Medical facilities for public is primary duty of government. Then why service tax on private hospitals?.

[C.A. DEV KUMAR KOTHARI]

Government’s duty:

One can say that providing medical facilities to public is primarily duty of government. The government collects taxes for various services (including medical facilities) required by public. However there is inadequate medical facilities provided by the government and the quality of service in government hospitals is also very poor. This is in spite of large facilities available at government hospitals.

Medical and health service is primary duty of government- failure of government in such duty is reason of flourishing private hospitals. Then why there should be service tax on private hospitals when we find that private hospitals is a result of failure of government to full fill its primary duties of providing medical facilities to the public. Making medical facilities at private hospitals more costly.

No justification of service tax on medical services:

When we consider that it is primary duty of government to provide medical facilities to public, then there is no justification of levy of service tax on health services provided by hospitals other than government hospitals.

Instead of admitting the failure in providing health services to public the government is extending levy of service tax on services of private hospitals. This is not justified.

Right to Health Care as a Fundamental Right being part of life to life: –

The Supreme Court, in Paschim Banga Khet mazdoor Samity & ors v. State of West Bengal & ors, (1996)  4 SCC 37. while widening the scope of art 21 and the government’s responsibility to provide medical aid to every person in the country, held that in a welfare state, the primary duty of the government is to secure the welfare of the people. Providing adequate medical facilities for the people is an obligation undertaken by the government in a welfare state. The government discharges this obligation by providing medical care to the persons seeking to avail of those facilities. Article 21 imposes an obligation on the state to safeguard the right to life of every person. Preservation of human life is thus of paramount importance. The government hospitals run by the state are duty bound to extend medical assistance for preserving human life. Failure on the part of a government hospital to provide timely medical treatment to a person in need of such treatment, results in violation of his right to life guaranteed under Article21. The Court made certain additional direction in respect of serious medical cases:

1.     Adequate facilities be provided at the public health centers (PHC) where the patient can be given basic treatment and his condition stabilized.

2.      Hospitals at the district and sub divisional level should be upgraded so that serious cases be treated.

3.     Facilities for given specialist treatment should be increased and having regard to the growing needs, it must be made available at the district and sub divisional level hospitals.

4.    In order to ensure availability of bed in any emergency at State level hospitals, there should be a centralized communication system so that the patient can be sent immediately to the hospital where bed is available in respect of the treatment, which is required.

5.     Proper arrangement of ambulance should be made for transport of a patient from the public health center to the State hospital.

6.       Ambulance should be adequately provided with necessary equipments and medical personnel

Government hospitals:

Government hospitals have very good facilities- large buildings, spacious wards, open space, equipments, and resources available.

In government hospitals good doctors are employed and at good remuneration. Hospitals attached with medical colleges have specialists and super specialist’s doctors.  In spite of quota systems and reservations, doctors engaged in government hospitals are by-an-large of good qualifications, quality and competence.

However, the resources available are not properly used. It is felt that only 1/3 of resources are used and there is lot of wastage of time and other resources just like in most of other government departments and offices.

Why private hospitals?

Private hospitals are flourishing due to very poor quality of medical services available in government hospitals. The poor service in government hospital is due to reasons that doctors and other officers and staff employed in government hospitals at hefty salaries do not work as they should. There also appears corruption in various departments which causes only about 25-30% of funds (except for salaries) reaching to intended beneficiaries. In case of manpower hours also the ratio is that only 50% of paid manpower actually goes to the benefit of patients.

It is observed that only on admission days of the unit in which a doctor is in charge, he works fully rather may have to put more than normal efforts and hours on that day. On other days, Senior doctors in government hospitals hardly work for about 40-50% of time which they should have spent. As a result junior doctors and also doctors undergoing internship has to work hard and extended hours.  

Corruption in government hospitals:

Lower attendance - working only about 1/3 of time on overall basis.

Poor working of sub-ordinates – about 1/4^th time is spent, there is not much control due to strong unionism and permanency of service. 

Wastage, pilferage and siphoning: The general feeling is that in government hospitals also there is lot of wastage, pilferage and siphoning of funds and material due to corruption in various kind and manner.

Hospitals- Public has general feeling that money spent on running and maintaining hospitals and for medicines is not properly spent and there is corruption. We find general doctors working only few hours of normal duty hours in hospitals, many specialist doctors who are also teachers in medical college, hardly take  regular classes, they teach students only while taking round of wards to see patients. Other doctors are also found to spend only about half of time on their duty in government hospitals and rest time is spent on private practice.

Simple example of corruption at grass root:

For a simple example we  find dirty toilets in government departments and also  in government hospitals, although the government and  municipalities have substantial budgets and  are paying (and/ or showing paid) hefty salaries to sweepers, and spending substantial amount on cleaning tools , apparatus and cleaning  materials but the fact is that toilets in government hospitals, government offices, other public places managed by government are not found suitable to use but one has to use when there is no other option.

The difference of cleanliness in a private hospital and government hospital is the most important reason that people who can afford cost of private hospitals want to avoid government hospitals. Other reasons are not getting adequate  care by doctors and other staff of government hospitals.

Corruption need to be removed:

Corruption need to be removed. If corruption is removed in government hospitals then the service available at government hospitals will increase by about 2.5 times, quality will also improve and there will be preference to get treated in government hospitals.

Duty in government hospitals:

 It is felt that doctors and others hardly spent about half  of time on duty in government hospitals. In case of doctors there may be some  valid reason for this for example (a) government hospitals are not found neat and clean (b) the overall environment is not good (c) there is difficulty in getting work done from sub-ordinates due to strong unionism and service of staff being almost permanent having no fear of losing job  (d) due to disobedience of sub-ordinates doctor do not find  proper working atmosphere (e) lack of decision making powers of doctors (f) interference of other administrative department and agencies of government (g) better facilities in private hospitals and chambers where doctors can have private practice (officially or unofficially)… etc.

Dream of good government hospitals:

If we dream of government hospitals where all funds spent are properly used  and all doctors nurses, and other officers and staff put in time sincerely (say even to the extent of 70%) the  government hospitals will be very clean, doctors and nurses will be available all times, there will be clean wards,  no shortage of beds and linen ,clean toilets, and no shortage of medicines and equipment. However, this is not so due to various reasons.

Resultant reality about private hospitals:

If this dream about government hospitals come true the other reality will be that private hospitals will have to shut down. In spited of poor service about 80% of medical needs of public of India is met by government hospitals.

Earlier articles:

When service tax was levied on cosmetic surgery an article By CA Dev Kumar Kothari

titled “Service Tax on some surgical services – is it a beginning to cover all medical services?” was published in the Service tax journal (STJ).

In that article author had apprehended by way of the following  question:

Is it an experiment to tax all doctors and medical services in future?  This new levy may be a trial attempt of the Government and in future other medical services may also be brought into taxable category.

It appears that what the learned author had apprehended is going to be actually happened partly through the present budget and rest in near future, unless there is forceful protest by all concerned.

In this article author has not discussed the proposed provisions because the same have been elaborated by other authors in articles webhosted on this website.

Request from readers:

Author request readers to send their feedback and experience about government hospitals and private hospitals. Readers and authors who specializes in constitutional matters are also requested to send their feedback and share knowledge on specialized subject.