Study on the Regulatory Framework for Consumer Redress in the Health Care Sector in India

Executive Summary

Background

Despite many reports in the popular press about the plight of health care consumers and the implementation of the Consumer Protection Act (CPA) of 1986, there is paucity of information about the current system of redress in the health sector in India. The present study seeks to help close this gap by providing an in-depth account of the functioning of patient redress systems within the country. The key questions addressed by this study are:

• What is the current state of patient redress mechanisms in place at different types of health facilities both in public and private sectors?





• What is the current status of adjudication of problems between consumers and medical providers in various Consumer Forums established under the Consumer Projection Act?

Methods

The study reviewed the current system of complaint redress in the private and public health care sector from three perspectives: the institutional view, the legal view and the patient's viewpoint. A questionnaire was administered at 81 randomly selected public and private sector hospitals of different sizes in Delhi, Lucknow, and Hyderabad to examine how facilities currently respond to consumer concerns. Another systematic sample of 86 medical negligence cases was selected from those filed at District Forums in the same three cities. The cases were reviewed, and structured interviews conducted with the complainants, providers, lawyers, and Consumer Forum members.

Results

The results suggest that public and private health facilities lack a professional approach to managing patient concerns, and have weak in-house redress systems. For example, a complaint box/book was physically found in only 33% of the private hospitals, and 22% of public hospitals. Only 17% of the private hospitals and 15% of public sector hospitals had guidelines for receiving and processing complaints. An analysis of the cases filed at Consumer Forums showed that very few of them were for medical reasons (they ranged from 0.1% to 2% of total cases). Complainants were largely educated and forward caste males. Only half of the complaintants were satisfied with the Consumer Forum mechanisms, compared with 65% of the providers. A long delay in reaching judgement was a major problem. Over 90% of the cases took longer than one year to reach judgement, whereas the law mandates a ruling within 90 days.

Conclusion

The study highlights the poor functioning of patient redress mechanisms at the facility level in both private and public sectors. Specific recommendations outlined in this paper include the use of mandatory citizen's charters and institutionalization of complaint procedures. Both consumers and providers need to be better educated about how to address consumer concerns and complaints at the facility level. Standards concerning the quality of care are needed so that the patient knows what they can expect, as well as standards established for consumer redress mechanisms.

For cases of alleged medical negligence and other consumer complaints that can not be dealt with at the facility level, there is a need to strengthen the legal redress mechanisms. Although the Consumer Forums show some encouraging signs, there is a great need to broaden the scope of legal redress for medical negligence for the poor and uneducated. Efforts are also needed to develop ways to speed up the redress process through the Consumer Forums, in addition to alternative regulatory and redress mechanisms. This report recommends how to improve the functioning of Consumer Forums, strategies to increase consumer awareness and empowerment, and recommends amending the Consumer Protection Act and Indian Medical Council Act, in part to bring public hospitals under the purview of the CPA.