No matter how compelling the reasons, governments cannot be guided by emotions of moral outrage and of right and wrong. A democratic society is founded on the basis of the rule of law that must guide government actions. This is so in order to avoid governments misusing their power, resorting to arbitrary action and ensuring fair play and natural justice. This then implies casting a special responsibility on the governments who are charged with the duty of providing good governance to its people.
- Having declared health as an industry working on the principle of return on investment and making profits over the welfare and well being of the patients, governments have a special duty to lay down laws, rules and regulations to stop providers and hospital establishments from getting away with predatory behavior or malpractice.
- During the past twenty years, following liberalisation policies, the growth of the IT industry and other factors, as well as disposable incomes among certain classes, have increased – though this is not the case across the social spectrum.
- As one doctor has said, Pune city, which should have fifty Sassoon Hospitals (public hospitals), has only one, although new corporate and multi-speciality hospitals are coming up daily.
- These corpotrate hospitals are bright and glittering. In some ways, they are like shopping malls. Some have even been registered as charity hospitals, but their only objective is profit. Partly because of their state-of-the-art equipment, but also because of a growing lack of choice, as older hospitals run by trusts or individuals close down, people are going to these hospitals. Such hospitals foster the impression that they provide high-quality services, which justifies their high costs of care.
- There is another important aspect of such “hospital-malls”. New technology costs lakhs and crores of rupees. If these machines are now indispensable for diagnosis, hospitals run by individual doctors are less able to compete. If the medical sector is left to the mercy of the market, and if the foundation of the whole business is profit, where will this take us?
- Government health services have been weakened due to government indifference, and that is why there is scope for corporate hospitals to prosper. Due to the entry of corporates, the order of priorities has changed. Now the doctors’ priority is no longer the best interests of the patients, but the profit earned by the shareholders of the company.
- In corporate hospitals, each patient may be seen by multiple specialists. An orthopaedic is called because the hands and feet are aching; a neurologist for numbness in the hands. They come and look at the patient and their charges are added to the bill. Is it useful for multiple specialists to examine a patient? This question is never even asked. Investigations are not based on what the patient’s illness is, and whether there is a need for specific investigations. Given any complaint, they produce a list of investigations that must be done.
- Totally unnecessary surgeries are being performed in corporate hospitals. During investigations, they may see a small stone in the gall bladder. It is not causing the patient any problems. But they scare the patient into going in for a surgery.
- Public relations officers of many corporate hospitals keep roaming around to visit doctors; they entice doctors to send patients (to their hospitals) by tempting them with cuts. Nearly everybody indulges in this practice. It must be legally banned.
- These corporate hospitals charge bills of Rs 1 lakh and more, while the surgeon gets only Rs 4000 to 5000.
- Some corporate and large hospitals admit bogus patients under the Rajiv Gandhi Health Scheme (a publicly funded health insurance scheme). They give the admitted person money, and plenty to eat and drink. They prepare records showing that an angioplasty or angiography has been done on that person, when actually nothing has been done. How the government comes out with such schemes, without first regulating private hospitals is a mystery? Without regulation, the basic objectives of such schemes are lost, and they become mechanisms for corporate hospitals to loot public funds.
- There is no humanism to be found in corporate hospitals. Small hospitals are being destroyed due to these corporates. In small hospitals, there is at least the possibility that the doctor has not lost his basic sense of humanism. They wait for the patient to make the payment. They give concessions. None of this happens in corporate hospitals. This must stop.
- A corporate ophthalmology hospital maintain everything five-star style, but forget about the patient. When the patient comes, they give him lemonade or tea. They advertise that they have the latest hi-tech optics shop. The patient melts because of the free lemonade, and he buys a pair of spectacles that have an actual value of Rs 200 or so, for Rs 3000–5000! The in-house optician is the main income avenue of corporate hospitals. Sometimes they offer a free check-up. The scheme has a 20-per-cent-off offer, just like in a mall. The whole atmosphere is designed to tempt.
- Corporates can implement government schemes and insurance schemes. For small private hospitals when reimbursements are delayed they don’t have the time to keep making trips back and forth to get payment from the insurance company.
- Corporate hospitals vie for tie-ups with large public sector companies. These public enterprises give exorbitant reimbursement to their employees. The big corporates draw in cases from all over the state. But junior trainee doctors operate on those cases! Further, often the quality of these corporate hospitals is not as good as they claim in their advertisements. When they do a cataract operation, they even charge a high amount of money for an expensive lens, but implant an average-quality lens.
- If a patient goes with my referral note, he gets 30 to 40 per cent off on an MRI (because I do not take any commission). One patient forgot to take my note. He was charged the full amount, and a cut went to some third party - says a practising paediatrician.
- Nowadays people want glamour and marketing. They have become used to the mall culture. The concept of ‘master check- up’ (packages of large number of tests, of which many may be unnecessary) has gotten into their heads. Now doctors who practise ethically and scientifically are looked upon with contempt, because they obviously can’t afford this glitter. But people often don’t know what they are getting into by going to corporate hospitals.
The current obsession to privatise health, as if it is a commercial enterprise like Air India or a ITDC hotel, is not founded on the belief that patients will gain access to good quality of health care. Instead it smacks more of an admission of governments’ inability to govern and enforce laws in order to ensure that in the name of quality, private hospitals do not play havoc with the vulnerable patients. If truly committed to patients well being, then it is incumbent on the government to come up with stringent laws that will not provide any scope to private players to be negligent, callous or exploitative.
Fighting the rot in India's private healthcare feat.
Dr Arun Gadre & Dr. Abhay Shukla
The corporate hospitals provide employment to almost 90% of graduate doctors, 95% of PG doctors .These corporate hospitals have numbed people’s sensitivities. These hospitals are like malls. Our society does not need them. Instead, all tertiary health care should be provided by the government. And corporate hospitals must also be compelled to provide mandatory treatment of emergency cases, whether paid or otherwise. This would enable people go to any of the nearest hospitals for emergency treatment, even if they don't have money or coverage.
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