COVID-19 and beyond
What has happened to Indian healthcare? Why is it so heartless, even mercenary, in this pandemic? Why is the crisis being seen only as a means to make a windfall?
Atul Makhija is a relieved man. Today. But things were staggeringly different just three weeks ago when he felt slightly queasy and uneasy. The investment professional and advisor to hundreds was running a slight temperature and coughing incessantly. Non-smoker and nearly non-drinker Makhija rushed to the nearest certified COVID-19 testing centre. The result – COVID-19 POSITIVE. Crushed, terrified and clueless on the next steps, Makhija rushed home, to quickly ensure that his wife and two kids — a six-year-old daughter and a 10-month-old son — were tested. And the parents. Six of a simple and nice, still unified Indian family. Result after result, COVID-19 POSITIVE. Each and every one of them.
Today, he recalls: "I have never been so scared in my life. I was paralysed. Petrified. What worried me most was what I was going to do to ensure that we all remained safe. COVID-19 POSITIVE? All of us? How? Because I went to the office for one day in 'Unlock 1'? And where could I get the entire family admitted? Suddenly, I was head of the family, also the reason this happened to us. The thought of healthcare bills never crossed my mind, or perhaps, I would have committed suicide…"
What, ironically, saved Atul and his clan from this predicament and malaise was a decent and caring healthcare professional at the testing centre itself. He told Makhija: "You are all COVID-19 positive, but the symptoms are not severe. Quietly go into home quarantine. No one needs to know. It will be the best for you since hospital bills can be exceptionally high in today's times…" Atul and the five others stayed at home for the next 20 days and, thankfully, they recovered. Today, they are fine, though rattled and extremely dazed.
High bills? How high?
Very, very much so. High enough for Makhija to actually commit suicide. At around Rs 1 lakh per bed per day per person then, he would have had to spend around Rs 15 lakh per person, amounting to over Rs 90 lakh, give or take a few rupees, for the 14-day quarantine, plus other expenses. Let's round it off – Rs 1 crore. Even if Makhija had sold the house that he worked for 20 years to pay off, he still would not have enough funds to pay for the treatment.
Really, what has happened to Indian healthcare and that it is so heartless in the midst of this global pandemic? Why is this scary situation bringing out the worst in our hospital systems, where it is interpreted only and only as a means to make a windfall? When did the Hippocratic oath give way to something mercenary and seedy?
Perhaps a statement from the healthcare powers that be would explain the approach, one made on June 19, 2020. Dr Alok Roy, Chair, FICCI Health Services Committee & Chairman, Medica Group of Hospitals, said: "The private healthcare sector, in spite of going through a difficult financial phase due to the impact of COVID-19, has been supporting the Government in combating the pandemic. FICCI had submitted a cost framework for COVID-19 treatment in April based and revised it based on the analysis of data from hospitals. A patient should pay Rs 17,000 per day for treatment in an isolation ward and Rs 45,000 per day for ICU (with ventilator). However, the rates for government-referred patients were Rs 13,600 for an isolation ward and Rs 36,853 for ICU (with ventilator). These rates include medicines, consumables and basic diagnostics, but exclude PPE costs, high-end drugs and any co-morbidities (abridged)."
Remember, the treatment for COVID-19 is paracetamol (when needed), vitamins and maybe 'nimbu- paani'.
Yet another acronym
Look at this excerpt from a recent report in the 'Economic and Political Weekly' (EPW): 'The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) is the Bharatiya Janata Party's flagship healthcare insurance scheme, stating its commitment to leave no one behind with the promise of providing health cover up to Rs 5 lakh for 10 crore people. This is to be done by relying upon private healthcare providers for service delivery. However, amidst the crisis caused by the (novel) Coronavirus, this has not proved effective. The National Health Authority notes that average weekly claims under the scheme have dipped by 51 per cent during the lockdown period. More worryingly, claims for cancer care and child deliveries fell by 64 per cent and 26 per cent, respectively.'
What the report does not mention is that the AB PM-JAY is little more than yet another fancy acronym. What is does mention is that this is another 'failed scheme' of the Government. And what the scheme's innards also fail to abbreviate is that this scheme kicks in only for those who are hospitalised. It offers nothing for those going for blood tests, kidney tests, cancer tests, even COVID-19 tests. Only for those who are hospitalised. And forget Makhija and his clan for a moment, millions of Indians are not being hospitalised, mostly by choice. No one wants the stigma, or the cost, or the universal wrath of being a COVID-19 patient (victim?) or posters pasted on their doors and homesteads. They would rather remain inside their doors, pray and hope for the best, as a billion-plus Indians are doing today.
Are hospitals fragile?
Well, they would have you believe they are. Those in the private sector claim that they have been "financially fragile for years now", largely stressed with unplanned investments for a COVID-19 response, even though COVID-19 happened to transpire three-four months ago. They also claim to have seen revenues topple by 60-80 per cent due to a decline in patient footfalls, leading to operational losses of Rs 4,500 crore per month. In their defence, they further claim that small hospitals and nursing homes in Tier II & III cities have almost become non-operational due to challenges of liquidity and cash flows.
Private sector hospitals have always charged patients through the nose and every possible bodily orifice for even the most basic of treatments. A heart stent, which costs around Rs 2,500, is administered to patients for over Rs 2 lakh, plus surgery charges, the totally amounting to well over Rs 5 lakh. Kidney transplants, legal and available in Tamil Nadu for under Rs 2,00,000, cost anywhere upwards of Rs 10 lakh in the rest of the country. Forget surgery and transplants, an OPD consultation at any private hospital is upward of Rs 500, if not Rs 1,000.
The World Health Organisation (WHO) thus defines universal healthcare: 'All people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.'
What is the answer?
As a first, the quality of equipment and healthcare services needs to be standardised and optimised. Two, we need to weed out the economic disparity between the haves and the have-nots. And lest we forget, let's create a national policy on health, testing and diagnostics. This is not rocket science, merely the very basic responsibility of investing in our people and their basic wellness.
As an example, West Bengal has shown the way, leading from the front on the 'Jan Aushadhi' programme, wherein medicines are being made available to the needy at a discount of up to 60 per cent. West Bengal has also teamed up with Sweden to make the Kovas COVID-19 testing kit available to the possibly-infected people in Kolkata and North Bengal in the first phase, in identified government hospitals and laboratories. Other states are now following suit, including the politically-troubled Rajasthan (owner of the 'Bhilwara model'), the seemingly unaffected Goa and the largely unruffled Himachal Pradesh, to name a few.
Business is business
One understands the compulsions. Businesses that are investing crores into making their ventures work need to make money. That is the basic premise of business. Further, the fragile condition of India's public healthcare system may one day soon force the Government to intervene more to cover all walks of society under the insurance umbrella to meet in-patient and out-patient care demands. Then the private sector healthcare system may be the most robust one around.
But today's ground-level realities are that it is only the Government-run hospitals that offer any hope or succour to people in this pandemic, while the private sector shamelessly lines up its wallets, without thought, care or mercy. We have all heard stories of Rs 8-10 lakh advance payments being demanded for hospital admission for COVID-19 patients across the country.
By the way, where are the crores of Indians living with cancer, diabetes, hypertension and kidney failure? And so many other minor ailments that need regular medical attention and advice? Have they all suddenly been cured, for we have no space for them in our hospitals, soon to turn hospice?
The writer is a business analyst and communications specialist. He can be reached at email@example.com