Lucknow, UP, India, 226028

HEALTH-CARE INDUSTRY – A GAME CHANGER

Dr. shivangi 2

EXECUTIVE SUMMARY

The health-care industry plays a very vital role as a game-changer during the pandemic, which stimulating the GDP and Indian Economy. It manages and strengthens the risk-taking ability which facilitates medical services. This article puts a glance into sectors of the health-care industry, the role of it, government regulation, and important amendments. This can be broadly categorized into medical services, paramedical services, and Insurance services. The scope and needs of those industries are created a bold impact on every common person. The scarcity of those industries experts created the doubts and controversy between the health-care industry and the common public. The risks and limitations of those industries are lit up the importance of those industries and their experts.

INTRODUCTION

India is facing the worst situation during the lockdown, which has impacted on GDP and the Indian Economy. But Health-care Industry works like a game-changer in a sense of financial transaction as well as earning through medical services, medicine, paramedical aids, and the most important health insurance. With the COVID 19 pandemic encircling the globe and more than 2 million-plus active cases of COVID 19 loomed over common people. The medical and insurance services by the medical practitioners and insurance experts are accompanying the precautionary measures and servicing best to all the citizens. But due to some members of the medical fraternity and health insurance experts, all industry has been accused of negligence in the discharge of medial duties as well as unprofessional insurance services.   The health-care industry is mainly divided into three types one is medical services and aids, paramedical aid, and health insurance, or mediclaim. The latest amendments in government regulation have come in force about medical negligence and compulsory inclusion of COVID 19 in all health insurance policies.  

ABOUT HEALTH-CARE NEGLIGENCE AND LEGAL LIABILITIES

Negligence is a simple word, which indicates neglecting something purposefully or coincidentally. In the case of the medical or insurance sector, any small negligence will be painful and counted a lot to that suffered patient. During COVID 19, no of cases are registered about health-care sectors. In most of the cases, negligence is related to medical aids or claim of health insurance / mediclaim services. The health-care industry is playing but some professional players. The medical negligence ratio hiked up to 400% during COVID 19. Medical negligence is punishable under following laws such as Torts, Indian penal Code, Consumer Protection Act, etc. Medical negligence can create liabilities on medical professionals in the following ways.

  • Liability under the Consumer Protection Act:

 Medical practitioners from all fields of medicine such as Allopathic, Homeopathy, and Naturopathy can be liable under the Consumer Protection Act. Duties that the doctors owe to their patients are clear. A consumer has the option to approach the Consumer Forums to seek speedy redressal of his grievances or file a criminal complaint.

  • Liability under the tort law:

A tort is a residuary civil wrong. Duties in tort law are fixed by the law and such duties are liable in rem or to the people at large generally.  Such wrongs have only remedies by which they can file for unliquidated damages. There are possibilities of cases where concurrent liability may have existed under tort and contract. For instance, if there is any contract existing between patients and doctors, then the doctors can be liable under contract for his negligence

  • Liability under criminal law:

In certain cases of medical negligence criminal proceedings are mandatory. A doctor can be punished under Section 304-A of the Indian Penal Code 1860 for causing death by his rashing or negligent acts or behaviors. According to a recent Supreme Court decision, the standard of negligence required to be proved against a doctor in cases of criminal negligence (especially that under Section 304-A of the Indian Penal Code 1860) should be much higher than it can be described as ‘gross negligence’ or ‘recklessness’, not merely lack of necessary care.

IS COVID 19 IMPACTED ON HEALTH-CARE INDUSTRY?

Pandemic time is the perfect time to set right the health-care sector with the medical industry and insurance sector but both sectors are intersected with each other and created the confusion. It may come as no surprise that COVID-19 has accelerated awareness on healthy lifestyle, important of life, and most important health insurance to protect themselves and dear one. COVID-19 brought sharped focus on health-care reforms that promoted global access to affordable care. The growing monetary concerns about health among people in India, at a time when the country’s economy is on the top of the recession, many employers have declared cut off on salaries and additional benefits. With the number of cases of coronavirus growing compounded in India, the terrifying stories of the medical sector like lack of availability of beds, organ theft, medical negligence in primary care, malpractice charges levied by private hospitals to treat COVID-19 patients, has emerged.  At a time like this, total coverage of medical costs is required in a health insurance policy. If we take analysis and review health insurance statistics, it is surprising that hardly 4% of the total population has health insurance, and others health is not secured with any health insurance.  In April this year, the Insurance Regulatory Authority of India (IRDAI) mandated to cover the costs of hospitalization treatment for COVID-19 in all insurance products, which are offered by general or health insurance companies. So people secured themselves with health insurance policy, which has COVID-19 treatment coverage. This amendment and regulations gave the opportunity to private hospitals and testing laboratories to grow health-care industry revenue. That’s why the Medical industry intersected with the insurance industry. A health insurance policy generally covers all hospitalization expenses incurred by the person insured for all ailments, except any critical ones like ICU, Ventilator charges that are not part of the policy. However, after the IRDAI’s circular, general health insurance policyholder is able to claim insurance for COVID-19 treatment. Those reforms are to be liked game changers in health care sectors.

SCOPE FOR HEALTH-CARE INDUSTRIES DURING COVID-19

  • Para Medical or Medical depended industries is hit:

The medical devices industry has also taken a hit. The country imports consumables, disposables, and capital equipment including orthopedic implants, gloves, syringes, bandages, computed tomography, and magnetic resonance imaging devices from China. Due to the current situation in China, the medical device manufacturers across India are finding it difficult to source raw materials, and other electronic components from Chinese factories export.

  • Medico Technology Industry came in fame during COVID -19

  • Online courses /webinar got tremendous support as a safety measure, sp. on International Yoga Day

  • Health Insurance got hike during COVID-19

  • Pharmaceuticals industries loomed over the domestic and international markets with the export of medicine. Eg. India exported medicine to the UK during COVID-19.

  • Private Medical practitioners/hospitals came in demand under a health insurance policy with COVID-19 treatment clauses.

CHALLENGES AND LIMITATIONS OF HEALTHCARE INDUSTRIES DURING COVID-19

  • Lack of Awareness about health policy and Insurance:

COVID-19 created the havocked situation, so people tried to secure themselves with health insurance or mediclaim policies, but 75-80% of health insurance agents have no idea about services under their insurance products or coverage of treatments. Many insurance agents took benefits of illiteracy about healthcare and gave wrong insurance products, which created confusion between policyholders and hospitals.

  • Cost of Healthcare in private Hospitals and institutions:

Government hospitals and medical services have no quality care during a pandemic so people have been left with private hospitals, but private hospital charges for COVID- 19 treatment started from min. Rs. 50,000 to Max. Rs. 8 lacs, which created the biggest challenges for the common public.

  • Malpractice of Medical practitioners.

Medicine is the noble profession but some medical practitioners started malpractice during Pandemic and purposely recommended the COVID-19 test.

  • Business and Marketing greed of Health Insurance Agents:

Business Development greed of Health Insurances agents created digital marketing games with the use of technology.  The insurance sectors created competition between companies and sales of policies.

  • The gap between medical treatments and health insurance services:

Medical treatments are expensive day by day. When policyholder requires treatment and insurance claim that time health insurance service providers start their inclusion and exclusion of medical treatment matrix.

  • Limited hospitals services of Health insurance:

Health Insurance is bonded with limited hospitals in any cities or star hospitals (as per their tie-up policy) but the rural areas also require those treatments and care but limited hospital tie-up is barrier between patients and health insurance.

  • The business of smuggling organs and other body parts during COVID-19:

No. of cases is filed about medical negligence as well as smuggling of internal parts and organs during COVID-19.

  • Malpractice of laboratories:

Various private laboratories charge heavily and started giving fake reports of COVID- 19. Recent Case – Thyrocare Laboratory from Thane, Maharashtra scammed of fake COVID-19 positive reports.

  • Dumping of Medicines by medical stores:

The market is running short with the dumping of medicine, due to this some drug suppliers and medical stores started selling essential medicines in the black market with extra charges.

  • Promotion of certain medicines or pharma companies:

Dumping of medicines created a scarcity of medicines. In this situation, some pharma companies took heavy benefits and launched their similar brand’s products/medicines in an expensive manner.

CONCLUSION AND SUGGESTION

Due to malpractice, dumping of medicines, scarcity of medical equipment, lack of awareness about healthcare policies, and insurance common middle-class person is suffering from tension, stress, anxiety, and fear of life. The coin has two sides; so on one side of health care industry growth helps people like lifesaver guards. These health care industries help our country economy with GDP and employment but another dark side created fear, confusion, tensions, bluff, and insecurity in common person minds.

  • Government Policies and awareness programs:

The government should launch medical educational awareness programs and champions like triple Polio about COVID-19; which can reduce fears about COVID-19 as well as people can get knowledge were to take treatments.

  • Strict action again malpractice and criminal liabilities:

No. of criminal cases has launched against well-known hospitals due to their malpractice or medical negligence. So the government should take strict action and stand against those hospitals.

  • Strict rules and regulation about health insurance:

Proper rules and regulations are required for healthcare insurance with guidelines for policyholders. Health insurance companies should give proper training of COVID-19 treatment inclusions and exclusions. The government should look after rules and regulations about insurance sectors.

  • Legal support for Medical negligence cases:

Victims, who are suffered during COVID-19 from hospitals, health insurance, pharma companies, or medical stores, should get proper legal consultations and remedies by legal professionals.

  • COVID-19 info line is required:

The government should start the COVID-19 info line and helpline to help COVID-19 Patients and post COVID-19 treatments.

  • Strict actions against medical stores and pharma companies about medicine dumping:

Medicine mafia started medicine dumping so the government should take a strict stand against such activists as well as their supporting pharms companies. Criminal cases are required to file against them and the government should take the leading roles to stop injustice.

  • Immediate treatments in medical urgency by private and government hospitals.

Heart attack, kidney failure, or any other medical emergency requires immediate medical assistance but due to COVID-19 treatments or Isolation, many hospitals and medical practitioners ignore emergency and create negligence. So the government must-have policy for non-COVID-19 patients in an emergency.

In the above suggestion, we have tried to put the light of the current scenario of healthcare sectors. During pandemic healthcare sectors are on leading positions and having a tremendous scope. They need strict regulation and action-oriented plans to implements. Common people should raise voice against such condition and starts to educate themselves during this situation. If the government takes stand against all kinds of injustice then healthcare sectors will be proven as Real Hero and Game Changer in a few months.

Author(s) Name: Dr. Shivangi Zarkar (Advocate & Corporate Counsel)

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