"Such corruption, predominantly in the private sector, leads to huge increases in the costs of care, causes impoverishment and compromises health outcomes for individuals and for society," pointed out JSA adding that such corruption was "in danger of becoming the acceptable norm of behavior, to be universalized by policy".
The letter talked of the all-pervasive feature of kickbacks and commissions for referrals which secured an unfair market advantage and stated that alarmingly, these were essentially bribes paid to secure unnecessary diagnostics and treatments.
"This practice started off with kick backs for high cost diagnostics, but today there are kick backs paid at almost every level - kickbacks to village level unqualified providers who act as touts for private hospitals, kickbacks paid to qualified doctors for specialist referrals, kickbacks paid for referrals between specialists. Kickbacks are also paid by diagnostic laboratories, radio-diagnostic centers and pharmacies to doctors and specialists who prescribe drugs and diagnostics," elaborated JSA's letter. It added that a number of "successful" business models, for both primary care and for hospital care that are built around such unethical commissions, some of which were attractive enough for venture capital. Thus the kickback system is converting the perception of a corrupt practice into a smart and acceptable business practice, warned JSA.
JSA sought immediate inclusion of provisions to ban kickbacks in the Clinical Establishments Act, legislation against kickbacks and for professional councils such as the Medical Council of India (MCI) to outlaw such commission payments.
According to the JSA, publicly-financed insurance programmes too constituted an expanding area of corruption. It gave the example of the Rashtriya Swasthya Bima Yojana (RSBY) the publicly funded insurance scheme of the government for the poor. "Many providers in these schemes routinely double charge—both patient and the government, when in most instances the services should be provided free. They convert primary care cases into secondary and tertiary care opportunities and add on prescriptions and other charges so that the sum assured is fully exhausted. They cherry pick cases that have higher profit margins and refuse services for cases that have lower margins," pointed out the letter. Several studies had exposed how insurance companies and private providers colluded to inflate treatment costs, said JSA and demanded that all public health insurance programmes be redesigned.
JSA has also sought a ban on capitation fee for education of health professionals, and the takeover or closing down of colleges that refused to comply. "The capitation fee ranges from a few lakhs for nursing education to over 2 crores for a postgraduate seat in some specialties, most of it paid as 'black money'. Though declared illegal by courts, this practice flourishes," stated the JSA expressing concern over the impact of this on the quality of education and skills imparted.
rema.nagarajan@timesgroup.com
http://timesofindia.indiatimes.com/followceleb.cms?alias=Rashtriya Swasthya Bima Yojana,Medical Council of India,Jan Swasthya Abhiyan,Harsh Vardhan
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