Stringent norms, over-regulation led to closure of 35 hospitals in Pune

Several small and medium-sized hospitals in the city are struggling to stay open due to over-regulation and have slowly started to extinguish, say health experts.

In Pune, as many as 899 hospitals are registered under the Maharashtra Nursing Home Registration Act 1949 and Regulations 2021 with the Pune Municipal Corporation (PMC). Out of these over 400 hospitals are small and medium size hospitals.

In the past three years over 35 hospitals have been closed and ownership of 50 hospitals has been transferred.

Furthermore, less than 50 hospitals are empanelled for cashless facility with insurance companies.

The Indian Medical Association (IMA) and Hospital Board of India (HBI) claim the stringent norms in the Maharashtra Nursing Home Registration Act (MNHRA) 1949 and The Clinical Establishments (Registration and Regulation) Act, 2010 have led to over-regulation.

Dr Sanjay Patil, chairman, Hospital Board of India, Pune chapter, said, that small hospitals provide accessible and affordable quality healthcare to the residents and the norms should be relaxed.

“Almost every month one to two hospitals are closed in Pune city due to over-regulation and financial losses. The over-regulation has added up to the cost of running the hospitals. Small and medium-size hospitals have limited sources of income and staff which makes it difficult for them to sustain,” he said.

The recent amendment of the MNHRA has made the situation even more difficult for these healthcare institutions to sustain.

In response, the Indian Medical Association (IMA) and Hospital Board of India are calling for accreditation to be chosen over-regulation for these hospitals, as it would be a more feasible option.

The association is demanding that all small and medium hospitals with up to 50 beds and clinics should be exempted from CEA and MNHRA. If registration and quality are the aims the goals will be better served by insisting on accreditation rather than regulation, they said.

As per the IMA and HBI the fire brigade department norms for hospitals are retrospective and even two and three-decade old hospitals are asked to submit the change of use. Various permissions, increasing Bio-Medical Waste charges, and charges for Combined Consent and Authorization (CCA) from the Maharashtra Pollution Control Board (MPCB) with penalties in lakhs of rupees add up to the financial burden. Also, the cost of fire compliance equipment, maintenance and auditing has become expensive, said officials.

A senior office bearer of IMA, Pune Chapter, said, “There is an increase in violence against doctors and the hospitals have to spend on security arrangements. The CCTV camera installation, security and bouncers in some hospitals require money.”

“The cost of healthcare staff has also gone up. Compliance like Health Management Information System, Nursing Home Act and computerization etc require additional manpower. There is also the burden of record maintenance, various notifiable diseases, government programmes and Medico-legal cases,” said the doctor.

The doctor added, “The recent decision by courts in the case of the Consumer Protection Act has also created a fear amongst the doctors running such hospitals. Small hospitals like corporate hospitals don’t have resources and dedicated teams to handle such cases.”

Dr Patil added, the Kerala government has decided to relax the norms for hospitals with less than 50 beds, but the state has only ten hospitals with less than 50 beds. This should not happen with the hospitals in Maharashtra. “The IMA and HBI are conducting a series of meetings with various authorities to raise the issue,” he said. Hindustan Times