1 consumer protection act & the medical services national workshop on “ accessibility &...
TRANSCRIPT
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Consumer Protection Act & The Medical Services
National Workshop on “ Accessibility & Affordability of Quality Health Services
in India”Trivandrum, 10-12 September 2004
ByBejon Misra, Chairman
Consumer Coordination Council (CCC)Delhi, India.
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About CCC
• Established as a Registered Society in 1993Established as a Registered Society in 1993
• Issue based National Coalition of 55 leading Issue based National Coalition of 55 leading consumer Organizations from all over Indiaconsumer Organizations from all over India
• Member of Consumers InternationalMember of Consumers International
• Recognized by Government of IndiaRecognized by Government of India
• Member in various advisory and technical Member in various advisory and technical committees at the National & International committees at the National & International level on Health & Food Safety related issueslevel on Health & Food Safety related issues
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Objectives
1. To make the existing consumer protection laws user- friendly to increase accessibility to the poor & accountability to the patients
2. To build a relationship between the patients & the medical practitioners based on trust, transparency & respect for each other
3. To insulate health care services from industry influence & increase involvement of the consumer organisations to benchmark quality of service in the health care delivery system
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Consumer Protection Act
• Enacted in the year 1986 & acclaimed as the most modern piece of legislation on consumer protection globally
• It gave legal rights to the consumers to claim compensation on deliberate act of negligence, substandard products & unfair trade practice which caused loss or damage to the consumer
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Rights of the Consumer
1. The right to be protected against marketing of goods which are hazardous to life and property
2. The right to be informed about the quality, quantity, potency, purity, standard and price of goods to protect the consumer against unfair trade practices
3. The right to be assured, wherever possible, access to an authority of goods at competitive prices
Contd…
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Rights of the Consumer
4. The right to be heard and to be assured that consumers interest will receive due consideration at appropriate forums
5. The right to seek redressal against unfair trade practices or unscrupulous exploitation of consumers and
6. Right to consumer education.
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Consumer Protection Act & Medical Services
• The significant judgment by the State Commission of Orissa in Smt. Sukanti Behera vs Dr. Sashi Bhusan Rath (1993), upholding the rights of patient to challenge the quality of health care services, was a landmark decree in the history of consumer redress within India
•The judgment by the Supreme Court of India in the Indian Medical Association Vs V.P. Shantha (1995), settled the matter by explicitly including medical services under the protective sheath of the Consumer Protection Act 1986
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CONSUMER REDRESS AT THE SAMPLED CONSUMER FORUMS
Distribution of Medical Negligence Cases Filed in District Courts in Three States
1997 1998 1999
Courts Total Cases File
Medical cases
% of medical cases
Total Cases File
Medical cases
% of medical cases
Total Cases File
Medical cases
% of medical cases
District Forum Delhi
6472
No
record
No
record
1728
3
32
0.2
20620
47
0.2
District Forum Lucknow
2260
8
0.3
2004
12
0.6
2138
13
0.6
District Forum Hyderabad
1400
No
record
No
record
4026
42
1
2052
2
0.1
Distribution of Medical Negligence Cases Filed in District Courts in Three States
1997 1998 1999
Courts Total Cases File
Medical cases
% of medical cases
Total Cases File
Medical cases
% of medical cases
Total Cases File
Medical cases
% of medical cases
District Forum Delhi
6472
No
record
No
record
1728
3
32
0.2
20620
47
0.2
District Forum Lucknow
2260
8
0.3
2004
12
0.6
2138
13
0.6
District Forum Hyderabad
1400
No
record
No
record
4026
42
1
2052
2
0.1
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PROFILE OF CONSUMERS PROFILE OF CONSUMERS USING CONSUMERCOURTSUSING CONSUMERCOURTS
Percent Female 33 Sex Male 67 Less than 8th class 14 Education Graduate and above 58 SC/ ST 3 Caste Other caste 97 Service 38 Business 21 Professional 9
Occupation
Agriculture 4
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CASES OF MEDICAL NEGLIGENCE: NATURE OF CLAIMS
• Wrongful death – Patient dying on account of wrong treatment
• Physical loss of function – Patient losing physical function such as eye sight, ability to walk etc. on the account of wrong diagnosis
• Other kinds of damage – Suffering due to operative or other treatment procedures without loss of physical function or death
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CONSUMERS SATISFIED WITH CONSUMER
REDRESSAL MECHANISM
Pending Cases
Indifferent11%
Dissatisfied51%
Satisfied38%
Bejon misra:Bejon misra:Bejon misra:Bejon misra:
Bejon misra:Bejon misra:
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CONSUMERS SATISFIED WITH CONSUMER
REDRESSAL MECHANISM
Decided CasesIndifferent
3%Dissatisfied59%
Satisfied38%
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COST INCURRED BY CONSUMERS
Rs. 1000 - 500053%
< Rs. 1000 22%
Rs.5000+25%
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COMPENSATION AWARDED COMPENSATION AWARDED IN 42% CASESIN 42% CASES
> Rs. 1 Lakh12%
Rs. 50000 - 1 Lakh
12%
< Rs. 1000047%
Rs. 10000 - 5000029%
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PROVIDER’S VIEWS (PENDING)
• 97% of providers said that consumers had not approached them
• 54% claimed to have special facilities for handling consumer complaints
• 25% said CPA was one - sided biased in favour of consumers
• 24% blamed heavy filing in consumer courts as the main bottleneck
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PROVIDER’S EXPERIENCES (POST)
• Dismissed 35%
• Had to pay Compensation 40%
• Received Compensation for Malafide Complaints 25%.
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TIME TAKEN FOR THE FINAL JUDGEMENT
0
20
40
60
80
100
Total
<1 yr 1-5 yrs >5 yrs
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LAWYER’S RECOMMENDATIONS FOR IMPROVING THE EFFICIENCY OF
CONSUMER FORUMS
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VIEW POINT OF MEMBERS OF CONSUMER FORUMS
• 79% agreed that medical negligence cases were not disposed of within the stipulated period
• 84% were of the opinion that the present system had provided an opportunity to the poor to voice there problems.
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Health Financing: How does India finance health compared to other countries?
• Moderate levels of overall spending on health (4.5% GDP)(middle 20% of countries)
• Low public expenditures on health (0.9% GDP; 3.9% of gov’t spending) (bottom 10% of countries)
• High proportion of private health expenditure (82% private) (highest 10% of countries)
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Who Pays for Health in India?
Private Insurance
0%
Private Investment
3%Public-States
14%
Public-Centre4%
Private Out-of-pocket79%
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State Level Per Capita Public Spending on Health
0 25 50 75 100 125 150
Bihar
MP
UP
Orissa
Andhra Pradesh
WB
Haryana
Gujarat
Karnataka
Maharashtra
Assam
Rajasthan
TN
Punjab
Kerala
Central Per capita State Per capita
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State Level Per Capita Private Spending on Health
0.0 100.0 200.0 300.0 400.0 500.0
RAJASTHAN
NORTH EAST
ORISSA
KARNATAKA
BIHAR
MADHYA PRADESH
GUJARAT
WEST BENGAL
TAMIL NADU
ALL INDIA
ANDHRA PRADESH
MAHARASHTRA
UTTAR PRADESH
HARYANA
PUNJAB
KERALA
Out of Pocket to Public Facilities Out of Pocket to Private Facilities
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How to make services affordable?
• Third party interventions:
Health financing is a means to mobilizing a volume of resources sufficient to meet the health goals of a country
• Provider interventions:
Transforming India into a regional healthcare hub.
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The Roles of Government – Beyond Service Provision
• Contract with the private sector for services
• Information collection and analysis
• Information dissemination / communication
• Coordination of health sector actors
• Regulation and accreditation
• Resource mobilization (“tax and spend”)
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RECOMMENDATIONSRECOMMENDATIONS
a. Mandatory Citizen’s Charter for all hospitals
b. Institutionalize complaint proceduresUser friendly complaint manuals Fixed time frame for redress
c. Improve infrastructure of Consumer Forums.Standard assessment of Consumer Forum every 2-3 yearsIncrease number of Consumer ForumsPanel of medical experts be made available
d. Amend Consumer Protection Act Bring free health care in the perview of CPA
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CONCLUSIONCONCLUSION
a. Benchmark quality of service in health care sectorb. Build awareness and generate demand for quality
service thru well defined legislationc. Induce competition with good regulatory
mechanisms• Promote accountability and transparency in health
care services
THANK YOUI AM NOW OPEN TO QUESTIONS