The growing cost of healthcare in the country has been harrowing the ordinary citizen who is driven into debt at the offset of even a mild infection, argues Yogesh Kant.
Massive outrage among citizens was expressed on social media over the hefty hospital bills charged to the family of a seven-year-old who died of dengue fever near Delhi. This has once again turned the spotlight on the poor state of public healthcare infrastructure in India, where private hospitals are able to slap their patients with excessively high bills.
Following the death of the patient, identified as Adya Singh, in September, the private corporate hospital Fortis Memorial Research Institute in Gurgaon, slammed the family with a bill amounting to Rs 16 Lakh approx. The 20-page itemised bill stoked criticism that the hospital prescribed expensive medicines and overcharged sundry items.
The father of the deceased patient has demanded a probe into the treatment and billing of the corporate hospital, while a family friend's tweet expressing anger about the billing sparked social media outrage. Following the ripples, Union Health Minister JP Nadda responded to the incident by tweeting: "We will take all the necessary action."
While this case has been thrust into the public domain, the bigger question is how private healthcare institutions which are known for charging sky-high fees for medical services operate without any accountability across the country.
"These five-star hospitals have no transparency and no regulation whatsoever. This is the new reality in India and we need a legislation to prevent patients from being treated like a cash cow," said a physician from a prominent hospital in Delhi.
Many doctors who spoke to Millennium Post on the condition of anonymity say that three types of malpractices are particularly common in private hospitals: kickbacks for referrals, irrational drug prescribing and unnecessary interventions.
"The decay is deepening with the increasing onslaught of big corporate hospitals, growing pressure from the pharmaceutical industry and the massively expanding clout of medical equipment agencies," said a senior oncologist.
Last year, investigative agencies busted a racket of top doctors, including the CEO of a private hospital, in north India in connection with kidney transplants across reputed private hospitals in Indian cities. Then, in 2015, the Supreme Court passed a landmark verdict awarding nearly Rs 20 million to a young victim who lost her eyesight due to the incompetence of doctors in Tamil Nadu.
The unfortunate aspect, though, is that India lacks appropriate laws to regulate hospitals, diagnostic centres and other healthcare facilities in the private sector. The more reputed the hospital, the more exorbitant its rates.
Just last year, a year-long investigation by a prominent web portal unearthed a racket of referrals in which private hospitals offer commissions ranging between 10 and 30 per cent to doctors and smaller hospitals or nursing homes.
Last year in May, medical journal Lancet pointed out that India ranks below poorer nations such as Bangladesh, Nepal, Ghana and even Liberia when it comes to providing healthcare for its masses. On the basis of data from the Global Burden of Disease Report, India ranked 154 out of 195 countries in terms of access to healthcare. The low priority accorded to health is highlighted by the fact that India spends less than 2 per cent of its GDP on healthcare, which is far less than what is required considering the country's massive 1.2-billion-plus population.
In March 2016, the long-awaited National Health Policy, unveiled by the Prime Minister Narendra Modi-led government, promised to increase public health spending to 2.5 per cent of the GDP in a time-bound manner and also guaranteed healthcare services to all Indians, particularly the underprivileged.
"We have to do more. I agree there is commercialisation of healthcare and there is overcharging, but there needs to be a serious rethink about how to go forward," Dr MC Mishra, former director of the All India Institute of Medical Sciences, said.
"The only way to tackle this situation is by boosting health insurance and educating people. Like financial inclusion we need healthcare inclusion," says Jitendra Kumar Singh of the Indian Medical Association.
Two grief-stricken fathers whose children died in big private hospitals that raised hefty bills for dengue treatment demanded a monitoring body for private hospitals that currently operate with barely any oversight.
"I've lost my child, I'm losing my house (because of the loan that he took to sustain his son's treatment) and I'm suffering to get justice (for what happened to my child at a prominent hospital)," said Gopendra Singh Parmar, father of late Sourya Pratap, who was treated for dengue at Medanta – the Medicity, Gurugram.
Parmar said more than 45 per cent of his bill of Rs 16 lakh was for medicines and consumables on which the hospital appeared to have taken huge margins.
"The government must frame rules to contain the rates charged by hospitals to make them affordable. Otherwise, families will continue to be forced to sell their assets, beg and borrow in their desperation to treat loved ones," he said in a press conference, breaking into tears.
"India needs a monitoring body to keep an eye on the malpractices in hospitals. In my petition, I would submit that this state of affairs has only come about due to the absence of an effective supervising agency, which regulates hospitals," said Jayant Singh, whose daughter Adya Singh died after she spent 15 days at the Fortis Hospital in Gurugram.
The hospital billed Singh nearly Rs 16 lakh for those 15 days. He said when the news on the overbilling hit the headlines a few weeks later, the hospital wanted to buy his silence – a charge that has been denied by the hospital.
The families came out in the open days after the National Pharmaceutical Pricing Authority (NPPA) released a report on the predatory nature of prominent private hospitals in Delhi after analysing four sets of bills.
Critics say hospitals are using their boom status and unfairly charging far more than the costs to provide services. "For heart surgery, the fee could range from Rs 4 lakhs to 6 lakhs, it can be very low but hospitals don't agree." The rise has been to the tune of 15-20 per cent in about six years at our hospitals says a senior doctor. If a double-room package for a heart bypass in 2007 at the Fortis Escorts Heart Institute was Rs 2.05 lakh, today it is around 3- 4 lakh, he points out.
The debate over hospital charges is part of a deeper change, say healthcare analysts. "There has been a paradigm shift in private healthcare, from simple cure to an array of services as per the paying capacity," says a professor at the Centre of Social Medicine at Jawaharlal Nehru University, New Delhi. Healthcare is being promoted as a brand. A report prepared by market consultant Frost & Sullivan shows how for a bypass surgery the cost difference between a branded and non-branded hospital comes to about Rs 1 lakh.
Another bereaved attendant, when his father needed an open-heart valve replacement surgery, the Delhi-based engineer called several hospitals, asking how much the surgery would cost. He got bombarded with questions: "Is your father insured?", "Do you want a tissue valve at Rs 80-90,000 or a cheaper metal valve?" Network hospital, cashless settlement, third-party administrator, room rent, package, billing after admission or before discharge – he was quizzed until, he felt, his exact worth was neatly measured in monetary terms. Aggressively competitive, all branded hospitals quoted nearly the same price (Rs 3.5 lakh), package (eight days) and room rent (Rs 5,000 twin-sharing). "It was like choosing a hotel," he said.
"It was heart disease that first pushed up the costs," points out a senior cardiologist, practising in a private hospital at Delhi. Technological advances formed the backbone of cardiac care. And they offset the cost impact. "The high prevalence of coronary artery disease and heart attacks in India brought in advanced technology in a big way," he said. After heart, cancer care took a big leap with the advent of the costly chemotherapeutic drugs. "Cost became a factor with the coming of expensive third and fourth generation medicines," a senior doctor of a government hospital points out.
Hospitals admit that increasing charges does not help. Indian patients are notoriously price sensitive. But even everyday cough syrups cost 20 per cent more than they did in 2007. High-end doctors who billed Rs 800 for a 15-minute consultation four years ago now charge Rs 1,500. Daily room charges exceed Rs 7,000 in some Delhi hospitals. A caesarean birth can go up to Rs 1.35 lakh. Luxurious private hospital suites at Rs 25,000 a day are mushrooming.
Government in action
The Delhi government, however, formed a nine-member expert committee to suggest norms to be put in place to stop overcharging by the private hospitals in the city and will recommend norms that have to be mandatorily followed by all private health clinics in the national capital. The committee will also formulate norms to cap the profit margin on medicines and consumables sold by private hospitals.
Delhi health minister Satyendar Jain reportedly said that the decision was taken after receiving complaints related to alleged overcharging, refusal or delay in providing immediate medical care to victims of crime or road accidents, or hospitals compelling patients to buy drugs from the in-house pharmacy, rude behaviour by healthcare workers and delay in initiating medico-legal cases.
The reports added that the committee will also look into consumables, behaviour protocol of medical staff, Economically Weaker Section (EWS) and misdemeanour at the hospital.
"The problem is being compounded in large private hospitals because they prey on patients by charging higher than market rates as well as adding on convenience fees," remarked Dr Dinesh Abrol, National Working Group on Patent Laws.
"Moreover, the testing and diagnostics industry is fueled through a model of cut practice, commissions and irrational, unnecessary prescription. Exploitation is aggravated and enabled by healthcare conglomerates formed by integrating pharmacy, diagnostic centre and hospital businesses. The Government should strengthen free diagnostics schemes, put in place national regulated prices and a system of prescription audit for diagnostics. In parallel, it should break the emerging monopolies of the conglomerates which contribute to driving up costs of healthcare", Dr Abrol concluded.