By asking five prominent private hospitals in the national capital >to deposit nearly Rs.600 crore to compensate for their failure to treat poor patients , the Delhi government has drawn attention to the social obligation of healthcare providers in the corporate sector as well as the need for timely enforcement of applicable regulations. According to the Kejriwal government, trusts and registered societies to which public land was allotted to establish hospitals were required to earmark a percentage of their medical facilities and services for indigent patients. The administration is now moving against institutions that failed to comply with the provision. As early as in 2007, the Delhi High Court had acted on a public interest litigation to lay down that 10 per cent of inpatient facilities and 25 per cent of outpatient services be provided free of cost to the poor. The effect of non-compliance was the repayment of the allegedly “unwarranted profits” the hospitals had made. The hospitals that have now been fined dispute any failure to treat the required number of indigent patients and plan to challenge the order. While the courts will have the final say on the dispute, the principle of opposing profiteering in the health sector cannot be faulted.
The World Health Organisation (WHO) estimates that government accounts for only one-third of India’s healthcare spend — well below what is desirable. As a result, we have a situation in which the private sector accounts for a significant part of healthcare services. Given the low penetration of health insurance, about 86 per cent of expenditure on health comes out of people’s pockets. This strengthens the case for private hospitals to dedicate a part of their services to those who cannot afford treatment. However, there is no national legislation that makes this mandatory. In the case of Delhi, it is enforced as a condition on which land is allotted to private hospitals. Wherever such regulations can be legally enforced, it is best that they are monitored on a real-time basis and rigorously enforced. In the present case, it has taken years to assess the audited accounts of the hospitals and initiate action to recover their profits. Enforcing social obligations of private service providers must go hand in hand with other measures to achieve the real goals of health policy: universal health coverage and protection for all sections against excessive out-of-pocket medical expenditure.