By Dr Mukul Kapoor | PUBLISHED: 03, Jan 2018, 17:04 pm IST | UPDATED: 03, Jan 2018, 18:03 pm IST
The medical profession in India is perhaps at its lowest repute. No profession is today as abused by the Indian public, as the doctors. You see doctors being abused, ridiculed, accused of murder/corruption and called inhuman/insensitive in the print, electronic and social media. The moment a hospital death is reported, the media goes overboard to carry out its own trial and pronounce the doctors guilty, all to improve their TRPs. The Indian media, which has itself been voted to be the most corrupt in the world, surprisingly behaves puritan and screams accusations all over.
Healthcare is a basic necessity. Unfortunately, specialized medical treatment is expensive all over the world. In most countries, healthcare is treated either as a basic right or is heavily supported by the government. In others, it is dependent on health insurance. In India, it lies in neither of the segments.
Healthcare is most neglected in our country with a very small percentage of the population having insurance cover and a miniscule percentage truly covered by a reasonable public healthcare system. Majority of the population is supposedly dependent on a skeletal public healthcare system with inadequate infrastructure and manpower. The public healthcare system is poorly funded and its quality abysmal. The public system also fails to attract qualified doctors, as it neither offers adequate money nor professional satisfaction. Rural healthcare is particularly deficient for it doesn’t even offer a decent place for the doctor and his family to reside and survive.
The central and the state governments have managed to keep the health budget allocations minimal and have gradually become cosmetic players in the medicare sector. Some elite hospitals have been made in the public sector but they mainly cater to the elite and the influential. The budgetary allocations of these elite hospitals eats up most of the country’s health budget, leaving some crumbs for other public hospitals. The less one talks about these money guzzlers, the better. It costs the exchequer more to do a special investigation, like CT and MRI, in these hospitals than it costs the government to out source them to the private sector.
Government hospitals are financial disasters with high overheads and poor services. No self respecting individual would like his body to be handled in the non-elite public hospitals. The only population these hospitals cater to is the true downtrodden, who barely afford to live and can’t afford to pay for even basic medicines. The Indian commoner is thus forced to look for affordable medicare in the private sector.
The country had a reasonable number of small hospitals and nursing homes to cater to the lower and the middle class population. However, in our effort to ape the western culture, we adopted standardization of hospitals. We introduced National Accreditation Bodies for standards of Hospitals and Laboratories. Though conceptually a forward looking step for a country aiming to be a leader of the world, the compulsions of trying to match western standards has lead to severe rise in healthcare costs.
Standards demand highest quality hygiene, documentation, use of disposable as far as possible, strict audit of quality and regular accreditation. A stark example of how it hits patient bills is the controversy related to the unfortunate death of a child in a Gurugram Hospital, consumption of gloves was perceived to be very high (change of glove is mandated by these standards every time the patient is touched or a procedure conducted). The need to adhere to these standards has also added to a major payroll load of non-medical personnel in the hospitals. In addition, the corporatization of healthcare has lead to a rise in expenditure on fancy human resource policy initiatives.
Land to most hospitals in the country has been allocated at concessional lease rates. The lease agreements require hospitals to treat free in out-patient at least 25% patients from the Economically Weaker Section (EWS) while 10% hospital beds need to be used for free treatment of EWS patients. In most hospitals, a large number of patients (nearly 50%) are treated at concessional rates, as they are government beneficiaries (CGHS/State Government/ESI). Although being on the government panels is not compulsory, multiple pressures make most hospitals to opt for them.
Where do hospitals get money to treat patients free and at concessional rates? The answer is the obvious – the paying patients share this burden of this pseudo-socialistic policy (you may call it a hidden tax). The government argues that the hospitals were allocated land at concessional lease rates but who pays for the hospital infrastructure costs which run to at least a 1000 crore for a big corporate hospital, the running cost and cost of medicines and disposables???
Most hospitals are constructed with help of bank loans and need to payback loan EMIs to the tune of 15-20% of the loan amount per annum. Meaning that a hospital setup with 500 crore investment needs to pay an EMI of about 100 crores per annum or 8-9 crores per month. In addition, hospitals are skilled-labor intensive businesses, with tremendous payroll burden. To add to the woes of patients, cost of medical disposables and medicines is not low. All these factors lead to high maintenance and treatment costs. The public does not perceive these not so visible costs and attributes the entire cost of treatment to doctors fee (and commission) and thereby term doctors as looters and extortionists.
Healthcare administrators need to ensure publicity of these facts. They should display the costs of these in the bills rather than try to cover these costs in marking up costs of drugs and disposables. A schematic publicity campaign needs to be made to be launched to make the public aware of these hidden costs. Governments should realize that the EWS category patient bills must be partly met from the taxes they collect rather than cost being indirectly transferred to the unfortunate paying patients. Government panel rates should be more realistic and not fixed arbitrarily by some Babu as per whims and fancy. Most CGHS rates for procedures are not just absurd but laughable.
Almost the entire country, including government servants, is dependent of the private sector for Medicare. It is important that policy is formulated to make this sector economically viable. Governments must increase their health budgets to provide affordable healthcare to the common man. The governments of the day are instead shying away from this responsibility and making the hospital business more unviable. In case remedial measures are not taken at this stage the healthcare apparatus of the country will crumble.
The medical profession is at crossroads. If a doctor successfully treats a patient but the bill is high, he is called an extortionist. If he treats a patient but it results in an adverse outcome, he is called a murderer. He is hardly ever appreciated by the media or the public. There is a satirical comment viral on the social media which says “Indians are immortal till they are confronted by a doctor”.
Violence and anger against doctors and hospitals is primarily due to inability of the common man to pay for Medicare. Unfortunately, this deficiency is perceived by the layman and the media as greed of the medical profession. The Medical Profession is thus being painted as criminal. Reports of corruption and the poor image of hospitals has changed the way people view doctors. The profession no longer attracts good quality talent and the quality of healthcare in the country is gradually worsening. Indian doctors are currently considered the best in the western world but if this image is not corrected, good doctors will not pass out of our colleges.
# The writer is Director, Department of Anesthesia, Max Smart Super Specialty Hospital.