Mamata takes on private hospitals

Corporate hospitals and private clinics have become villains in a country where nearly 40% of the population are poor, and over 90% live without medical cover. Private hospitals are fleecing patients, in connivance with doctors, drug manufacturers, medical devices suppliers and, often, with the central and state administration. They make money but offer no guarantee for a cure. The private healthcare system has become so corrupt and ruthless that it has reached a diseased proportion by itself. Lack of government spending on healthcare, huge gap in the doctor-patient ratio, fewer opportunities for post-graduate medical education, attractive target-oriented pay packages offered to doctors by private hospitals, nursing homes and clinics and drugs-and-devices marketing kickbacks given to hospitals and physicians feed the viruses to the disease. All low-cost government hospitals, including Delhi's prestigious AIIMS and Safdarjung Hospital, are highly overcrowded, bursting at their seams, giving private hospitals absolute freedom to exploit patients with impunity financially.

Ultimately, for the first time in this country's history, a state chief minister--Mamata Banerjee of West Bengal--lost patience against such persistent unethical practices by private hospitals, healthcare enterprises and nursing homes and summoned their top management to an unprecedented face-to-face. She accused them of highly inflated medical bills, medical negligence and, even, running organ racket. She concluded the fiery session with an announcement to set up a state health regulatory commission to screen treatment bills, performance and transparency of clinical establishments. The West Bengal chief minister's exemplary initiative against the ruthless exploitation of the helpless and hapless common man by private clinics and healthcare centres is most welcome. However, the viruses infecting the system are too robust and complex to be handled by a state government alone. Unfortunately, the Centre is doing little to tackle the issue and create an atmosphere for a healthy growth of the healthcare facility for the common man's benefit.

Every Indian budget had cut the healthcare cost in real terms. As per a World Bank estimate, the per capita healthcare expenditure in India is only about USD 60, and this has been stagnant over the last decade or so. This sum is paltry when compared to indicators from China (around USD 300) or Brazil (around USD 1000), not to mention developed countries of Western Europe or North America. The public expenditure on health is estimated to be around 1.2%t of the Gross Domestic Product (GDP), while the government's documents like the draft National Health Policy 2015, 12th Five year Plan and even the 11th Five-Year Plan explicitly set modest targets like 2.5% health spending. Yet, the government has been unable to provide a policy direction, which could improve the abysmal state of public health systems. The central government is primarily responsible for the mushrooming growth of private hospitals and nursing homes and their systematic and shameless exploitation of suffering patients.

A small beginning here and there won't help. The National Pharmaceutical Pricing Authority (NPPA) may be doing a good job in regulating prices of essential drugs, trying to force physicians to prescribe medicines in their generic names as against brand names, contain the prices of devices. But, they cover only peripheral areas. The real issues are making healthcare accessible, its ultimate cost and quality and affordability, or the way to cover the treatment cost by a patient. With these issues getting increasingly unresolved, the government promise of a universal healthcare for all our people will remain a meaninglessly pompous proposition. Controlling greedy private hospitals, clinics, private practitioners, prices of medicines, medical devices and prosthetics and providing easily accessible and affordable healthcare facilities are easier said than done. For instance, as soon as the NPPA slashed the prices of stents used for the treatment of heart artillery functions by up to 80%, private hospitals raised 'other costs' involving the insertion of the implant to ensure that their fat profit from the procedure does not get compressed. Many of them continued to overcharge the prices of stents. Acting on complaints, the NPPA issued show cause notices, last week, to Max Hospital in New Delhi (Saket) and Nidaan Hospital in Haryana (Sonepat) and initiated investigations against some of the country's very high-profile hospitals such as PGIMER, Chandigarh, Lilavati Hospital, Mumbai, Metro Hospital, Faridabad, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Bharat Heart Institute, Dehradun, and Oxygen Hospital, Rohtak.

However, this is only one part of the story. The government is not investigating the cases of stent implant itself on patients to detect if they at all need such implants. The procedure had come under scanner in the USA, Western Europe and Japan where the practice was often found unnecessary and led to coronary complications later. Stenting is not a substitute for heart bypass surgery. While stenting is a quick-fix job that can be done in less than an hour, the cost of such operations in India is almost the same as more reliable bypass surgery that takes nearly four hours to complete. No one is questioning the need and ultimate result of stent implants in India. Similarly, no one questions the need for the reckless implant of pacemakers on heart patients apart from their cost. No one wondered why medicines in private hospitals are sold at MRP while outside pharmacies offer them at 10-20 per cent discounts.

Take other instances. In India, almost 200,000 new patients need dialysis every year, and it is estimated that less than 30% of patients manage to receive this life-saving therapy mainly due to non-availability or unaffordability. Efforts to provide dialysis to those with end-stage kidney disease should be made in conjunction with more cost-effective efforts while maintaining minimum standards of quality and safety, a paper published in the journal Lancet said. Similarly, private banking of umbilical cord blood is a big business running parallel to childbirth in large private hospitals, but is it worth the cost? Thus, the situation is complicated and all pervasive. The West Bengal chief minister has taken the first significant step to stem the rot. But, the central government, other states and medical council need to do a lot more to offer affordable quality healthcare to all our citizens. After all, nothing is more important than life.