Private Hospitals and Nursing Homes: Need for an Accreditation System

How does one make the widespread and unethical private sector accountable? The deliberate nurturing of this sector has made it financially and politically very powerful. As a consequence even, simple attempts by some state governments to enact legislation for registration of private NHs/hospitals (without any provision for minimum standards) have evoked angry protests from the medical establishments. They have also ensured that registration laws are either not implemented or are entangled in bureaucratic red tape. During its campaign on medical malpractice in Mumbai, the MFC (BG) had discovered that the registration law of Maharashtra was not properly implemented. It filed a Public Interest Litigation for its implementation. Although a court appointed committee in its study discovered appalling physical and medical standards of the NHs/Hospitals in Mumbai, and it formulated and recommended minimum standards, the government has done nothing in the last one decade to change the law. On the other hand, with increasing criticism towards the commercialisation of the private health sector and the possibility of health insurance companies imposing their own standards on the NHs/hospitals, the private health sector has been brought under great pressure and is now looking for new ideas.

It was in this context, and in order to understand views of various stakeholders of the private NHs and hospital system in Mumbai, that this study was planned. Accordingly, 113 NHs/hospital owners, eight medical associations, two consumer organisations and 100 patients were studied.

• Almost all the stakeholders surveyed in the course of this study favoured accreditation. Five probable reasons could be identified:
• There has been great increase in competition.
• Those not observing good standards were taking unfair advantage and lowering credibility of the profession.
• The apprehension that the opening up of the health insurance sector would force providers to accept the standards set by the insurance companies.
• An Accreditation system would help the providers not only to set its own standards, but also facilitate selection of providers by the insurance companies for their schemes.
• The growing consumer awareness and increasing litigation against the providers have shown that people are becoming more vigilant. Interestingly, the 100 indoor and outdoor patients interviewed in this study overwhelmingly supported accreditation.
• Of the 113 hospital owners/administrators interviewed, 93 said that an accreditation body was essential to assess hospitals for compliance with physical and functional standards. 87 of them said such a body should assist hospitals in continuous quality assurance. 42 of the owners interviewed held that it should also serve as a forum for consumer redress. 31 wanted the body to take punitive action against hospitals. 101 agreed that the body should monitor physical aspects such as operation theatres, space, wards etc., and only 44 of them felt that it should monitor the quantum of fees charged.
• While hospital owners/administrators wanted the government to keep out of the process, all other stakeholders felt that its participation would provide much needed legitimacy to accreditation.
• Most stakeholders felt that insurance companies should not be involved in accreditation.

The findings of the study indicate that the self-regulatory system would have to be sensitive to the views of various stakeholders and governmental monitoring. Since the stakeholders would determine its eventual success, such a self-regulatory system is likely to take a middle path.

Supported by: The World Health Organsiation Research Team: Sunil Nandraj, Anagha Khot and Sumita Menon]]