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Updated: July 31, 2011 23:10 IST

Getting for the poor their due in private hospitals

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S. Viswanathan
The Hindu
S. Viswanathan

The recent direction of the Supreme Court of India to government hospitals in Delhi to refer poor patients to private hospitals gains significance not only as one more pro-poor judicial pronouncement but also because it highlights one of the major contradictions in India's health care service: even as there has been a mushrooming of huge, well-equipped, multi-discipline hospitals in big cities serving the rich, thousands of rural India's poor patients have to go without even a semblance of medical care when they desperately need it.

A two-member bench of the apex court comprising Justice R.V. Raveendran and A.K. Patnayak said that private hospitals would provide the patients from the crowded government hospitals necessary treatment free of cost, pending the preparation of a scheme that would involve private hospitals in treating the poor. It is perhaps to find out how far the private hospitals are right in claiming that if they provide total free treatment to the poor they would become bankrupt. When one of the counsels of the private hospitals told the court that nobody was occupying the beds allotted for the poor, the Bench responded stating, “It means you are not welcoming anybody.”

The Bench was hearing an appeal filed by private hospitals against a 2007 judgment of the Delhi High Court, which directed the private hospitals to ensure free treatment to 10 per cent of in-patients and 25 per cent of outpatients. The High Court ruling made it mandatory for private hospitals on the ground that they had received subsidised land after giving an undertaking that the hospitals they built would provide free treatment to the economically weaker sections of the people.

The Supreme Court directed the Delhi government and the private hospitals to draw the necessary modalities for the purpose. During an earlier hearing of the appeal, the court came down heavily on the private hospitals. Stating that they behaved like “star hotels,” they were highly critical of these hospitals for collecting abnormal charges from the poor. They also took strong objection to their failure to honour their word and violation of the condition that the poor be given free treatment.

The Supreme Court's bold initiative should enthuse social activists, political parties, and the media to carry the message that there is an urgent need to strengthen the public health security system in the country so that deprived sections of the people could have greater access to medical assistance in time. Only recently Nobel laureate Amartya Sen warned that gigantic inequalities in access to healthcare would lead to poor health in general. Commending the splendid work done by human rights activist, Dr. Binayak Sen among tribal people, he said that inequality in access to healthcare was not only bad distribution of the overall health benefits; it also reduced the overall health benefit.

Practical, valuable suggestions

Many readers, in their response to the last column (“RTE: States can still do it with media backing,” July 18, 2011), have come out with practical suggestions to get the RTE enforced in its true spirit. Dr. A. Padmanabhan, a former Governor of Mizoram with long civil service experience, highlighted in his letter the urgent need to give adequate attention and importance to elementary education. His five-point suggestion will be of value to educational administrators in their efforts to put the school education back on the rails.

First, free night coaching classes for rural students could be organised by NGOs and others. Such classes were conducted by Village Development Sabhas or Sangams in the 1950s and 1960s. Secondly, frequent parent-teachers meetings could help everyone understand the needs of students and guide them on the right lines. Thirdly, a separate elementary education inspectorate must be set up in each Education District under the overall guidance and supervision of the District Collector and the District Education Officer. This inspectorate should visit schools more frequently, check on attendance, and ensure availability of the needed facilities, including mid-day meals. Fourthly, all elementary schools should have an adequate number of teachers and attendants. Finally, the media, NGOs, and public-spirited persons could play a vital role in addressing problems such as the high dropout rate, the poor quality of education, and non-fulfilment of the constitutional mandate that free and compulsory education be given to all children under 14.

Saji V. Nair (Kochi) emphasised in his e-mail that the States should provide free primary education to children, now that they could afford to do it without private sector help. Kerala's commendable achievement in this field was possible thanks to the vision of its political leaders. Government-run and state-aided schools also deserved acclaim for this. He also suggested a common curriculum for schools across the country.

Referring to the dearth of qualified teachers, Ritvik Chaturvedi (New Delhi) commented that the institution of teaching had been degraded to such an extent that teaching as a profession had become the last option for highly educated persons. Corruption and irregularities in examinations had devalued classroom teaching. Poor students found it difficult to study under such circumstances. In States such as Chhattisgarh that were affected by terrorist organisations, schools were being used for stationing policemen, he pointed out.

S.V. Venugopal (Chennai) in his e-mail saw the issue from a different perspective. He commented that the neo-liberal supporters targeted the school education with ulterior motives because they were fully aware that it was elementary education that shaped the future of children. Hence blatant commercialisation of education began at the pre-school level, he stated.

Is there is any probation or law ,that a hospital first do the treatment then they may demand the money?
supriyo Bhattacharjee,

from:  supriyo Bhattacharjee
Posted on: May 12, 2012 at 18:22 IST

The supreme court of India has now given a verdict in favour of the suffering poor in our land. Aravind hospital at Madura has already given the lead in giving free treatment to the poor since 1984 and many private hospitals in our country should be in a position to follow that model. The govt hospitals in the country are overcrowded with patients and considering the verdict of the Apex court, the govt can think of legislation as well , to guarantee free treatment by the big private hospitals in India initially. If Aravind hospitals can treat sixty percent of the patients freely( source.Fortune at the bottom of the pyramid by. C.K.Prahlad) other hospitals can follow the same route in medical service.DR Amartya Sen stresses mainly on medical services to the poor and increase of literary levels for the countrys growth,and the lawmakers should take the clue from the SC decision.

from:  C.p.Chandra das
Posted on: Sep 13, 2011 at 10:10 IST

the article brings out social consciousness and urge to do something to lessen the problems.

from:  mohor
Posted on: Aug 10, 2011 at 16:57 IST

Govt strengthen govt hospitals and govt schools and provide require funds for the effective functioning of these institutions. At the same time govt institutions provide these facilities to the affluent sections at cost thereby burden on the govt will be reduced to that >extent. Private hospitals using govt subsidies but they are not extending the derived benefit to the downtrodden people. Osmania and Gandhi hospitals once very good hospitals provided free treatment to all sections of society Now they donot have good diagnostic infrastructure nor personnel to operate those instruments. Govt should review their policies that they strengthen govt institutions particularly primary health centres primary & higher schools instead of providing funds to private sector and ask them to extend free treatment to the poor people.

from:  M R K J Prasad
Posted on: Aug 6, 2011 at 21:14 IST

I myself am a doctor practised in India and now in U.K.I don't agree with Mr.Sastry the advanced medical equipments has made wonder in the clinical outcome.All the modern equipments especially in India is only to make money and doesn't have a great impact on the health outcome in general. Only those people who have charitable mind and want to spend their surplus wealth to the humanity should come to health industry. Because health industry has a humane touch.When christian missinories can run their hospitals for centuries,I don't see any reason why others can't run it.Indian government should make it compulsory that poor can get admitted in any hospital but govt. should pay all the disposal cost including medicines.If people really want to earn money there are so many profession like land grabbing, politics, swamijis, prostitution, drug trafficking, lending money for high interest,kidnapping most of this are accepted in India by political elite, but certainly not health industry.

from:  R.Manivarmane
Posted on: Aug 5, 2011 at 14:18 IST

Thanks Mr. Viswananathan for focussing this article on the judgement of the SC and emphasising the need to come out with a scheme to make the right to quality health accessible to the poorest of the poor of this country. In a country where the right to health is a fundamental right, it is time the state starts thinking about a 25% reservation to weaker sections and disadvantaged groups from the immediate neighbourhood of the hospitals to be entitled to free health care in private hospitals as the right to education has been made in all private achools under the RTE 2009. At least in the case of emergencies as in the case of the EMRC in Andra Pradesh, where the first 24 hours of a patient in any hospital to whom the patient is rushed is made free, the TN government should ensure that this is also enforced in Tn in the cases of all medical emergencies rushed to the nearest hospitals for the first 24 hours.
SR for RTE in TN of the National Commission on Protection of Child Rights.

from:  Henri Tiphagne
Posted on: Aug 4, 2011 at 06:57 IST

Neither the article nor the judgments are practical. It has become fashionable for every one to say that heath care has become commercial. What exactly they mean by it. More fundamental than health, hunger and thirst would kill people if not fulfilled. Then why are people selling food and water. We don't you find problem with any one for not providing safe drinking water or enough calories to every one. No one find fault when food and water are sold but they find fault with selling health services? Can some one impose that hotels should give free water and food to all the needy? What exactly they mean by giving free heath care. No one goes in to the nitty gritty of the costing of health services but every one wants to criticize the heath care industry. Every individual and industry wants to make money but not doctors and hospitals in spite of huge investments they make in terms of time and money respectively. Yes, the profits should not be unreasonable but one should know that medical technology itself is advancing so much and it is becoming more and more costly. Yes it won’t cost much to prescribe few medications without doing any tests, close monitoring or surgical or other invasive procedures. Without using all the advances in Medicine, clinical outcomes will be poor. Sophisticated and advanced health care needs investment. The health care industry has to spend money on equipment, their operational costs, land costs, water, electricity, man power costs and so on. Who will pay for all this? Investors expect dividends, professionals after years of burning mid night oil and long working hours would need proper remuneration, and employees proper salary. An MBA or even a soft ware engineer, often with much less intelligence and hard work can get a fat pay check but doctors should not get. If investors do not get reasonable returns, then no one would like to invest in health care industry and society as a whole would suffer. If heath care industry does not earn even marginal profits, there can’t be any further expansion or growth. Even to sustain at the same level, one has to earn profits. The extremely poor performance of government in developing health care delivery is well known. I don’t think that beaurocracy and the executive wings of the government have any moral right to criticize private health care industry. If one wants to kill even private sector by this kind of comments, judgments and articles - better be aware that society as a whole would be deprived of advanced health care systems. It is high time people realize that heath is a purchasable commodity and stop demonizing the hospitals and medical professionals. Please don't kill the goose that lays golden eggs.

from:  B K S Sastry
Posted on: Aug 3, 2011 at 19:33 IST

Thanks for such a nice article and making the people to know about the high court decision on hospitals and thanks for Hindu for bringing it notice to the public. Even though this decision helps the poort first of all we (the ppl or govt) need to concentrate on increasing the facilities in the Govt hospitals and Govt schools.

from:  Pavani
Posted on: Aug 3, 2011 at 15:05 IST

Anay, very well said. I also am disheartened by public apathy and though legislations and court orders are encouraging, the matter again boils down to implementation. Just as an example, in the town of Dehradun where I work with slum dwellers and homeless migratory families, we were offered free pre-natal and post-pregnancy care by one of the best doctors here. We took a 23 year old anaemic woman who weighed 42 kgs in her 7th month of pregnancy. However, during her first visit and stay at the hospital, the staff there treated the couple so terribly; things like asking them to bathe and come (this to a couple who does not have access to water, running or standing), snubbing them when they asked a question that our woman refused to return there even for the best treatment from the best doctor. Our poor in many instances do not constitute vote banks and so we need an active and sympathetic 'affluent class' to raise voice and demand rights with the poor.

from:  Shweta Kakkar
Posted on: Aug 2, 2011 at 20:57 IST

Though i agree in principle that there is a general disregard within the government and society to extend quality health care service to the poor, there are statements in the piece which i disagree with. 1. There is no 'inherent contradiction' in India's health care service. The reason is because India does not have a health care service. What you are referring to is healthcare 'industry', and if so then there is nothing contractictory in pursuit of profit. Unethical? may be. 2. The order of SC to direct government hospitals is toothless. I disagree with the fact that government hospitals have hitherto been disinterested in referring poor patients to pvt hospitals. They may have been ignorant about it,or hesistant to refer since if such referrals are refused by the pvt hosp then it puts the Doc in bad light. The Supreme Court would have done better by ordering the govt media agency and requesting other media agencies to carry out publicity of existence of such policies. 3. I think the entire focus of healthcare reform in India is misguided. We keep hearing and reading that the government is trying to intrude in private healthcare space and make some arrangement for treatment of the poor. This, in my opinion, is a 'compromise' approach to the problem. It stinks of the understatement that we cannot build a quality public medical infrastructure system ever.
That aside, assuming all pvt hospitals loan a part of their services to the poor as a part of policy, the sum total of this service will still be insufficient to address the medical concerns of the poor. The debt which the state may incur in the life of policy is a different matter. So, why don't we focus on creation and improvement of public medical infrastructure? The political apathy towards taking bold and concrete step is striking. The public apathy, disheartening.

from:  Anay Shukla
Posted on: Aug 2, 2011 at 12:20 IST

Thanks S Viswanathan and the Hindu for highlighting innovative judgement of the Supreme Court to provide treatments to poor patients in private hospitals. Earlier the Delhi high court has had also directed the private hospitals for such treatment on quota basis in percentage . Some time it is really heartening SC delivers some judgements on social issues aflicting the poor in India instead of making oral observation, lambasting govt, people ignoring such observations must come up in writings. SC has rightly directed the govt to prepare modalities for such treatment to poor free of cost. Sc has rightly snubbed the private hospitals lawyers not to create hurdles in providing specialised treatments to poor in private hospitals on humane approach and made it clear that private hospitals are functioning like 'star hotels'. Private hospitals must think their social responsibility and to come to recue of poor in the country. blog

from:  Krishn Kumar Singh
Posted on: Aug 2, 2011 at 11:36 IST

Now a days healthcare and education have become hot commercial commodities. Both these fields are important for survival of mankind. forgetting the future of mankind and the survivability , the people in these areas run after money. they lack wisdom but only look for wealth. only rich can afford and access to reasonble meical treatment and good education. Hence private hospitals and private educational institutions should volunteer themsevles to serve the poor and needy people so that the rich and poor divide can be bridged.

from:  Raghavan
Posted on: Aug 2, 2011 at 08:08 IST

A welcome judgement in all respects.It is yet to see how it becomes practical.In another judgement the SC ordered to stop mining in Bellary district.But the mining goes on unabated.Is there any mechanism to oversee it?

from:  Parameswaran Nair
Posted on: Aug 2, 2011 at 00:14 IST
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