Amendment to the KPMEA - Why YOU should be concerned.

Namaskara (customary greeting in Kannada, considering the flavour of the moment)! 

I will be taking a short break from my gestational blues to address a far more pressing issue. The amendment to the KPME (Karnatake Private Medical Establishment) act. I say, far more pressing, since, if the amendment is passed, it will not only be a blow to the medical community in Karnataka, but for the entire population! And who’s to say that this may not happen in the other states then?

To be honest, I awoke to this very late in the day, despite being a doctor myself, partly due to my aversion to the tone of reporting on Indian television news channels, partly owing to my current gestational state, rendering me bound to the bed and partly because I’ve been practising in the state of Maharashtra. However, I reiterate, if this amendment were to be passed, it will affect everyone in the long-term, irrespective of state, irrespective of profession.

For those of you, unaware of the KPMEA, and why the amendment proposed has been causing such a furore amongst the doctors in Karnataka; The KPME act of 2007, was a law enacted in public interest to promote quality health care by qualified medical professionals, stipulating minimum standards of health care, and to monitor the functioning of private medical establishments by law. You can read more about the stipulations of this act here.                              (https://www.karnataka.gov.in/hfw/nhm/.../KPME%20Act%20and%20Rules.pptx)

Recently, the Karnataka health minister proposed an amendment to the act, the proponents of which serve in stripping the medical community of our rights and freedom, and impose a dictatorship over the private medical sector.

One of the stipulations states, the government will fix the prices of the medical procedures and facilities offered in the private hospitals including doctor consultations. This, just so, these facilities are made available to the underprivileged as well. (Apparently doctor consultations will be capped at Rs. 150 and surgeries that cost around Rs. 30,000 will be capped at Rs 900, amongst other changes). I have a question (one of many, that will come). 

• While fixing the price-cap, will due consideration be given to land rates, infrastructure related expenses, salaries for manpower involved, maintenance of expensive medical equipment, cost of consumables used;These being only a fraction of elements to be considered? 

Yes, I agree that charges levied in private hospitals are quite high, some more than others. 

I, a Surgeon myself, having been brought up in an upper middle-class family, find it unaffordable! Reason being, the low salaries paid to us doctors (I know for a fact that my neighbourhood dog-walker earns more than I do, in a month…but that is a topic for another day), but also because, I don’t have medical insurance! 

Health, my friends, is not a luxury. It is a necessity. Without health, there’s no life. When we don’t raise eyebrows at blowing a few grand over a labelled outfit, paying monstrous amounts for dining at a 5-star restaurant or a holiday to a foreign locale, then why do we take affront at having to pay a top hospital for services rendered by a well-qualified specialist doctor? Is there no value that we place on health? We, as Indians, have a reputation for saving for a rainy day. Then why not invest in medical insurance? Why is that being seen as an unnecessary expenditure, when illness and death will ultimately come to all? Man, after all is a mortal being! Are we taking health for granted?

The reason cited for the price-cap, is making health care affordable for the underprivileged. Having worked as a salaried employee in a corporate hospital myself, let me assure you, private hospitals do provide subsidised health care to those who cannot afford it, under various government schemes. I, personally, have worked with senior consultants, who slash their charges, when a patient cannot afford it, over and above the discount that they’re already entitled to, thanks to various government schemes and aid from NGOs. This, despite the existence of government-run hospitals. 

• Why do people from all income brackets flock to private medical establishments for treatment? They have a choice, don’t they? The knowledge and expertise of doctors in government hospitals is equal to that of those employed, in the private sector, if not better! 

• Why do our esteemed politicians head to Singapore, Europe or the US for their treatment? Aren’t our government hospital doctors good enough for them? Aren’t our government hospitals armed with the equipment to provide them with the best of health care?

• Private sector today provides nearly 80% of outpatient care and about 60% of inpatient care in Karnataka. Why do you think that is? 

A friend of mine recently posted this very question on his Facebook page and the majority responded saying that they flock to private hospitals for the comforts, amenities and technology provided. 

• Why is this not being made available in a government hospital then?

• Would you tolerate being asked to share your bed with two other people in the general ward or rats scurrying about in the operation theatre (in what is supposed to be a sterile environment), in a private hospital? 

• Would you be offered comfortable rooms, with air condition, television and a personal washroom, in a government hospital? 

• Would you be satisfied with a personal consultation hardly lasting 2 minutes, with your doctor in a private hospital? Aren’t these the very criteria that help you decide between the two?

• I am not against regulation of the quality of service, and a review of the prices quoted by private hospitals, but fairness must be ensured. Take into account all the expenditure incurred. Keep a profit margin and then cap the prices. Or else why will a private investor choose to invest in the medical industry?

• There are already various accreditation agencies such as NABH, NABL etc. that set stringent standards for private hospitals to abide by, to be considered for their certification. 

Who wouldn’t love to don a Manish Malhotra or a Sabyasachi? I would, but, I can’t afford it. So, do I threaten them to sell it to me at a price that I can afford, or maybe for free? Do I force them to be charitable, since clothing is an essential human need? Or do I get hold of the lawmakers to pass a law where they cap the prices at which India’s top designers sell their wares? Instead, we snap out of our very pleasant day dream, head to our neighbourhood cloth store to make a purchase or maybe don a fake. You don’t think it fair to equate clothing to health care?

Alright then. How about housing? We all have the right and the need for shelter, as human beings.  Then, why aren’t the premium, luxurious apartments made available to the population at dirt-cheap rates? After all, one does expect premium healthcare at the bare minimum cost!  

How about education? Another essential. I would like my child to study in the most renowned schools in our country, for free…Will that be possible? No? Then, isn’t that unfair? After all, we are applying the same rationale to healthcare! Or, are the real estate developers, architects, lawyers, engineers and other members in the population exempt from such binding?

• Don’t you think a specialist doctor, who has spent 10-15 years and more, studying, to gain the necessary expertise to treat you, who has spent immense amounts of money towards college fees and exam costs, has the right to quote his/her price for his/her valuable opinion? Do their sweat, efforts, sacrifice and most importantly, their families account for nothing?

• When land, salaries, and cost-of-living vary from one district to another, one city to another;How can one levy uniform rates throughout the State? Buying an acre of land in the city of Bangalore is definitely going to cost much more than an acre in a smaller city! 

• If the government provides us with access to the same facilities, technology and amenities as that of a private hospital, then why would anyone in their right mind, spend lakhs at a private medical set-up? Why impose unreasonable restrictions and impose a dictatorship over private medical set-ups across the state?

• Each and every individual in India has the right to be represented by a lawyer, when accused of a crime or injustice. But, not a doctor, as per one of the stipulations of the amendment to the KPMEA. Instead, we will be judged by a ‘Grievance Redressal Forum’, composed of mainly non-medic government employees, where we have to present ourselves, without a lawyer! This, despite already being covered under district, state and consumer related forums. Is that what we doctors have been reduced to? Status worse than that of a criminal? Well, if you honestly believe that the loss of life gives us some sort of genuine satisfaction, don’t you think we might have opted for another career path, rather than waste years of our lives learning how to save lives?

C’mon folks! We only ask for fairness! This is a fight for our rights, our freedom, our dignity! 

I know that there are many of you, who empathise with our cause, but we need you to speak up. Join us to fight for our cause! Otherwise, we will continue to become victims of vote-bank politics. If this amendment is passed, it’ll unleash an uncontrollable chain of events akin to wildfire! None will escape, unaffected. One can expect a massive brain-drain of some of the best doctors. The private medical set-ups will have no choice, but to shut down, since they won’t be able to bear the high incurring costs towards maintenance of required standards. Scores of people will be out of jobs! People will no longer aim to join the ’noble’ profession of medicine, in the fear of imprisonment or penalty. Where does that leave the rest of the population? With absolutely no choice!!