New Delhi: Starting January 1, US hospitals began posting their prices online – complying with a Trump administration order from April 2018.
The move is expected to increase the transparency and accountability of hospitals towards patients, and give them more choice.
In India, the same proposal has been on paper since 2010, when the Clinical Establishments Act was passed in both houses of parliament. Hospitals are required to display their rates at a “conspicuous place.”
Till date, however, only 17 states and union territories have in theory adopted the Act. Despite this, private hospitals do not display their charges publicly.
This month, the health ministry was asked in parliament what they had done to control “inflated bills” of insured patients, whether they had launched an investigation into it and enforced penalties.
The central health ministry replied with an oft-repeated answer, saying health is a state subject and therefore it is the responsibility of respective states and union territories “to take measures to regulate exorbitant expenditure in the healthcare and taking appropriate action against clinical establishments as per the Act/Rules applicable.”
But the government also said that under this Act, all states are required to display their rates at a “conspicuous place” and set their rates for procedures and services in consultation with the state government.
New York Times recently reported that while US hospitals have started complying with the new rule, several issues remain – the hospitals have been publishing this information cryptically, in ways that are not intelligible to the general public. The report remarked that a “brain surgeon” would be needed to decipher these rates.
US government’s experiment with transparency
“We know that hospitals have this information and we’re asking them to post what they have online,” a US government official said while announcing their new transparency policy last April.
Trump administration’s nearly 1,900-page rule is meant to give patients information about the cost of healthcare as well as better access to their medical history. For now, it is directed at Medicare patients and providers but could expand to those outside this net.
In India, the only recent and official analysis of hospitals rates and billing was in 2018 by the National Pharmaceutical Pricing Authority. It showed private hospitals making margins of up to 1737% on some items. None of this margin was being passed off as a benefit to patients who were being charged exorbitantly.
In an interview with The Week magazine this month, Jagdish Prasad, director general of health services in the Union health ministry, said the Central government has repeatedly written to state governments to enforce the Act: “These rules will help specifically to prevent overcharging. For instance, display of rates by the clinical establishments so that patients can know the rates of facilities and services available in advance and make an informed decision.”
But private hospitals and lobby groups like the Indian Medical Association have been opposing several sections of the Act, regularly taking out protests in Delhi and elsewhere.