|Year : 2018 | Volume
| Issue : 3 | Page : 113-115
Draft Charter of Patients’ Rights: An Appraisal
Vivek R Minocha
Former Professor & Head, Department of Surgery, University College of Medical Sciences, University of Delhi, New Delhi, India
|Date of Web Publication||31-Dec-2018|
Dr. Vivek R Minocha
20 A, S.D.F., Sector 15 A, Noida 201301, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Minocha VR. Draft Charter of Patients’ Rights: An Appraisal. MAMC J Med Sci 2018;4:113-5
The Ministry of Health and Family Welfare, Government of India, has placed draft of “Charter of Patients’ Rights” in public domain vide F.No. Z-28015/09/2018-MH-II dated 30.08.2018 inviting comments/suggestions. In response, some of these observations are being conveyed in the following paragraphs.
The objective of this charter is obviously to ensure provision of good-quality medical care to patients. But important question arises to what extent such a provision is likely to achieve its perceived objectives and whether it is the best option for “good quality medical care.” In my opinion, the doctrine of “Rights” is self-defeating and not in the best interests of the patients or in the interest of the doctor–patient relationship which is the back bone of satisfactory medical attention. Some additional thoughts are as follows.
Organization of health and medical delivery comprise of two components: first, professional aspect essentially dealing with evaluation of the medical condition and its treatment, and second, financial aspects, billing, and payments. Although interrelated, both are distinct entities and require due consideration independently on their own merit.
Addressing the concerns of medical delivery first, the proposed doctrine of “rights,” it needs to be appreciated that the rights given to the recipients (the patients) require corresponding obligations to the caregivers (the medical profession). This obligation on the medical establishment already exists. The hospitals/clinical establishments and the medical profession at large are accountable to and are under supervisory control of the regulatory institutions and professional bodies. The medical profession is governed by the medical ethics, code of conduct prescribed by the Medical Council of India and state medical councils and other entities formulating “Practice Guidelines.” If the perception is or there is reason to believe that these provisions are inadequate to address the concerns of “good-quality care,” though I believe such is not the case, an exercise of scrutiny of these provisions may be undertaken to identify the shortcomings and introduce necessary changes/modifications. An alternate system as proposed ignoring the existing mechanisms is completely uncalled for.
In addition to built-in system of professional conduct, there is provision of “Consumer Protection Act,” “Doctrine of Informed Consent,” etc. Further normal jurisdiction of “Civil” and “Criminal” justice is applicable and available to aggrieved patients, and these provisions have extensively been used to resolve concerns of dissatisfaction including false cases. There does not appear to be any additional necessity of formulating “Charter of Patients’ Rights.”
Health and medical care is a complex issue and requires good rapport among the practitioners, the caregivers, and patients, the care recipients. Mutual trust plays an important role in medical care. This role may get eroded significantly by too much of bureaucratic or legalistic approach. Strengthening of the patient–doctor relationship with emphasis on interpersonal communications involving both the parties, the patients and doctors will be of immense value in this respect. Lay press and media can contribute a lot in educating general public regarding etiquettes and orderly conduct in seeking medical consultations so as to make the process smooth and satisfactory. Likewise, the regulatory bodies may undertake similar exercise of continuing education augmenting behavioral aspect in medical practice.
It is good to see that document of draft rights has included a segment on responsibilities of the patients. But unfortunately it is sketchy and does not address the relevant issues adequately. More than patients’ rights, responsibilities for proper conduct are required to draw maximum benefits from the medical services. It is essential that patients and their families act responsibly to communicate details of symptoms without suppressing or exaggeration.
It is observed that at times the patients, family, and friends involved in attending to needs of the patients indulge in violence following death or any perceived negligence. There is no place at all for disturbance of normal atmosphere in the hospital. The grievance redress mechanism is available to attend to these concerns. If needed, the system may be reviewed. At times, the police are involved to sort the matter, but usually do not go beyond diffusing the situation. The culprits must be detained and charged under the relevant sections of criminal justice so as to discourage the practice and indiscipline. Condoning the actions of the public by liberal explanation of being disturbed is not convincing or in the best interest of effective and peaceful medical care system. Identity of the patients with correct address should be recorded at the initial registration or soon thereafter to help trace the concerned persons in case of need. Aadhaar card and mobile telephone number may be of great help.
Now turning to the second component dealing with financial aspect of the experience of interaction with medical professionals/hospital. This is very important because a large number of grievances and dissatisfaction by the patients and their families are arising from the disputes on the bills. Allegations are made of inflated bills which may or may not be true. Obviously these allegations are to be looked into by a credible system.
The medical establishment has legitimate expectations of timely payment of just and due compensation for the services rendered. It is essential to devise a system for ensuring payment of bills. Holding back discharged patient or not handing over dead body without clearance of the bills may sound harsh and emotionally disturbing and a way out has to be found. It is not sufficient to compel the hospitals/medical facilities to not insist on clearance of the bills. It is equally essential to appreciate and address the issues leading to such a situation by devising a “mechanism,” ensuring payment of the bills without holding back the discharged patient or refusing to hand over dead body to the relatives.
One possibility worth exploring is introduction of a “mechanism” which will make the payment in first instance to the hospital/clinical establishment whenever there is dispute or inability to pay expressed by the patients. The concerned “mechanism” then seeks reimbursement of the payments from the patients’ family in due course within a short period of time. Such a system will provide opportunity and time to the patient party to mobilize money and/or settle dispute regarding bills. The identified agency may be vested with powers to scrutinize the bills and moderate it in case there is an evidence of inflated bills. The said agency must be empowered to invoke coercive methods to receive money from the offending party. The “agency” may be government sponsored or a “nongovernment organization” with sound financial backing and adequate buffer money.
Proposal of attending emergency patients without seeking advance payment included in the charter is a good intention, but caution has to be exercised against misuse. There need not be any reservation to take up the issue of financial aspect after starting the treatment. An impression or interpretation that the treatment of emergency patients is free for categories of patients in the private hospitals must be dispelled. It may be prudent to introduce a system of inclusion of details of address and financial status at the time of initial registration. However, formalities should not delay treatment process.
The services in the public sector must be strengthened with adequate financial support and expanding the facilities, so as to infuse confidence in government hospitals and reliance on the private sector is reduced.
Health needs of the society should not be a subject of enterprise. Profit making and commercialization in health sector must be curbed and eradicated completely. It may be remembered that outlay toward health care is an investment and not expenditure. Healthy manpower contributes significantly to the society’s social and economic well-being. Opening and maintaining hospitals in tiers 2 and 3 cities should not be relegated to private players as is being mentioned repeatedly and government should not abdicate its responsibility.
An important constraint in public sector in health is availability of funds arising from competitive demands. There is a need to work out a strategy of mobilization of funds. A policy may be formulated to provide health care in government institutions on sliding scale of payment according to paying capacity including free service to the needy. Free service is not for everyone seeking care irrespective of financial status. Such an arrangement will mobilize funds from beneficiaries and provide some relief to fund starved institutions. This will also enhance credibility of the institutions. Donations from charitable organizations and individuals with “tax exemptions” may also be permitted to augment finances of course with due safeguards. Utilization of funds under ‘‘corporate social responsibility’’ should be encouraged for hospitals.
Introduction of government sponsored insurance scheme with subsidized premium for poor families is a good initiative. If the government hospital is providing bad services as mentioned above, it can receive payment from the insurance company further augmenting their financial position, enabling expansion of facilities. There is a clear case in favor of extending insurance facility to persons with self-paying premium with a view to promote universal coverage by health insurance. Rates of premium may also be fixed on sliding scale as per paying capacity with possible subsidy to deserving persons.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Minocha VR. National Health Protection Scheme: A Proposal in the Budget 2018 – Medical Care Facilities Essential for Utilizing the Proposal. MAMC J Med Sci 2018;4:59–60. [Full text]