Do private hospitals need regulation?

Earlier this week the Delhi government cancelled the licence of Max Hospitals in Shalimar Bagh in Delhi for alleged medical negligence in multiple instances. However, India's top doctors and healthcare executives have slammed the government for this decision.

The health minister, JP Nadda said that private hospitals must be regulated. He also said that the Model Clinical Establishment Act can enable the centre to regulate private hospitals. This has not gone down well with India's private healthcare sector which said that instead of regulation, the government should be supporting the private sector to help them serve their patients better.

They even said that a capital intensive sector cannot ignore the cost of healthcare delivery. CNBC-TV18 caught up with Devi Shetty, Chairman & Executive Director, Narayana Healthcare to discuss whether private hospitals need to be regulated.

Below is the verbatim transcript of the interview.

Q: Let me first start by getting your comments of the two incidents which has been in the news. On one hand, you have Max Shalimar Bagh, and on the other hand you have got the Fortis Gurgaon. Delhi government has cancelled the licence of Max, while Haryana government has filed for an FIR against Fortis Gurgaon due to serious allegations related to service delivery, ethics, and pricing. How do you see these government actions in both these cases?

A: First of all, I would like to tell you that healthcare is the only sector in the world, when we deal with a client or a patient, we have to discuss about the death. There is no other industry where you take a consent from the patient, that person, or your customer, that you can die following my treatment or my service. It is a very serious industry. Now, you have given an impression that any patient who spends money and goes to a private hospital cannot have any complications or cannot die.

Healthcare is not safe, hospitals are not the safest places. You forget about India, let us look at US. In US, which is considered as having some of the safest hospitals on the planet, if 200 patients get admitted and spend one night in an American hospital, one in 200 dies due to medical error; it is not medical negligence. Getting admitted to an American hospital is 10 times riskier than skydiving. This is a reality. Patients can die following the treatment.

If you think that every death is due to an act of negligence, it is a criminal act, and hospital into the justice without going into the details, you have done a great injustice to the profession, and you have done great injustice to the people of this country. The reason is, today everybody watches media, today when they look at us, they look at us doctors as thieves, conmen trying to cheat us. What is the result? You are going to fall sick one day or the other and you have to come to us. I don’t think an American or European doctor will take care of you. So all I am trying to say is that you have created that mistrust and misguided the people which is not fair on your part because you have a responsibility.

Q: Let us talk about the fact that the healthcare sector, you have pushed for, you have lobbied for self-regulation, but that has not worked. Why don’t you agree to uniform set of norms and practices through legislative backing for the private healthcare sector? In fact, even in markets like US, Japan, Germany, some of the examples that you are giving, they accept something like this. Why don’t you accept it in India?

A: There are enough legal bodies investigating all the so called crime committed by the hospitals and the doctors. If you are not able to implement the existing rules and regulations, creating one more body is not going to solve the problem. We have to ensure that the laws are followed. These regulatory bodies are built by the government to take care of these issues. You have to trust them but from our point of view, since there is a public outcry and there is a need that we also believe that we are also going to do the self-regulation, this is also what the Indian Medical Association (IMA) has explained a few days ago that we are going to regulate ourselves. Definitely we will try to do everything possible to show you a very transparent way of functioning.

Q: Let us talk about implementing the model Clinical Establishment Act which has been there for several years, a solution the central health ministry believes and has been insisting that private healthcare sector should be regulated through this act. How do you look upon that?

A: The government comes up with the Clinical Establishment Act to safeguard the interest of a patient in a private hospital. However, the same government does want to have the same regulation to control the quality of service in the government hospital. Is it fair? Can you have one set of rules only when you go in a -- private hospital patient has to be safe and we will make sure he is safe, but when the patient comes to my hospital, I am not going to take care of him, patient has no right. So that is unfair. You cannot have two sets of regulation in the same country, one for private hospital and one for the government hospital.

Second thing is, when you come up with the regulation, you have to be cognizant of the fact that we are still an underdeveloped country. Our biggest problem is we want first world regulatory structure with third world infrastructure. If you implement everything what is written in the Clinical Establishment Act, take it from me, 80 percent of the hospitals in the country will close down. Most hospitals in the country don’t even have occupancy licence, occupancy certificate.

It is good for all of you to sit in Delhi and make regulations, but Delhi is not India. India is much bigger than Delhi. You go to tier-II, tier-III cities, there are hardly any hospitals where pregnant lady can give birth to her baby. If you close down the hospital, who is going to take care of the 26 million pregnant ladies in the country?

So when you are talking about high moral standards, high expectations, look at the common man of the country. Rich people, living in Delhi can take care of themselves, they don’t need rules, regulations by the government, look at the common man of the country. All the developments which are going to happen will ensure that nobody will build hospitals in tier-II, tier-III cities and that is where 60 percent of the country’s population, the most deserving people live and you are going to hurt them.