr Sreejith felt that the role of smaller hospitals and clinics has been overlooked and that the effects of such an Act would be largely seen in these sectors and that the larger private hospitals would not be impacted as much.

“The current bill is helping only the large corporate hospitals. In the name of setting standards, corporate hospitals are being helped. Insurance companies are favouring these hospitals,” he added.

Doctors representing KASC protested on Thursday marching to the Assembly and demanding that the smaller hospitals be exempt from the entirety of the act. According to leaders of KASC, small and medium hospitals, where people are able to easily access affordable healthcare in the state risk being closed if the Act is implemented.

“What we are trying to say is we want all the clinics and the hospitals with less than 20 beds, run by a doctor, should be exempted from the purview of this bill. On the other hand, the government in fact should facilitate these clinics and hospitals by giving aids to the employees, by giving subsidized equipments, giving concessions in power and water supply just like how they facilitate small industries,” said Dr Sreejith.

According to him, if the Act comes into effect, the state would see low quality healthcare system at high cost. “This will replace the current scenario we have, which is the good health care at low cost. We want to prevent this. Our strike was to send out that message," added Dr Sreejith.

Speaking about displaying costs for treatment at private hospitals Dr Sreejith said, “We don’t have any objections to displaying cost, as such we are running at low cost. But IMA (Indian Medical Association) has certain reservations on this. These cost displays are portraying health care as commercial ventures.”

He explained, “There are certain areas where you cannot charge. How much will you charge for diagnosing a fever? What about a situation in which a patient is to undergo a laparoscopic surgery and it has to be converted on surgery table into an open surgery? These are situations in which health services cannot be tagged like a commercial venture.”

Dr Sreejith asserted that if displaying costs at hospitals would restrict exorbitant pricing it was a welcome move, “The cost end of the day should be affordable to people,” he said.

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