Regulating the private health care sector: The case of the Indian Consumer Protection Act

Abstract

Private medical provision is an important constituent of health care delivery services in India. The quality of care provided by this sector is a critical issue. Professional organizations such as the Medical Council of India and local medical associations have remained ineffective in influencing the behaviour of private providers. The recent decision to bring private medical practice under the Consumer Protection Act (COPRA) 1986 is considered an important step towards regulating the private medical sector. This study surveyed the views of private providers on this legislation. They believe the COPRA will be effectivein minimizing malpractice and negligent behaviour, but it does have adverse consequences such as an increase in fees charged by doctors, an increase in the prescription of medicines and diagnostics, an adverse impact on emergency care, etc. The medical associations have also argued that the introduction of COPRA is a step towards expensive, daunting and needless litigation. A number of other concerns have been raised by consumer forums which focus on the lack of standards for private practice, the uncertainty and risks of medicines, the effectiveness of the judiciary system, and the responsibility of proving negligence. How relevant are these concerns? Is the enactment of COPRA really appropriate to the medical sector? The paper argues that while this development is a welcome step, we need to comprehensively look into the various quality concerns. The effective implementation of COPRA presumes certain conditions, the most important being the availability of standards. Besides this, greater involvement of professional organizations is needed to ensure appropriate quality in private practice, since health and medical cases are very different from other goods and services. The paper discusses the results of a mailed survey and interview responses of 130 providers from the city of Ahmedabad, India. The questionnaire study was designed to assess the opinion of providers on various implications of the COPRA. We also analyze the data on cases filed with the Consumer Disputes and Redressal Commission in Gujarat since 1991. Four selected cases filed with the National Commission on Consumers Redressal are discussed in detail to illustrate various issues affecting the implementation of this Act.The private sector provides an important proportion of overall health care delivery services in India. As such, efforts must be made to ensure that such services are of acceptable to high quality. With professional organizations such as the Medical Council of India and local medical associations unable to influence the behavior of private providers, the recent decision to bring private medical practice under the Consumer Protection Act (COPRA) 1986 is considered an important step toward regulating the private medical sector. The author surveyed the views of 130 private health care providers from the city of Ahmedabad on the legislation. Data were also analyzed on cases filed with the Consumer Disputes and Redressal Commission in Gujarat since 1991. While respondents believe that COPRA will reduce the levels of malpractice and negligent behavior among private practitioners, they envision an increase in physicians' fees, a greater number of prescriptions made and diagnostic tests conducted, and an adverse effect upon emergency medical care. Medical associations have argued that introducing COPRA will foster expensive and needless litigation. Other concerns have been raised by consumer forums.