Health Regulations Need a Base to Top Approach

Why in News?

• In the last week of May, a devastating fire in a private neonatal care nursing home in New Delhi shocked the nation.
• The aftermath saw intense media coverage and political blame games, while the grief-stricken parents of the affected infants faced the tragic loss.
• This incident underscores the critical issue of systemic failures in health-care regulations and therefore it is crucial to explore the complexities of health-care regulations in India, the challenges faced by both the private and public sectors, and the necessary reforms to ensure effective and equitable health services.

An Overview of Health-Care Regulation in India: A Systemic Issue

• India's health-care regulation system is characterised by an excess rather than a lack of regulation.
• Some states require over 50 approvals under various regulations for health-care facilities.
• Despite this, there is a widespread belief that the private health sector is under-regulated.
• This paradox arises from the unrealistic standards set by these regulations.
• The Clinical Establishments (Registration and Regulation) Act, 2010, though well-intentioned, has seen limited adoption due to its impractical provisions.
• Similarly, the Indian Public Health Standards (IPHS), established to ensure quality in government health-care facilities, are met by only 15-18% of primary health-care centres even after 17 years.

The Mixed Health-Care System in India: Contributions and Dynamics

• Public Health-Care Sector
  • The public health-care sector in India comprises government-run facilities at various levels, including primary health centres (PHCs), community health centres (CHCs), district hospitals, and specialised tertiary care hospitals.
  • These facilities are intended to provide free or highly subsidised health services to the population.
  • The public sector is primarily responsible for public health initiatives, maternal and child health services, and managing communicable diseases.
  • Government health facilities are distributed across rural and urban areas, aiming to make health services accessible to the most remote and underserved populations.
• Private Health-Care Sector
  • The private health-care sector in India includes a diverse range of providers, from single-doctor clinics and small nursing homes to large, multi-specialty corporate hospitals.
  • Private facilities cater to a significant portion of the health-care needs in India, particularly in urban and semi-urban areas.
  • Many private hospitals offer high-quality services, advanced medical technologies, and efficient care delivery and this attracts patients seeking timely and specialised treatments.
  • Private clinics and nursing homes are often more accessible to patients, offering services with shorter wait times and personalised care.

The Interaction between Private and Public Health-Care

• Patient Choices
  • Patients often prefer private facilities over public ones, despite the higher costs.
  • This preference is driven by perceptions of better quality, shorter wait times, and personalised care in the private sector.
• Complementary Roles
  • In some regions, public and private sectors complement each other.
  • For instance, public health campaigns and preventive care initiatives are often supported by private providers who handle more complex and specialised treatments.
• Health Indicators
  • States with robust private health sectors, such as Maharashtra and Kerala, often report better health indicators.
  • This is not solely due to exceptional public health services but because the private sector fills critical gaps in service delivery.
• Regulatory Challenges: Effective regulation of the mixed system is challenging. Private facilities may face more rigorous enforcement of regulations, leading to perceptions of unfair treatment compared to government facilities.

Challenges Faced by Private Health-Care Providers

• Regulatory Burdens
  • Some states impose over 50 different approvals under various regulations, which must be followed by every health-care facility.
  • This creates a cumbersome process that is difficult to manage.
  • Applications for necessary permits and renewals often experience significant delays.
  • Facilities that apply well in advance can wait months for approval, disrupting operations and planning.
  • Regulatory enforcement is often inconsistent, with private facilities feeling targeted more than their public counterparts.
  • This discrepancy leads to perceptions of unfair treatment and regulatory bias.
• Financial Constraints
  • Maintaining and upgrading health-care facilities to meet regulatory standards and patient expectations requires significant financial investment.
  • This includes costs for advanced medical equipment, infrastructure, staff salaries, and compliance with safety norms.
  • Smaller private facilities often struggle to secure funding and loans needed for expansion or upgrading their services.
  • Banks and financial institutions may be hesitant to lend to small health-care providers due to perceived risks.
• Operational Challenges
  • Recruiting and retaining qualified health-care professionals is a persistent challenge.
  • Many providers face shortages of skilled doctors, nurses, and support staff, which affects the quality of care.
  • The extensive paperwork and administrative tasks required for compliance and operational management can divert time and resources away from patient care.
  • Smaller facilities may lack dedicated administrative staff to handle these tasks efficiently.

Case Study of Challenges Faced by Private Health-Care Providers: The Delhi Fire Tragedy

• The fire tragedy in a private neonatal care nursing home in New Delhi underscores the challenges faced by private health-care providers.
• The incident highlighted issues related to safety compliance, regulatory oversight, and the subsequent response by authorities.
• The private facility faced severe regulatory action, including a temporary suspension of its license, whereas similar incidents in public hospitals often result in less stringent consequences, such as the formation of inquiry committees.
• This discrepancy illustrates the regulatory pressures and operational difficulties unique to private providers.

Necessary Reforms for Effective Health-Care Regulation

• Streamlining Regulations
  • Simplifying and harmonising health-care regulations can reduce the administrative burden on private providers.
  • A single-window clearance system for approvals and renewals can expedite processes and minimise delays.
  • Financial Support: Providing financial assistance, such as subsidies, low-interest loans, and grants, can help smaller private facilities meet regulatory standards and improve infrastructure.
• Capacity Building
  • Investing in training and capacity building for health-care professionals can address staffing shortages and improve the quality of care.
  • Support for technology adoption and digital health initiatives can also enhance operational efficiency.
• Equitable Enforcement
  • Ensuring fair and consistent regulatory enforcement across both public and private sectors can build trust and encourage compliance.
  • Creating a transparent and accountable regulatory framework is essential for equitable treatment.
• Focus on Primary Care Providers:
  • Supporting single-doctor clinics and small nursing homes, which are vital for providing affordable and accessible primary care, can help bridge the urban-rural divide and ensure comprehensive health service delivery.
  • These are what deliver primary care and contribute to keeping the cost of health care low.

Conclusion

• The New Delhi fire tragedy is a stark reminder of the need for reform in India's health-care regulation system.
• Simplified, realistic, and inclusive regulations are essential for promoting accessible, affordable, and quality health services.

By supporting primary care providers and ensuring fair enforcement, India can move towards achieving the goals of the National Health Policy, 2017.

Q) What are the primary regulatory challenges faced by private health-care providers in India, and how do these affect their operations?

Private health-care providers in India face significant regulatory challenges, including excessive regulations, delayed approvals, and inconsistent enforcement. Some states require over 50 different approvals for health-care facilities, creating a cumbersome and time-consuming process. Delays in approval and renewal applications, even when submitted well in advance, disrupt operations and planning. 

Q) How do financial constraints and operational challenges impact smaller private health-care facilities in India, particularly in delivering affordable care?

Smaller private health-care facilities in India, such as single-doctor clinics and nursing homes, face considerable financial constraints and operational challenges. High operational costs, limited access to capital, and the significant expense of complying with stringent regulatory standards make it difficult for these providers to maintain and upgrade their services.

Source:The Hindu