The Kerala Clinical Establishment Act: Will Regulatory approach alone be sufficient enough to achieve ‘Health System Quality’?

Abstract

After a long time of debate and discussions, the clinical establishment act is now on the roll out. This article is a brief narrative review on the current situation and suggestions to effectively implement the act along with few suggestions for increasing quality dimensions of clinical practice ecosystem in Kerala. The history of clinical establishment act is described first. The situation in the country and Kerala about the implementation of the act is then reviewed.  Importance of private sector provision of health care is described. Popular criticisms regarding private health industry are mentioned. Salient attributes of functioning of public health system are briefly discussed. Efforts taken by Govt. to ensure quality of clinical service provision is briefly discussed and the role of Clinical Establishment Act in this regard is mentioned. Suggestions for achievement of quality of clinical service provision are listed.  The purpose of clinical establishment act is to ensure minimum standards or quality in health care. The basic initiative proposed is clinical governance which is already popular in most of the developed countries. The message is that reforms for improvement of quality and effectiveness of clinical practice ecosystem should happen through physician led initiatives like clinical governance. Accreditation focus mainly on structural elements of clinical service provision while clinical governance address process elements.