In Retrospect

Chaos ensues

Incidents of overcharging by private hospitals and general lack of necessary equipment and supplies reveal how underprepared India’s healthcare systems are for a major crisis

Sarjuk Das is sitting thousands of kilometres away in a small village of Bihar, waiting for the papers of his dead son to arrive. Das is 70 years old and had come to Delhi three months back to get his son operated for mouth cancer at a government hospital. He along with his wife had undertaken a difficult journey only to lose their son and get mistreated by the authorities.

Monica belongs to an upper-middle-class family and lives a comfortable life in the suburban complex of Dwarka. A few days back, she was standing outside a private hospital begging them to admit her ailing father who was having a heart attack. With tears in her eyes, she rushed to the ambulance trying to get her father to another private hospital after the authorities denied them admittance, saying they have no beds.

Both the cases had one common factor and that is the broken healthcare system. While Das lost his son not to the disease but to the ignorance of the authorities, Monica was left stranded in a crisis situation. Both cases come at a time when the country is fighting a pandemic.

The world is facing its biggest threat, a virus that has forced countries to go into lockdown and has brought the economy to its knees. In India, the situation is no different as cases are increasing almost every day.

Medical experts in India assert that the lockdown slowed the speed of the transmission of infection. This, they say also helped by buying more time for the health infrastructure to meet the challenge posed by the pandemic. However, experts still feel the worse is yet to come.

Still, there are those who still see the situation as being under control.

"In the US, there've been almost 40,000 cases per day in the last two days, our numbers aren't that high. Cases per million population continue to be low and we still have a low mortality rate," said Randeep Guleria, AIIMS Director.

Health infrastructure

An interesting piece of data given by the Indian Government revealed that about eight states are contributing to 85.5 per cent of active COVID-19 caseload and 87 per cent of total deaths in India. Maharashtra, Tamil Nadu, Delhi, Telangana, Gujarat, Uttar Pradesh, Andhra Pradesh and West Bengal are the major contributors to the highly infectious disease, the Government said.

Maharashtra continues to remain the worst affected with 79,927 active cases and 1,04,687 discharged or cured cases. Meanwhile, Delhi confirmed 26,148 active cases and 65,624 recovered cases. Tamil Nadu and Gujarat are the third and fourth most affected states with 42,958 and 6,148 active cases respectively as of Saturday.

Many medical experts have claimed that while no one was prepared to fight the virus, India's suffering is compounded by its already tumbling infrastructure. A senior doctor at AIIMS, on the condition of anonymity, said that while government hospitals are in deplorable conditions, they are at the forefront in tackling the Coronavirus situation. "We need a strong healthcare policy. This pandemic was a wakeup call for the already weak infrastructure. I will not say that we don't have a good policy, we do, but it is the implementation that creates hurdles."

He cited the example of private hospitals, stating how before the capping of prices they were looting the common people. "We still get complaints from colleagues or relatives telling us how private hospitals charged them a heavy bill," he added.

Data for the public sector obtained from the 2019 'National Health Profile' (NHP) in late April estimated that public health facilities had about 7 lakh hospital beds. However, no such data could be found regarding the private sector.

Private players & approach

Many patients who have been tested positive, are facing a major issue of getting a bed at a hospital. Sahil (name changed) had gone to Max Hospital as he had tested positive for COVID-19 but was asked to "arrange his own bed and ventilator as there was no bed available". Taking to social media, he was seen crying for help, asking the Delhi Government to intervene.

"I was asked to arrange for a ventilator by Max Hospital. They asked me to shift as they don't have the capacity to provide adequate treatment. They might have tried to do something from their end but they asked me to arrange the bed. Now tell me, will it be possible for me to arrange the bed? There are no beds and I have never felt so helpless," he said in a video.

A doctor working at a Centre run government hospital said that there is a shortage of beds and ventilators. "Patients are being turned away due to unavailability of bed and are being asked to move from one hospital to the other," said the doctor.

Another patient who was turned away by most of the government hospitals tried to get admitted at a private hospital in Dwarka was also turned away.

If one has to talk about Delhi in terms of the availability of beds for treatment of Coronavirus patients, a combined number of 14,243 beds were available in three

different facilities — dedicated COVID hospitals, dedicated COVID care centres and dedicated COVID health centres as against 7,831 beds occupied by positive patients.

With private players getting involved, the burden of cost for people became huge as hospitals slapped sizeable bills for treatment. After complaints of overcharging by private hospitals became commonplace, Home Minister Amit Shah constituted a committee under Dr VK Paul to fix the rates charged by private hospitals in Delhi for isolation beds, intensive care units (ICUs) without ventilator support and ICUs with ventilator support.

The committee recommended Rs 8000-10,000, Rs 13,000-15,000 and Rs 15,000-18,000 as the price slabs for each category, including personal protection equipment (PPE), compared to the current charges of Rs 24,000-25,000, Rs 34,000-43,000 and Rs 44,000-54,000 (excluding PPE) .

The Delhi Government has asked private hospitals to reserve 40 per cent of their beds for COVID patients. "The rates approved by the Committee would be applicable to all COVID beds up to the upper limit of 60 per cent of the total bed capacity of the private hospitals," the Delhi Government had said.

As per the Delhi Government's order, only 60 per cent of the total beds of private hospitals will be given at a capped price. The remaining 40 per cent will be provided at a regular price, even if the private hospital is 100 per cent reserved for the treatment of the virus.

In Maharashtra, the Government is claiming that public hospitals are playing a major role in the fight against COVID-19. The Maharashtra Government has claimed that about 82 per cent of the people have been treated free of cost under the Mahatma Jyotiba Phule Jan Arogya Yojana. Many complained of overcharging by private hospitals in Mumbai, which is when the State Government appointed five IAS officers to look into these allegations.

The Brihanmumbai Municipal Corporation (BMC) has also appointed two officials from their audit department for each private hospital to keep a tab on billings. The BMC has also reserved over 80 per cent of all beds in private hospitals and their price has been capped.

Meanwhile, the Tamil Nadu State Health Department has determined maximum applicable rates for per day treatment of COVID-19 patients in private hospitals.

The hospitals have been classified under two categories — Grade A1/ A2 and Grade A3 / A4. An official release said, in the general ward, Grade A1 and A2 hospitals may levy a maximum of Rs 7,500 per day, whereas Grade A3 and A4 hospitals may levy up to Rs 5,000 per day of admission.

However, in case of admission to an intensive care unit, all hospitals, irrespective of the grades they fall under, have been instructed to not charge over Rs 15,000 per day.

Small players struggle

Dharamveer Solanki nursing home in Rohini is run by Dr Pankaj Solanki. The 50-bed nursing home was recently turned into a COVID-19 dedicated centre after the Delhi Government order. "My life has come to a standstill since then. I have dedicated about 10 beds to fight COVID-19. It has also left me in huge debt," Dr Solanki told MillenniumPost.

At present, the nursing home, which has earmarked 10 beds for COVID patients, has five people with the virus admitted to the hospital.

"If this continues for longer, I will have to shut down my hospital," he added, stating that he has no issue complying with the orders, however placing such small nursing homes at the same place as corporate private players might create an issue.

He said that half his staff resigned when it was announced that his nursing home would be turned into a COVID designated centre, adding that since he complied with the order, patient footfall has decreased drastically.

"There are only three patients in the nursing home who are currently paying for treatment. The non-COVID patients have stopped visiting the hospital and in the last two weeks, there were only two admissions in the non-COVID ward. Expenses have gone up but the number of patients visiting the hospital has gone down," he said.

Several nursing homes in Delhi with a bed capacity of 50 beds or more have been asked to reserve 20 per cent of their beds for COVID patients. With electricity charges, cost of PPEs, ventilators and infrastructural changes of converting a non-COVID hospital into a COVID facility many owners claim they have been left in heavy debt, forcing them to call out to the authorities. Many are considering shutting down the nursing home altogether.

Struggle for 'non-COVID' patients

As COVID patients swarm the hospitals, the situation for non-COVID patients is not easy. Sarjuk Das whose son died of cancer was forced to move out of the hospital and onto the road. Meanwhile, Monica whose father was also a non-COVID patient was left helpless after three private hospitals refused to admit her father.

Patients who are in dire need of surgeries or other medical attention have nowhere to go, leaving them perplexed. At a private hospital, many patients were seen pleading with doctors for a bed, while the healthcare workers were running here and there trying to handle all possible cases. At a section which is solely dedicated to COVID patients, healthcare workers were struggling with tests. "There is just chaos here and we are trying our level best to manage everything," a senior doctor stated.

For non-COVID patients, the struggle continues due to the non-availability of beds and most of the services being shut. "Please, can't you arrange a bed for me? I am in a serious condition," a patient was seen pleading with healthcare workers at Manipal Hospital.

Such cases have left many non-COVID patients in desperation as private hospitals are charging extra for COVID tests. For a normal delivery at a Fortis Hospital, a patient is charged Rs 90,000 to Rs 1,50,000, depending on the room the patient is taking. However, with new policies in place, a patient has to be tested before getting admission.

Private hospitals were charging as high as Rs 6,000 for a COVID test, after which the Government intervened and reduced prices for RT-PCR tests from Rs 4,500 to Rs 2,400.

Situation at large

The way things are playing out, India is bracing for a long fight. With the second phase of the unlock underway, doctors are concerned about the situation escalating. For now, both COVID and non-COVID patients struggle to get by, while private players have been trying to collect a good enough margin, held back from such wanton greed only by the Government's intervention.

By and large, as medical experts have pointed out, this pandemic has been a wakeup call for the authorities to start taking health policy more seriously in India.

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