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Amendments to KPME Act: Good, bad or ugly? - Part 1


By Dr M Kamath Ammembal
MD, DGO, DNB, MRCOG


Mangaluru, Nov 14: The proposed amendments to the KPME (Karnataka Private Medical Establishments) Act have been in the limelight for the last two weeks due to strong opposition from private medical practitioners. An open debate is essential to understand the issues both from public and doctor’s perspectives.

First of all, let us understand the background for the government’s purported intentions to amend the act which was originally enacted in 2007 with a view to regulate private medical establishments. It is supposed that there is a significant socio-economic disparity in the society preventing citizens from deprived backgrounds from accessing the highly advanced healthcare available in private hospitals. There is a suggestion that private medical establishments are charging exorbitantly and unscrupulously thereby causing severe hardships to the common man.

There is a perception that treatments are being recommended recklessly, resulting in complications and in some cases, death. Overall, the government suggests that private medical establishments have been insensitive to the plight of the poor. The amendments aim to set these problems right by imposing severe penalties and even imprisonment if the doctor concerned has been found negligent. The amendments provide for "capping" the rates for treatments, investigations and charges. An appellate will be formed at the district-level to provide "immediate justice" to aggrieved patients. This appellate will comprise members from local governing bodies as well as an AYUSH doctor.

The doctors in general and private medical practitioners in particular, are vehemently opposing the amendments for several reasons. Private medical establishments come in several categories starting from stand-alone clinics to high-end multi-speciality corporate hospitals. Vast majority of establishments are small to medium nursing homes and hospitals which cater to 70% to 80% healthcare in the state according to various estimates. Most of these establishments are owned by doctors themselves who would have taken huge loans to purchase land, construct the building, purchase equipment and install infrastructure. Many of them will have to pay EMIs for several decades. Simultaneously, they have to appoint and maintain staff as well as pay decent salaries to prevent attrition. In addition, healthcare sector is a rapidly progressing field with new developments coming up almost everyday. To keep oneself up-to-date, one has to subscribe to journals, attend (expensive) courses and conferences as well as regularly invest in new equipment. In other words, running a successful practice is an extremely expensive and intensive project for a professional from middle-class background. There is practically no help and support for these doctors-cum-entrepreneurs from the government.

For the above reasons, healthcare in the USA is completely dominated by the insurance industry. In the absence of insurance, one would not have access to any healthcare except for the most basic provision. In the UK where I worked for several years before returning to India, private healthcare is practically non-existent as the British Government takes almost complete responsibility for health of the country through National Health Service (NHS). NHS hospitals are some of the best in the world, equipped with ultra-modern equipment and skilled nurses and doctors. One would get excellent care irrespective of socio-economic background. However, it is important to bear in mind that the government has prioritised health over everything else. The situation in Scandinavian countries is even better. Private doctors in India are doing what NHS in UK is doing, albeit at a much smaller level. They may not always be doing an excellent job because they are after all ordinary humans and not governments with near-infinite resources at their disposal.

Human body is a mystery and it is often difficult to predict how it will react to a particular treatment even when a highly experienced clinician is treating the patient. In the event of complications or death, doctors in India have to often deal with physical violence, which is unheard of in the western world. Any death or complication in the UK is investigated and analysed by highly respected bodies such as the General Medical Council who have the necessary knowledge and experience to deal with same. Whilst it is absolutely essential that any negligence on the part of doctors has to be dealt with severely and appropriately, it should be done fairly and by a body which has the necessary understanding of the nuances of clinical science.

In summary, many of the concerns which the public and the government have are valid. They need to be addressed in a calm, systematic and dispassionate manner if we are really sincere about achieving health indices comparable to developed world. Blind and brutal legislation, that too targeting the very foot-soldiers who are providing 80% healthcare in the state will only lead to long-term deterioration of health of the state of Karnataka. In the next part, I shall address the possible long-term consequences of the proposed amendments and how to co-opt private entrepreneurship to overcome the serious health deficit suffered by the people of Karnataka.

 

About the author: Dr M Kamath Ammembal is a consultant gynaecologist with keen interest in public-private partnership in achieving health indices comparable to the developed world. He was a consultant at Hinchingbrooke NHS Trust, UK, before returning to Mangaluru and setting up Ammembal Women's Health.


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Comment on this article

  • Ivar, Mangalore

    Wed, Nov 15 2017

    The next one.
    Why don't the patient get a bill for "Doctor's Charges" in any hospital?

    DisAgree [5] Agree [9] Reply Report Abuse

  • Dr M Kamath, Mangalore

    Wed, Nov 15 2017

    Hello sir, I assume acknowledgement is not one of your weaknesses! May I request that allegations have to be backed by names and evidence. Generic answers to your questions have already been given by me...kindly refer to my previous replies. Warm regards and all the best

    DisAgree [5] Agree [4] Reply Report Abuse

  • Ivar, Mangalore

    Wed, Nov 15 2017

    Doctor,
    I have clarified at the outset that these are the questions raised by everyone.. the cause for the trust deficit which you mentioned!
    If the questions seems to be uncomfortable to answer, please ignore it. I am least interested in arguments.
    I rest.

    DisAgree [6] Agree [7] Reply Report Abuse

  • Dr M Kamath, Mangalore

    Thu, Nov 16 2017

    Thank you for your reply.
    Generalisations such as “everyone asks them” don’t help. Perhaps this is precisely the problem in our country....much of our minds work on “hear say”.
    I am not here to defend the indefensible such as not giving receipts for consultation. Don’t you think the patients also have a responsibility in demanding for the same when they pay for services? Is it possible that they don’t because that is the normal practice in almost all transactions in our country?
    Doctors are a part of this society and tend to imbibe many of its imperfections. They need reform as much as the rest of the society and that is precisely my point.
    Again, It is courtesy to acknowledge answers but I am not too optimistic!
    Warm regards

    DisAgree [2] Agree [4] Report Abuse

  • fred, Mangalore

    Fri, Nov 17 2017

    Many hospitals do provide bills. If not maybe probably because earlier clinics and hospitals were not included as a commercial establishment. After its inclusion things have changed.

    DisAgree [2] Agree [3] Reply Report Abuse

  • Avinash, Mangalore

    Wed, Nov 15 2017

    Dr.Kamath...A very well balanced article which covers the entire spectrum in Health Care and Continuos challenges faced by Heathcare Industry . We in Mangalore particularly are very lucky to have such a great Healthcare system for last so many decades , perhaps the best in the country . The credit for this should go to the commitment/quality of doctors and private hospitals/colleges. Mangalore is the only place in India where you can get a Quality Healthcare at Affordable cost .

    DisAgree [4] Agree [9] Reply Report Abuse

  • Dr M Kamath, Mangalore

    Wed, Nov 15 2017

    Thank you for your kind words. Your words give us succour at an extremely difficult time.

    DisAgree [1] Agree [8] Reply Report Abuse

  • Ivar, Mangalore

    Wed, Nov 15 2017

    The next one.
    Now that there are many companies have local representatives in Mangalore, it is not difficult to get an idea about the exact cost of surgical implants being supplied to hospitals.
    The cost of procedures like angioplasty, arthroplasty and THR themselves is exorbitant. Why the implants like stents, Charnley prosthesis are charged so high in the hospital bills ? Even simple femur nails, tibial nails or austin moor prosthesis are charged many fold! (with reference to the costs at which hospitals procure it)

    DisAgree [4] Agree [8] Reply Report Abuse

  • Dr M Kamath, Mangalore

    Wed, Nov 15 2017

    Thank you for your questions, Sir/ madam. Courtesy requires that you at least acknowledge my answer to your previous question.
    The costing of healthcare is an extremely complex issue and even after 25 years experience, I haven’t come to grips with it.
    The most important factor in my observation, is the wide variation in the quality of various consumables. For example, Johnson and Johnson high quality tape used for urinary leaks would cost over 34k whereas a Chinese-make would cost less than 7k. It is anybody’s guess on what the results will be of cheap devices are used in human body! Another example- I recently bought a Karl Storz equipment for 1.1 lakh. An Indian make would cost just 8k! But most doctors are quality-conscious and given the choice, would only use the best possible device or equipment. KPME act will compel doctors to use cheaper devices which will eventually show up in poor results.
    Also, hospitals procure consumables in bulk and therefore are are charged less than the marked price. These consumables have a sell-by date after which they cannot be used in human body. It is often the case that many such devices have to destroyed due to expiry. Therefore, it is well within the rights of the hospitals to charge at marked price to balance out this loss. Regards

    DisAgree [4] Agree [8] Reply Report Abuse

  • steev, Udupi

    Wed, Nov 15 2017

    Take a example of cataract Eye operations. Recently I researched about a eye operation. In my particular case import cost of carl zeiss lens was only US $60 ( which is 60x65= Rs 3900) . Total cost of the operation ( one eye) turned out to be Rs 28000.
    Is this justified ? Doctor said lens costs more than Rs 20000 . See the 5 fold increase in price from import price value to the value charged to patient . The Eye clinic did not even give the bill. I see this trend in most of the private Eye hospitals in Udupi Managlore.

    DisAgree [1] Agree [6] Reply Report Abuse

  • Ivar, Mangalore

    Wed, Nov 15 2017

    Dear Doctor,
    I will not respond to your answers coz that will lead to further arguments. My intention is to seek a justifiable answer from medical fraternity for questions troubling any layman like me. Daijiworld has got a vast reader base, who will analyse your answers and decide whether to support KPME act or oppose it.
    The agree and disagree clicks can be considered as a sample opinion poll.

    DisAgree [2] Agree [8] Reply Report Abuse

  • steev, Udupi

    Wed, Nov 15 2017

    I support Karnataka govt in this regard. My family has suffered lot because of greedy and negligent doctors of a highly reputed hospital in Udupi district.

    In the past I have seen, how doctors were good and had lot of human values and would care for the patients and would give good advice and treatment. This was about may be 25 years ago. Then doctors were less , but we had good doctors with human values. Now we have many doctors and many hospitals but the humanity aspect is almost non-existent. Just money and only money that matters for them. I can say this applies to almost 50% of the doctors today . That is very sad fact. Sorry Dr Kamath , this is the experience from our suffering in the hands of the doctors.

    But why we have this problem today. Because govt has not invested in medical education and hospitals. The govt should first fix root cause of this issue. That is they should open at least one medical college and super specialty hospital in each district . Fees for the medical students should be less than 1 lac per year. Then lot of good deserving and capable candidates can afford medical education. At present only rich(some who are not capable ) can afford medical education . Lower section of the middle class can not afford medical education.
    So when one spends lacs or even crores to get medical education from private colleges , obviously to recover that cost doctors would charge very high fee which can not be afforded by poor . Without finding a solution for the root cause of the problem , it can not be solved by just bringing a act.

    DisAgree [3] Agree [9] Reply Report Abuse

  • Ivar, Mangalore

    Wed, Nov 15 2017

    I will pose a series of questions, one by one, which are the common questions on general public's mind. Dr M Kamath Ammembal and other eminent doctors from the region should answer the same and we all will support their demands. Be assured, there will not be any derogatory statements from my side.

    First question.
    Why does a doctor in a private hospital ask a patient to get all the tests redone in the same hospital even though the patient has the reports of the same tests done on the previous day, somewhere else? Even X'rays for that matter!

    Next one will follow.

    DisAgree [2] Agree [9] Reply Report Abuse

  • Dr M Kamath, Mangalore

    Wed, Nov 15 2017

    Is this a universal behaviour or limited to a few doctors? What percentage of doctors behave this way? We need hard evidence that such behaviour is universal. Again, we need to know if government doctors are also behaving in unethical ways. (KPME act does not cover government doctors).
    The above mentioned issue may have been your personal experience and if so, I apologise on behalf of the medical fraternity. There may be reasons why doctors ask for a repeat test. The problem is, doctors have not been effective communicators and that is why, may often be misunderstood despite best intentions. However, you must understand that one anecdote does not make real evidence of a systemic problem.
    There are problems in medical profession as much in other aspects of our country. The solution is not to blietzcrieg the whole private health sector but to help reform it so it serves the underprivileged better. This act is anything but reformation.

    DisAgree [4] Agree [4] Reply Report Abuse

  • Robert Pais, Mangalore

    Wed, Nov 15 2017

    Every Clinical Diagnostic Lab has to send 10 % from every test ordered from that doctor. The survival of a private laboratory depends on that. Otherwise the doctor will tell the patient, I do not believe in their report.

    There are instances where superspecialists ordering multiple tests and initiating therapy based on that , but due to pure luck the patient gets a second opinion that reveals problem is something else.

    Let me give an example : a woman complaining cough and congestion gets treatment for allergy with bronchodialators. But it turns out she was suffering from acid reflux. what about the suffering, money spent on , loss of work etc due to this superspecialist allergy specialist?

    Therefore there should be accountability and regulation.

    DisAgree [1] Agree [6] Reply Report Abuse

  • Vincent Rodrigues, Bengaluru/Katapadi

    Wed, Nov 15 2017

    Instead of doctors going for strike some other routes would have adopted to settle their demands without effecting the sick and serious

    DisAgree Agree [2] Reply Report Abuse

  • Dr M Kamath, Mangalore

    Wed, Nov 15 2017

    The proposed amendments are so serious that the effects will be felt immediately. The law was passed in West Bengal in March 2017 and according to some estimates, over 100 establishments have closed down already. I am concerned that many more lives will be lost over due course, especially in the rural areas, if the act is amended.

    DisAgree [4] Agree [7] Reply Report Abuse

  • fred, Mangalore

    Fri, Nov 17 2017

    there are two ways, either pay in crores or protest. We are now protesting. No

    DisAgree Agree [1] Reply Report Abuse

  • Sethu Madhavan, Mangalore

    Wed, Nov 15 2017

    Elected Government shall be the master of roaster on Public Health and cannot wash off its hands so easily. If the Government were sincere, fee for for UG and PG courses in medicine should have been fixed reasonably with due weightage for meritocracy, but everything but that happened clandestinely. In fact, fee was fixed in crores in connivance with Private Lobby on a quid pro quo basis. Fee fixation Committee was dissolved soon after admission process and Chairman resigned in protest. The fact that many of the politicians including Dr. Parameshwara, S Sivashankarapa, Prabhakar Kole etc., owning medical colleges speaks for itself. Here, Government needs to show more sincerity and integrity towards the cause and need of general public. This move on election eve raises many questions and all wise men know it as a dirty play to appease the gallery with no tangible benefits going to accrue to common man in long run. If the Government was serious to issues in health care system, recommendations of Justice Vikramjith Sen Committee should have been implemented in toto with serious efforts to raise the standards of Government Hospitals. Needless to say, asking private medical establishment to step in to the shoes of Government to ensure delivery of affordable healthcare to citizens is an utopian idea. The state of affairs at Government Hospitals are pathetic with no medicines and consumables. Even disposable syringes in short supply are used multiple times before disposal. Operation theaters are infested with rodents and wards are worst than slaughterhouses. On the other side, Health Minister is climbing on roof top to proclaim that world class facilities are ensured in Government hospitals and Government doctors prescribing medicines and diagnostics to outside will be summarily dismissed from service. This has resulted in a serious trust deficit and, with introduction of draconian KPME Act, Karnataka Government is setting standards of governance to unspeakable levels.....

    DisAgree [2] Agree [13] Reply Report Abuse

  • Dr.S.Kamath, Mumbai

    Tue, Nov 14 2017

    Excellent write up Dr M Kamath mam

    DisAgree [7] Agree [12] Reply Report Abuse

  • Dr M Kamath, Mangalore

    Tue, Nov 14 2017

    Thank you, sir.

    DisAgree [5] Agree [4] Reply Report Abuse

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Title : Amendments to KPME Act: Good, bad or ugly? - Part 1


 
 
 
 

 
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