Dissecting the WB Clinical establishments bill

So the latest curb on medical practices in the country has been imposed by Ms. Banerjee, honourable chief minister of West Bengal. With the measures being lauded by the general public, let us just dissect and review some of the points mentioned in the WB Clinical Establishments Bill, which was passed by the Assembly, last week.

1) Hospitals are mandated to declare bed charges, ICU charges and package costs, which can’t be altered.

Transparency is actually the need of the hour. Not just 100 bedded, any hospital must have a price list displayed and made available to the patient. Even the accreditation bodies have a norm asking for the same. Having said that, adding the clause that it can't be altered, takes away the freedom of updating pricing (to keep up with inflationary costs of providing the services) from the hospitals. I would say the public display is more than a sufficient measure of enabling transparency.

2) Hospitals with more than 100 beds must start fair price medicine shops.

Fair price medicine shops, well isn't that what the government is supposed to do. In fact the private healthcare industry exists because the government is unable to provide the fundamental right of Health to all its citizens. So, because the government has been unable to provide for it, it can't mandate the private players to do so. Having seen a couple state governments do it successfully (Delhi and Rajasthan as examples), I don't see a reason why WB government should be pushing it on to the private players.

3) Provide proper estimate of costs not covered under Package. Final bill not to exceed more than a percentage of the estimate provided.

Last time I got my car serviced, they provided me with an estimate, and I must say they did a good job in sticking to it. That put me into thinking, if that's possible with healthcare. Can we have a predictive model for pricing, for each individual patient, which could be as accurate as theirs? I personally believe the number of variables involved is so drastically huge that a predictive model may not be possible. Medicine is a never ending science. We haven’t been able to understand fully the functions and capacity of the human body and mind. Each latest discovery adds a bunch of new variables to the known. We don’t even know most of the variables, how do we, in such a scenario, have a 100% predictive model?

4) Penal measures in cases of medical negligence.

Just like any judicial proceedings, it would really be good if the justice could be served in cases of negligence at a faster pace. I am all in for a faster judicial response. But the three issues I have here are, firstly, it shouldn’t be misused to satisfy the politicians, secondly, it has listed penal measures for negligence, but none for wrongful accusations, thirdly, with the increase in the defensive practice, it would add to cost of care provision, by the sharing of the cost burden of litigation/insurances and by making doctors more averse to procedures/modalities that have higher mortality rates.

5) Clinical establishments are supposed to treat accident, acid attack and rape victims even if they cannot pay for treatment immediately. The hospital would have the right to recover the cost of treatment "in due course"

The last 3 words give away what is objectionable here. The private establishments, like any other business entities, are there for profit. Why not clarify the “due course” in exact duration of time and also specify remedial measures, in case the same is not done.

6) Clinical establishments should release the body of a patient even if the bill for treatment has not been paid.

Personally, as a human being, I am against hospitals holding up the dead bodies of patients for non-payment of bills. So, I see this as a very positive move, but again here, I would like to see from the government, some remedial measures that should be available to hospitals in case of non-payment of bills. If I ever pick up a water bottle from a store and move out without paying, I could be charged for shop-lifting, but none such measures are available in case of hospitals. May be, the government could work at the root cause of why such a practice is being adopted to, rather than passing mass-appeasing laws.

7) Government body to regulate pricing of treatment

While writing about stent price controls, I have already written in detail about my views on how pricing control can hamper the availability and affordability of care. (It can be referred to here.)