Nadia Ghumman
Countries around the world have diverse healthcare systems, and most are changing with time to best suit the needs of the populace. With this continuous evolution, there is a constant demand for current and up-to-date healthcare laws that meet those needs.
While many aspects of the healthcare system can and should be discussed, the focus of this article is the general problems with the existing healthcare laws, the need for developing new laws in the missing areas, and updating existing healthcare laws in Pakistan that can be justly implemented.
Notably, in healthcare, there are parties involved other than the patients. Healthcare laws protect all parties involved—most crucially, the people whose lives and health are at risk—and those who provide care, manage it, resolve disagreements, and preserve parties’ legal interests.
In general, the existence of laws in the health sector establishes the obligations of providers, evaluates the validity of contracts, sets standards for practice, and establishes whether the interactions between various organizations and the individuals who work for them are within the predetermined bounds. This makes the delivery of healthcare more equitable and seamless.
The health industry is dynamic and always changing. If the laws and policies don’t keep up with these advancements, people’s health deteriorates, which affects the country’s economy. Although it would be wonderful if I could offer some evidence to support my claim, these effects are ironically rarely measured in our country, but according to Harvard Business Review, bad health is an indicator that reduces the global economy significantly.
However, Pakistan’s healthcare laws do not fully cover all the WHO’s recommended coverage areas, and some of these laws have not been updated in decades.
Furthermore, a lot of people find these policies confusing or hard to understand, which puts stakeholders’ rights at risk and raises the possibility of inadvertent harm to people and the system. The absence of a robust system for ongoing education about these laws among stakeholders, given their diverse range of literacy levels, results in a lack of clarity regarding rights and responsibilities.
The presence of strong legislation becomes even more important when we bring new elements to healthcare delivery. The most recent instance of this occurred in Pakistan when eligible families received health cards, but stakeholders were not clearly informed about the proper utilization of these cards.
The benefits given through the Sehat Sahulat Program were an incredible achievement for Pakistan’s healthcare system, but with such privileges, there is a risk of overutilization of services and undue recommendations of services, which can cripple a new system like this.
While rights and obligations are addressed in the Sehat Sahular Program’s Charter of Services, which was drafted in 2021, further laws like the US anti-kickback statute, which imposes civil and criminal penalties for accepting or soliciting payments in exchange for services that are either unnecessary for the patient or give improper financial benefits to stakeholders like hospitals or doctors, were necessary while these cards were issued. Laws that forbid fraud and the improper use of government-approved services for private financial gain are essential for the equitable utilization of such resources for health.
I find it heartbreaking to learn how some physicians/surgeons in local hospitals refer patients to another hospital and decline services while themselves having the facility to provide emergency treatment. As a result, some patients pass away while being transported. We need accessible, up-to-date malpractice legislation to put an end to this kind of practice. We need laws that specify exactly who has the duty to treat, who should be held accountable, and what should be the remedies.
The Law of Torts, which places civil obligations on providers, is the legislation that is most frequently applied in medical negligence proceedings in Pakistan. However, not every instance of negligence falls into the category that falls within the purview of civil liability.
There are legal remedies available for serious incidents of carelessness, including criminal culpability under the Pakistan Penal Code and disciplinary proceedings under the Pakistan Medical and Dental Council.
The UK has very comparable malpractice laws that are applied considerably more equitably.
Regretfully, in Pakistan, even with these remedies present in our legal system, improper stakeholder education and multiple other reasons prevent these remedies from being applied fairly. For example, according to a study performed in a civil hospital in Karachi, around 70% of providers were not acquainted with the complete definition of malpractice, the defensive practice was more prevalent, and there was a fear of assault from relatives for disclosing medical errors.
There are many other areas where healthcare laws are either absent or public and providers are unaware of their existence; listing them all is beyond the purview of this article. These areas range from public health laws regarding smoking and vaccinations to the individual rights of medical decision-making to preventing medical malpractice, fraud, and abuse.
I’ve noticed that in developed nations, when a problem arises and the current legal system does not have the necessary laws or regulations, it initiates a dialogue in which all points of view, regardless of how divergent, are welcomed. Drafting new legislation often involves an attempt to consider the interests of the most vulnerable stakeholders. Even though entrenched interest groups and lobby systems frequently impede or complicate the process, attempts to make reforms that will improve the system’s equity and efficiency are typically not stopped by them.
In this context, the Sindh Injured Persons Compulsory Medical Treatment Act, enacted after the loss of a 10-year-old Amal Umer, that imposes liability on hospitals to treat injured patients without delay is appreciable. This should set an example for making laws in other missing areas.
Committees that examine various pieces of healthcare legislation from a fresh perspective and develop a process for gathering relevant data are desperately needed. Learning from other countries’ healthcare legislations, incorporating the finest aspects into our own, and doing comparative research might also be prudent moves.
It is also imperative to have a process in place that determines the continuous education of those involved in delivering medical care about these laws and regularly measures the impact of these laws on all stakeholders.
Above all, the laws need to be written in plain language and presented to the most vulnerable people, such as those who are seeking medical care. In this regard, emergency rooms are great places to highlight patients’ rights. Campaigns for public awareness that use succinct social media messaging can also be used to increase awareness.
By outlining our responsibilities and holding each other accountable, equitable and well-considered healthcare-related laws can fortify the legal foundation of our healthcare system and safeguard all parties involved, not just patients.
Reference:
1-Tassaduq R; Hamid S; Abdul Ghaffar. Health laws of Pakistan: compilation and commentary. East Mediterr Health J. 2021;27(6):538–541. https://doi.org/10.26719/2021.27.6.538
2-https://hbr.org/2020/07/research-poor-health-reduces-global-gdp-by-15-each-year
3-https://pmhealthprogram.gov.pk/downloads/charter.pdf
4-Sheikh, A., Ali, S., Ejaz, S. et al. Malpractice awareness among surgeons at a teaching hospital in Pakistan. Patient Saf Surg 6, 26 (2012). https://doi.org/10.1186/1754-9493-6-26
5-Rukhsana Shaheen Waraich. Healthcare System and Medical Malpractice Law in Pakistan. Policy Perspectives: The Journal of the Institute of Policy Studies. 2018. Vol. 15(3):85-98. DOI: 10.13169/polipers.15.3.0085
The author is a physician registered with the PMDC, has published clinical research, and has a master in healthcare administration from the US
