Laws for Health Care Providers: Legislation and Legal Aspects of Health Care Delivery

Although numerous government appointed and other committees have brought out their reports which have influenced frequent changes in health care delivery, there has been little long term concretisation of policies in the form of proper legislation. As a consequence, the services established by the government have only created entitlements without giving any right to people to take judicial action when the service is inadequately rendered or under some pretext, summarily withdrawn. This study reviews reports of most of the committees since independence. It shows that some of these committees, while lamenting on the government's lack of political will to properly implement good health policies, have themselves been lacking in providing plan for operationalising their own recommendations through suitable legislation(s), thereby giving adequate rights to people for demanding services. The study also does a global survey to understand existence of right to health or in its lieu, the legislated entitlements to create right to basic minimum services.

The study also looks into three other legal frameworks on the delivery system, namely, laws for self-regulation of health care professionals, regulation of hospitals and the tort laws.

• The analysis of the medical council and the laws governing them show that they have failed to use the laws to establish their monopoly for regulation of medical care. The medical professionals too have shown indifference to self-regulation. The nurses, on the other hand, are clamouring for self-controlled regulations and they are denied this facility. In fact the nursing councils are under strong control of medical professionals and bureaucrats who have kept under the lid nurses' demands to increase their number and to stop exploitation of the unregistered nurses in the hospitals and nursing homes.
• The legislative framework for private hospitals and nursing homes is in an even worse shape. The law for registration of private hospitals and nursing homes with the health department exists only in a few states. Even in the states that have such laws, there are no guidelines for the minimum standards requisite for establishing and running nursing homes. This situation is indeed very dangerous for the large number of patients using them.
• There are very few path-breaking judgements on the medical malpractice cases, thereby making case laws on medical negligence underdeveloped. The Consumer Protection Act would thus help in evolving case laws on the subject. At the same time, the study analyses the inherent anti-people logic of the tort laws and argues that at least in the cases of injuries due to adverse outcome during medical care, the tort system should be replaced by the "no-fault compensation" schemes. It also recognises that introduction of no-fault compensation would also mean strong regulation of, if not moving away from, the market dominated health care.

Projected Supported by:The Research Project on Strategies and Financing for Human Development