Regulation of Private Healthcare Institutions

In the year 2015, the Government of NCT of Delhi decided to standardise the services, charges and norms for all medical establishments across Delhi. The lack of a strict regulatory mechanism had led to the rise of corrupt practices, irregular and irrational charges in private healthcare facilities, poor quality of equipment, untrained or non-certified staff and lack of accountability of private establishments. The existing law, the Delhi Nursing Home Registration Act 1953 was outdated and lacked the teeth to curb the large-scale corruption that plagued the medical sector.

As such, the Dialogue and Development Commission (DDC) worked round the clock to develop and draft the Delhi Health (Standards and Care Quality) Bill in 2015 and revised it in 2016. While drafting the bill, the DDC took into account the perspectives of different stakeholders involved and the impact that the bill could have on the society and economy by regulating the profit-maximising motive of private health businesses. The idea was not against private hospitals making money but to draw a line between profiteering and protecting the rights of citizens seeking health services at these institutions. The Delhi Health (Standards and Care Quality) Bill 2016 recognised the gaps in the healthcare delivery system and planned to introduce several provisions to support patients against higher margins on drugs, and devices, excessive charges on services and unethical practices.

Recommendations
 

1. Recognised Clinical Establishments:
   
   The Delhi Health (Standards and Care Quality) Bill 2016 recognised all such places and institutions that offer services, and facilities requiring prevention, diagnosis, treatment, or care for illness, injury, deformity, abnormality, dental care or pregnancy. It includes all public and private healthcare institutions except armed forces healthcare establishments.

2. Delhi Health Standards and Care Quality Council:
   
   The Bill mandated the constitution of a Delhi Health Standards and Care Quality Council to determine the standard for clinical establishments; classify clinical establishments into different categories; safeguard the interests of patients and health care providers; conduct the medical, clinical and social inspection and audits of the clinical establishments and take the necessary action as prescribed, amongst other important functions.
    
3. Maintenance of Minimum Standards:
   
   The Bill also mandated for the Delhi Health Standards and Care Quality Council to be responsible for the registration of clinical establishments, enforcement of compliance with the provisions of the Act, ensuring maintenance of the minimum standards, call for periodic reports from registered clinical establishments, investigate complaints of breach of the provisions of the Act or the rules made thereunder and take appropriate action like cancellation of registration if deemed necessary.
    
4. Research and Data Analysis:
   
   The Bill empowered the Council to conduct research, gather data and evidence and draw analytical reports on important public health and safety issues, incidence and spread of diseases, cost towards healthcare incurred by users, malpractices of healthcare establishments, the requirement of personnel, services and others resources that are crucial for the healthcare delivery system.
    
5. Registration, Certification and Grievance Redressal:
   
   The Bill contained provisions regarding norms for registration of clinical establishments, conditions for registration and continuation, the procedure for application, certification and validity of provisional and permanent registration, an inspection of registered establishments, and setting up of a grievance redressal mechanism.
    
6. State Unified Information System:
   
   To adopt the latest technological advancements in the health sector, the Bill provided for the development and maintenance of a State Unified Information System for the purpose of collection and storage of data and information, ensuring transparency in the functioning of hospitals, creating a database of all healthcare establishments public or private, etc.
    
7. Technical Working Groups, Consultants, Experts and Public Health Agents:
   
   The Bill authorised the Council to establish Technical Working Groups and also appoint consultants, experts, inspectors, public health agents, independent contractors or auditors to support the Council with their sectoral expertise and technical skillset.
    
8. Register of Healthcare Establishments:
   
   The Bill authorises the State Council to compile, maintain and publish a register of all registered and provisionally registered healthcare facilities, to be known as the Register of Healthcare Establishments.
    
9. Delhi Health and Safety Fund:
   
   The Bill recommended the constitution of the Delhi Health and Safety Fund for salaries, allowances and expenses of the Council for the discharge of its functions and any other special circumstance.
    
10. Fines and Penalties:
    
    Finally, the Bill described in detail the penalties and fines that would be levied on anyone who contravenes its provisions, disobeys legally directed orders, causes obstruction or refuses to provide information to the competent authority.

Intended Impact
 

The Delhi (Standards and Care Quality) Bill, 2016 was put up for public comments where it received positive feedback and has been welcomed by the general public.
 

1. Once implemented, the legislation would lead to greater transparency in the entire public and private healthcare delivery system in Delhi.
    
2. The legislation would mark a shift in paradigm amongst policymakers and provide a conducive environment for the development of trust and positivity towards both private and public healthcare providers.
    
3. It would also pave the way for greater engagement between the government and private institutions to deliver quality healthcare services without compromising on affordability.
    
4. The Bill, once enacted, would impose restrictions on disputable, irregular or illegal clinical establishments that undermine regulations and do not adhere to standard government protocols.
    
5. The legislation would lead to greater financial, ethical and moral accountability amongst private healthcare providers by enforcing profit caps and compensation to patients in cases of negligence.
    
6. The legislation would prohibit any form of discriminatory practices by healthcare providers by ensuring that no person with a medical emergency is refused, denied or delayed care by any emergency healthcare establishment on any grounds and everyone avails the right to emergency medical care and treatment upfront.