Transparency is critical for efficiency in the healthcare sector and for patients.
KPMG, a global consultancy firm, in a recent study has found that India is second from bottom, only above China, in healthcare transparency. The global firm has surveyed the healthcare sector in 32 countries on transparency using six measures (quality of healthcare, patients’ experience, finance (price and payments), governance, personal healthcare data and communication of healthcare data).
The top five countries are Denmark, Finland, Sweden, Norway and UK. The bottom five countries are Mexico, Saudi Arabia, South Africa, India and China.
The report also says that the Clinical Establishment Act, which the Mamata Banerjee government has passed, is likely to face stiff opposition from doctors and private healthcare establishments. The report has added that the central government should therefore seek to bring about change in a “phased approach and lead by example”.
Speaking about medical malpractices, an Indian doctor based in Brisbane, said: “Medicine needs regulation. And action is needed to change the entire paradigm of health care in India.
“At the heart of this behaviour is the economics of medicine and complexity of providing universal health care,” he said.
The doctor has added that pharmaceutical companies, allied services to health, health policy and doctors are all responsible for this tragedy.
“Health economics do not follow normal market forces, and its demand and supply therefore do not act and react as traditional commodities would. This is precisely the reason for government regulation for equity of care, moral aspects, and legal aspects.
“A strong government is defined by its laws and its ability to enforce it. Appealing to the individual’s moral code is important but legal and ethical enforcement needs a presence,” said the Brisbane-based doctor.
“Inventive policies and its enforcement are the keys to success in squashing malpractices. Better quality of care can be available at an affordable price. Alas! I don’t see this happening in India any time soon,” he rued.
“Australia, UK and USA are far from perfect and differ in many ways. Australia has a hybrid system. General practitioners function as fee for service, and hospital doctors are in salaried service. Then there are some who act in both roles. Government and regulatory and licensing authorities control a lot of activity here. There are severe consequences to malpractice. There’s auditing of practice regularly. This is good for the public.
“Despite this, unusual activity occurs. One of the great things has been the banishment of pharmaceutical companies from giving doctors gifts to prescribe their drugs. This has regulated a lot of poor practice,” he said.
A recent incident of cardiologists announcing brand names while doing live surgeries has sparked strong criticism in India.
Dr Amar Jasani, one of the founders of Indian Journal of Medical Ethics, is a strong critic of live surgeries. “It raises the risk for patients. Why can’t it be pre-recorded if they want to use it for teaching purposes? But surgeons are flamboyant and want to show off their skills.”
He added: “Are doctors salespersons of the company to promote a specific product? The code of ethics says doctors cannot take money to promote a product. With the medical councils exempting doctors’ associations from the code, the companies pay the organisers or associations instead of individual doctors.”