Reform of the healthcare system is a major priority for governments virtually everywhere. The approval given by the Union Cabinet for the Clinical Establishments (Registration and Regulation) Bill, 2010, comes at the appropriate moment. Several expert committees have pointed out the parlous state of healthcare in India, which results in impoverishing expenditures for millions of households. Shockingly, only 10 per cent of Indians are estimated to have any form of financial cover for health. Moreover, about 70 per cent of health spending, as estimated by the 60th round of the National Sample Survey, is out-of-pocket. While the important questions of equity and access need to be addressed with higher spending, a key measure that can bring about change in the provision of care is the recognition of the patient's rights. The rights of patients are recognised by the World Health Organisation as a part of the Universal Declaration of Human Rights; the state and the physician are both obliged to respect them. What will make these rights actionable is a regulatory framework that is genuinely empowering. Any new law must contain unambiguous provisions for patients to be informed, in a standardised, written format. That would include the treatment choice for their condition, the risks and costs involved, as well as the alternatives. In the case of medical procedures, the experience of the doctor and the outcomes at the hospital should also be documented for the patient's benefit.
The informative model of patient rights, widely adopted in the developed world, can be readily applied in all settings where the care sought is elective. In emergencies, a system where the doctor unilaterally makes a choice in the best interests of the patient, who is unable to participate, would seem appropriate. The importance of a statute that empowers patients cannot be overemphasised, against the background of rising, out-of-pocket costs. The emphasis on costly health insurance plans operated by for-profit companies to cover catastrophic expenditure necessarily requires that patients are made part of the equation when costs are determined. They have no scope to participate now because hospitals and insurance administrators decide, through an opaque system, the treatment protocol and expenditure. Obviously, in such a system, informed consent by the patient is ruled out. Potentially, patients can benefit if the accreditation process launched by the National Accreditation Board for Hospitals and Healthcare Providers goes about its task sincerely. The ability to assert the patient's rights will, however, depend on total transparency in public and private healthcare institutions, rigorous benchmarking of treatment, cost control, and good regulatory oversight.
