Finding a balance

Shashi Tharoor recently raised a question about the Home Minister's decision to seek treatment at Medanta Hospital for COVID-19 infection instead of going to AIIMS. Strange as this may sound, but isn't that rich coming from a celebrity politician when most of the wealthy and powerful people, if necessary, access exclusive private health care facilities within the country and not infrequently abroad. We are used to hearing news of top cricketers, influential politicians and silver screen stars often visiting the most expensive hospitals in the US, UK or other developed countries when bad luck befalls them with serious illness. Of course, the life of 'celebrities' is more valuable than ordinary folks and if someone has the ability to spend money from their own fund, no one should ask any question as that must be individual's prerogative. Under normal circumstances, people in this country have accepted that public hospitals run by the Government will cater for ordinary citizens while private hospitals of a different grade will be the destination for those who are in a position to pay for their treatment. Since private hospitals are not regulated by a regulatory body, pricing is widely variable and individuals choose the ones suited to their paying capacity. Many people now also have some sort of insurance cover and cashless facilities which has become popular among the middle-income group of people and most of the private hospitals, excepting the 'exclusive private health care providers', accept such patients. But when a disaster such as COVID-19 strikes, that balances somehow gets disturbed. Suddenly a large section of the population becomes ill and may be in need of acute medical care which the current infrastructure fails to support. Stories of different sorts start appearing in print and social media and fingers are pointed easily at private hospitals with the accusation of patient refusal, money extortion and such. Since the operation of individual private hospitals can be very different, it is important that sufficient care is taken before making a general statement about private health care services. Let us examine the present scenario in the state of West Bengal.

Department of Health is coordinating COVID-19 care in the State and has asked the private hospitals to take an active part in the process. Only a handful of private hospitals have been taken over by the Government but the majority are operating independently and as advised, have designated a proportion of their total beds for COVID patients. It is mandatory to declare what percentage of COVID beds are vacant on a daily basis and it is apparent from the available information that 90 per cent or more beds in all private hospitals dedicated for COVID patients are occupied while more than 50 per cent of declared beds in Government hospitals remain empty. It is necessary to keep a few buffer beds for patients coming to a private hospital without known COVID status, who may later turn out to be positive, and then require urgent admission and management. There may be empty beds in the wards where there are a number of non-COVID patients. To put a COVID patient in those wards is not only unethical but also dangerous for other patients and staff. Unlike large Government Hospitals, private hospitals have a limited capacity and that has got to be used judiciously.

We have seen in the print media, occasional reports of exorbitant amounts of money being billed for the treatment of COVID-19 patients. If it is true, it is really unfortunate in a country like India. It is unfair to comment on the isolated reports without knowing the background of such billing but I can say, taking full responsibility for that in the hospital I work, on average, the total bill in the general ward for COVID patients not requiring critical care does not usually exceed Rs 2 lakh. For patients in an intensive care unit, the average cost has been between Rs 3.5-Rs 4.5 lakh. There may be some deviation in an occasional patient but the figure has never been in two digits. Private hospitals have got to earn money not only for subsistence but also to make sure that they have sufficient fund to keep pace with continuous development in health care which is expensive. There is no subsidy for the private health care system and unreasonable restrictions on billing are being imposed by the insurance companies at their will. In addition, nonpayment or part payment of bills by the users is not uncommon particularly if a patient has an adverse outcome.

In this unforeseen disaster where there was no preparedness, the situation was expected to go out of control. Policymakers at the helm should have got together to make sustainable and realistic plans to overcome the crisis and reassure people. Instead of blaming private hospitals for everything, one should think why people do not prefer to use the Government facilities which have not only got many-fold greater resources, both in terms of money and manpower but also should be in a position to take a major role in guiding the rest of the health care fraternity. It is not proper to suddenly fix the price for some items in private hospitals without having any discussion, which at times is even lower than the cost price.

It is possible that some private hospitals have refused patients or overbilled patients, but I would like to think that a greater number of private hospitals have maintained sanctity in those respects. It is, however, time for management in private hospitals and the Government to enter into serious negotiation about the pricing of health care in all regions of the country where health economists must participate and all issues are tackled in a sensible and realistic manner. If the pricing is imposed unilaterally, the private hospitals will find a way out to bend rules to their advantage using unfair means, if necessary, because health care is no longer seen to be serving humanity but another profit-making industry. Private health care has become a lifeline for many and most prefer to go to such institutions for better care. Society must recognise this and instead of blaming and at the same time accepting their services, it is essential to analyse the problems in an open mind and arrive at a solution acceptable to all sides. This exercise should not only be done for the present crisis but also for the future so that parity is established in the cost structure of the whole of the private health care system. There is no plausible explanation for such a wide range in cost between different private hospitals in this country because, in the western countries, the variation in the cost between hospitals is much narrower. We need to bring transparency and trust to all users in private healthcare.

The writer is the Managing Director, Peerless Hospital, Kolkata. Views expressed are personal