Competition Commission of India (CCI): While rejecting a complaint filed by a retired Wing Commander alleging that Director General of Health Services (DGHS) was abusing its dominance for empanelment of private hospitals for purpose of healthcare and medical services to Central Government Health Scheme (CGHS) beneficiaries in Delhi-NCR region, CIC dismissed the allegations of anti-competitive practices against DGHS, Ex-Servicemen Contributory Health Scheme (ECHS), Quality Council of India and National Accreditation Board for Hospitals and Healthcare Providers (NABH). It was submitted in the complaint that an office memorandum was issued by DGHS for fresh empanelment of private hospitals and revision of package rates applicable under Central Government Health Scheme (CGHS) in Delhi wherein it prescribed different rates of reimbursement to the private hospitals based on their accreditation with NABH. The complainant contended that the said office memorandum does not spell out any rationale or logic behind the different rates of payment for treatment of a disease or medical condition as there is no relationship between NABH accreditation and efficacy of treatment offered by a hospital. It was also alleged that such a categorization of hospitals is based on wrong presumption of efficacy of NABH accreditation without any scientific basis and DGHS has colluded with the other Opposite Parties to give benefit to a selected few hospitals having NABH accreditation and reimburse them with payments at higher rates compared to other hospitals without NABH accreditation. CIC observed that “For applicability of the provisions of Section 4, the entity or entities in question must be an enterprise in terms of section 2 (h) of the Act. In the instant case the allegations of the Informant primarily against DGHS which is working under the Ministry of Health and Family Welfare, Government of India. The activities being performed by DGHS cannot be covered in the definition of ‘enterprise’ because it is not directly engaged in any economic and commercial activities. Its role is limited to control and regulate the health care system in the country”. While holding that no prima facie case is made out against the opposite parties CIC rejected the contentions of complainant and held, “The different rates prescribed by DGHS for NABH accredited hospitals cannot be considered as anti-competitive in any manner, rather it would act as an incentive to non-accredited hospitals to secure such accreditation and provide quality health care services, which will ultimately benefit the patients.” (Dr. Biswanath Prasad Singh v. Director General of Health Services, Case No. 20 of 2014, decided on June 23, 2014)

To read the full judgment, refer to SCCOnLine

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