Behaviour of the private sector in the health market of Bombay

Abstract

The government of India has been unable to meet the health care needs of its people especially in rapidly expanding urban areas so private sector health services have proliferated. In 1990 for example the private sector in Bombay ran 87.9% of the 602 hospitals and provided 39.8% of the total beds. Members of all socioeconomic groups use the private facilities and the willingness of people to pay for health care heralds the expansion of private sector services yet there is no policy governing such an expansion. A study was undertaken therefore to document the different types of private services offered in Bombay analyze the private sector delivery of health services access the existing control regulations and consider policy options available for private sector regulation. Information was obtained from 15 individuals who hold key positions in the health sector including hospital executives medical school professors hospital managers private practitioners and a social activist. In addition information was obtained from the findings of a committee investigating conditions in private nursing homes as part of a law suit. This committee found that many of the nursing homes were substandard and were operating without regard to antiseptic procedures. Most of the individuals queried reported that private hospitals do not pose the same problems as private nursing homes since the private hospitals are situated outside of residential areas and have a proper waste disposal system. The respondents felt that the private facilities were well equipped and that the use of modern technology was justified in the hospitals but not in the nursing homes or clinics. Most respondents felt that the nursing homes and clinics lacked properly trained medical personnel. It was acknowledged that some private physicians abuse their honorary staff positions in public hospitals by using the facilities to treat private patients or by diverting public patients to their private practices. Charges of medical malpractice were also proffered with examples given of collusion to extort fees from patients or to provide people with false medical documentation for a price. These unethical practices are mirrored by negligent medical practices. Calls for regulation of the private sector have increased. The existing regulation dates from 1949 and its implementation has been far from satisfactory. Public confidence in the Maharashtra Medical Council and the Indian Medical Associations ability to regulate individual doctors has also dwindled. A regulatory policy should be directed toward the expansion of the private sector in Bombay and should include measures that will contribute to the overall improvement of public health. Once formulated the regulations should be implemented by the Public Health Department of the Municipal Corporation with the responsibility vested in a Deputy Executive Health Officer who should also be able to report unethical practices for action. A holistic approach to this problem will result in better health care for the citizens of Bombay.