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TODAY’S TALK ON EDITORIALS CIVILS360

JULY 28, 2017

Regulation of DNA profiling

  • The Law Commission has drafted a Bill on the use and regulation of human DNA profiling. The 271st report of the Commission has prepared the draft Bill named ‘The DNA Based Technology (Use and Regulation) Bill, 2017’
  • The Commission records that DNA profiling is used for disaster victim identification, investigation of crimes, identification of missing persons and human remains and for medical research purposes. It notes that privacy concerns and the ethics involved in this scientific collection of data are very serious.
  • Primarily, the Bill provides for the setting up of a statutory DNA Profiling Board to spell out procedures and standards to establish DNA laboratories.
  • It provides for the creation of DNA data banks, at national and regional levels, which would be responsible for storing DNA profiles received from the accredited laboratories.
  • Sharing of DNA profiles with foreign governments or other government agencies, organisations or institutions would only be for the purpose of this Act or any of its agencies, including identification of missing persons, disaster victims, suspects. Any violation would lead to imprisonment, which may extend up to three years, and a fine which may extend up to Rs. 2 lakh.

Public health, private players?

  • The NITI Aayog has recently unveiled a grand plan to effectively privatise district hospitals in Tier-I and Tier-II towns. It has developed what it calls a “model concessionaire agreement” for provision of healthcare services for cardiac and pulmonary (lung) diseases and cancers.
  • It is proposed that public facilities in district hospitals would be outsourced to private providers. They would be free to charge full treatment costs from patients not covered by government schemes (such as the Rashtriya Swasthya Bima Yojana) and the providers would be reimbursed by the government for treating patients referred by the government

What are the implications for accessible healthcare services?

  • First, the proposal implies that most patients would have to pay for care even in public facilities.
    • The promise that patients covered by government health insurance schemes would access care free of cost needs to be seen in the context of recent surveys which show that just 12-13% of people are covered by public-funded insurance.
  • Second, the proposal is designed to further worsen inequity in access to healthcare services.
    • Private providers will concentrate on better-off districts, leaving the poor and remote districts for the public sector to manage. This will further weaken the ability of public hospitals to attract and retain trained doctors and other health workers.
  • Third, the scheme will expose thousands of patients to unethical practices by private providers, compromises in quality and rationality of services and additional ‘top-up services’.
    • A specific section in the document on ‘risk management’ is primarily concerned about risks of private providers, with very little about robust mechanisms to protect patients from unethical practices.
  • Fourth, outsourcing of hospital care to private providers inevitably becomes increasingly unsustainable over time as they ratchet up demands on reimbursements and fees.
    • The proposal to hive off hospital care to the private sector is justified by the argument that public services are not financed adequately and face an acute shortage of trained human resources.

REMEDY?

  • The simple remedy could be to significantly enhance investment in public healthcare services, including in the training of health workers.
    • Success stories of public health, in diverse settings such as the U.K., France, Cuba, Thailand and Sri Lanka, are all related to public systems.

The NITI Aayog’s proposal involves the handing over of public assets to for-profit companies, and represents a clear abdication of duty by the government.