Claps on aim, doubt on rate...proposed hospital bill to provide patients' rights, a grievance redress mechanism,introduce transparency and standardisation of rates.

G.S. Mudur, TT, New Delhi, March 2: Bengal's proposed hospital bill appears intended at codifying some practices already adopted by healthcare institutions but also contains "unreasonable" suggestions, sections of the medical community outside the state have said.

The state's move is in line with long-standing demands from health activists campaigning for tighter governance of the healthcare sector through the Clinical Establishments Act 2010 that they say has been adopted by only some states but remains largely unimplemented even there.

Senior doctors with private healthcare establishments outside Bengal say hospitals are already expected to practise certain provisions in the bill such as providing immediate emergency treatment to accident victims or releasing bodies of patients irrespective of the capacity of the patients or their relatives to pay.

"We encourage doctors and hospitals to be completely transparent about their costs," said Krishan Kumar Aggarwal, senior consultant in medicine and cardiology at Moolchand Medcity, New Delhi, a private healthcare institution, and president of the Indian Medical Association.

But Aggarwal and other doctors say it is impractical to expect healthcare institutions to agree with a proposed provision in the bill that the final bills submitted to patients "shall not exceed estimates by a certain percentage, as may be prescribed by the government".

"In every medical treatment or procedure, there is some degree of uncertainty," Aggarwal said. "When there are no complications, a doctor or a hospital can specifically predict the costs of treatment, maybe plus or minus five or 10 per cent. But if there are complications, no one can predict the new estimates. It is unreasonable to fix a percentage cap."

A senior consultant in a New Delhi-based hospital said even insurance companies agree to examine revised estimates but scrutinise them to determine whether they are justified or not.

Community health specialists say any state moving towards regulating healthcare is welcome.

"I think we're seeing politicians responding to a public demand," said T. Sundararaman, the dean at the school of health systems studies at the Tata Institute of Social Sciences, Mumbai.

"There are exploitative practices in the private healthcare sector and thus a need to regulate the private sector."

The Union government had notified rules for the Clinical Establishments Act in 2012. Assam, Bihar, Jharkhand, Rajasthan, Uttar Pradesh and Uttarakhand are among states that have adopted it. But health activists point out that the rules have not been implemented in full in any state.

The rules provide for a charter of patients' rights, a grievance redress mechanism at the district level, a process to introduce transparency and standardisation of rates charged for common medical procedures as well as standard treatment guidelines and clinical audits.

"Unfortunately, there is not a single state where all these four components have been implemented," said Abhay Shukla, a community health specialist and coordinator with Sathi-Cehat, a Pune-based non-government organisation campaigning for regulating the healthcare sector.

Healthcare industry executives point out that it is not easy to work out operational costs of healthcare institutions.

"When you consider drugs or coronary stents, you just look at manufacturing costs, assign margins and fix maximum prices," said Girdhar Gyani, director general of the Association of Healthcare Providers of India, an industry body that represents hospitals.

"But it is not easy to compute costs for treatment and medical procedures where you have to take into account everything such as costs of medical equipment, doctors, nurses, building maintenance. It is a difficult exercise."