Regulation And Corporate Hospitals

Written by YRK Reddy | Updated: Aug 23 2004, 05:30am hrs
The Ministry of Health is attempting again to regulate clinical establishments, which is heartening. No state was willing to endorse the drafts circulated in 2000 on Clinical Establishment Regulation and the Maintenance of Clinical Records, and an earlier act in Tamil Nadu remains the proverbial paper tiger.

Over the years, institutional mechanisms have not kept pace with the frenetic growth in medical needs that has created new markets and new agents, such as the breed of corporate hospitals. Large scale ignorance, unwillingness to assert rights and weak legal and enforcement mechanisms have led to exploitative conditions especially if there is congenital compulsion as in the case of a corporate form, unlike the public trusts and government.

Most doctors and hospitals are doubtless professional, conscientious and make qualitative difference to our lives but the debate is not of them but the small minority of delinquents who could grow and get worse amidst the compulsions of a corporate setting.

Companies, public or private, have limited liability and can do every thing that an individual can such as buying and selling property, executing contracts, and even undertaking questionable research, drug trials or clinical experiments. However, a company cannot be jailed or hanged, like Dhanonjoy, nor shot in an encounter. The recent Supreme Court judgment assures that negligence and recklessness of a doctor, resulting in death, can at best be paid for. Except in extreme circumstances, there would be no criminal liability either for the doctor or the company, thus promoting a moral hazard.

The corporation as a legal entity has been controversial for centuries despite the libertarians constantly misquoting Adam Smith and hoping that somehow the market can turn greed into social good. Adam Smith was wary of the corporation and considered it as potentially dangerous. He was convinced of the manic greed that surrounds the corporation. Carrying this thought further now is a film and a book titled The Corporation - The Pathological Pursuit of Profit and Power by Joel Bakan. They explore why a corporation is a greedy psychopath interested only in making money any which way, notwithstanding nice credo statements on ethics, consumers, quality and society.

Hospitals are not immune to the compulsions of a corporate setting
The proposed law must devise institutional mechanisms to cover ethics
When Adam Smith talked about free enterprise, he was hoping that a mystical unseen hand would somehow curtail the psychopathic nature and ensure just dealings with people. Though the unseen hand has not been defined there was speculation that it was Jesus of Nazareth I believe it is probably a set of institutional mechanisms that he hoped could ensure ethical behaviour.

In the case of corporate hospitals, there appears very little of the benefactor in the form of institutions. The medical council is ineffective and medical ethics are as violated in daily life as the Ten Commandments. Several hospitals have marketing departments to expand their market and enlist more and more patients. Some have been creative to establish undeclared transactions with potential suppliers of customers including autowallahs who fetch patients from railway stations.

True to its nature, the corporates first information needs from the consumer are his paying capacity and insurance details. The corporate has to maximise the utilisation of space as well as the expensive equipment and hence every bit has to be used to full capacity. If there are many vacant rooms, there has to be subtle elongation of hospitalisation. If the MRI equipment is underused, a probable migraine must be first investigated for a potential brain tumour.

Growth is a compulsive crave for corporates. Consequently, the space increases and the equipment proliferates. To keep them abuzz, it needs more fodder in the shape of patients. As reputation is the key in this business, it has to be aggressively advanced through the media while competitively demolishing the rivals through the same channel.

The proposed law must overcome the resisting lobbies and devise institutional mechanisms and standards that are even more comprehensive than the earlier drafts. They must cover ethical aspects that elude normal oversight. The law must counterweigh the inherent tendencies of the corporate form and guide them to honour the Hippocratic traditions, ethical trials and experiments more than their hyper-growth ambitions.