New Delhi: For hospital businesses facing challenges following rising budgets and a fall in profits, the recent Delhi High Court (HC) order, directing the Aam Aadmi Party (AAP) government to fix minimum wages of nurses in hospitals with less than 50 beds at ₹20,000, has aggravated the situation.
The high court has directed the Delhi government to implement the Supreme Court’s order related to minimum wage and working conditions of nurses in private hospitals. An expert committee, set up by the Centre in pursuance of the SC order, had recommended a minimum wage of ₹20,000 for nurses working in hospitals with less than 50 beds. It also said the working conditions of nurses in private hospitals should be on a par with nurses at government hospitals.
The Association of Healthcare Providers (India), representing the majority of healthcare providers in India including private and corporate hospitals, has raised concern over the order explaining how hospitals will take a hit following the implementation of the order.
“The number of nurses employed in a private hospital is almost 3-5 times more than the government hospital for same number of beds. This means the budget of private hospital will rise in that proportion and which will not be sustainable," said Girdhar J. Gyani, director general AHPI.
“Average emoluments for B.Sc. Nursing in metro town like Delhi are one third of emoluments being paid in government service. Sudden hike of this magnitude is never heard for any of the service. The raise in emoluments of nurse will open the Pandora box as other categories of healthcare workers will come up with similar demand," he said.
Corporate hospitals have argued that the Supreme Court-appointed committee had said hike in salary be implemented through legislation, while in case of Delhi, it has been done through an administrative order. Officials from corporate hospitals claim that their business was suffering and a hike in nurses’ salary will hit sustainability.
“While operating expenses in a hospital keep increasing at normal rate driven by the inflation, there is no provision of hospitals increasing their rates for various medical procedures. There is growing perception that private healthcare providers were generating huge profits, on the contrary hospitals are finding difficult to survive," said Gyani.
“Central and state insurance schemes keep reducing the reimbursement rates and hospitals in general and those required maintaining quality accreditation standards are finding extremely difficult to meet the two ends. While fair and decent wages for nurses is good, its impact also needs to be evaluated in holistic way. The increase in wages has to be studied in the overall context of sustainability of hospitals," he said.
Gyani recommended that like the ‘Jagdish Prasad Committee’ the Supreme Court may appoint similar empowered committee which may study the sustainability of hospitals and fix the rates of medical procedures accordingly.
“It is important as in the pretext of making healthcare affordable, patient safety is taking back seat and honorable Supreme Court will do yeomen service by appointing such a committee," he said.
According to the high court order, in case of more than 200-bed hospitals, salary given to private nurses should be at par with the salary of state government nurses given in the concerned State/UT for the similar or corresponding grade. In case of more than 100-bed hospitals, salary given to private nurses should not be more than 10% less compared with salaries of state government nurses given in the concerned State/UT for similar or corresponding grade.
In case of 15-100 bed hospitals, salary given to private nurses should not be more than 25% less in comparison of the salary of state government nurses given in the concerned State/UT for similar or corresponding grade. Salary given to private nurses should not be less than ₹20,000/– pm in any case even for less than 50-bed hospitals.
“If hospitals have to implement then for 200-and above size of hospitals, it would be close to ₹60,000 while presently the entry level pay in private sector is ₹20000. The government has already implemented minimum wage for nurse as ₹19,000 and therefore asking for ₹60,000 is contradiction of its own order besides being unviable," said Gyani.
When contacted, BLK Hospital was unavailable for comment. While Apollo hospitals refused to give any statement, some hospitals said they have started complying with the directive on minimum wages for nurses. “Max healthcare has been paying minimum wages to nurses as decreed by government of Delhi since April 2018. This in effect is also the policy statement of our company. We are in line with government directive of providing starting salary at ₹21,000," said Dhirja Sharma, vice president - head nursing, Max Healthcare.