A punitive overdose

Cancelling a hospital licence does not address a core issue

The cancellation of the licence of a Max Hospitals unit following the uproar over the tragic case of negligence concerning a premature baby has brought into sharp focus all the weaknesses of India’s public health care system. In its keenness to allay public outrage and crack the whip against callous negligence of private hospital authorities, the Delhi government may have taken resort to amateur populism and ended up administering a punishment that inconveniences hundreds of its citizens without addressing the core issue. It is worth noting that Health Minister Satyendra Jain stated that the licence of the hospital in question was being cancelled as a compounding punishment for three notices that were sent to it earlier for failing to comply with the stipulation for admitting low-income patients. This sort of transgression is one of the worst-kept secrets about private hospitals in India, that come up on free or heavily subsidised land on the condition that a certain percentage of beds are reserved for economically weaker sections. But it is a symptom of a bigger failing. 

In the initial days, this private hospital-building spree was seen as a handy proxy for the state and central governments’ inexplicable disinclination to invest in adequate health care services. The steady expansion of the private hospital network has emphatically failed in achieving this outcome. Instead, it has resulted in expensive “five star” private hospitals which automatically exclude the lower middle class and poor people, who remain hostage to a public health care system that has deteriorated sharply over the past two decades. Delhi, a relatively sophisticated polity because it includes the national capital, is a good example of this growing imbalance. The state has just 2.71 beds per 1,000, a little less than half the World Health Organization’s prescription of five beds per 1,000. Though this is appreciably better than the all-India average, it marks but a minuscule improvement from 2.24 beds per 1,000 in 2004. High-cost private hospitals have proliferated at the cost of public hospitals, leaving the state’s citizenry far more dependent on them than ever before. 

Although the Aam Aadmi Party has made appreciable efforts to expand public health care delivery by setting up its mohalla clinic network and investing in the expansion of several public hospitals, some estimates say private hospitals still account for 80 per cent of the patients’ burden in Delhi. Cancelling the licence of Max’s Shalimar Bagh unit, therefore, punishes patients in search of scarce hospital beds and services (such as outpatients’ department) just as much as the hospital chain itself. Shutting hospitals forecloses the very possibility of health care for most of these patients. There is also the question of due process. The hospital licence has been cancelled even before the Delhi Medical Council had submitted its report. Then again, suspending the doctors concerned for gross malpractice is a valid step but it is worth wondering whether promoters should also bear some responsibility for the quality of service – from attitude to diligence – in their hospitals. Simply cancelling a hospital licence may have cathartic value in the court of public opinion, but as a constructive approach to a chronic problem, it falls woefully short.