Till some time ago, when people fell ill, they used to go straight to the government hospital, get their treatment and return home. Not only this, when people used to go to doctors, the doctors used to first feel the pulse of the sick people and give their advice, but now the situation has changed. Now people go to private hospitals instead of government hospitals where doctors advise various types of medical tests without listening to the patient completely. Treatment is not done without medical examination. The cost of investigation and doctors’ fees is so burdensome on patients that many patients stop treatment midway and start worshiping God. The Supreme Court has also expressed concern over the arbitrary bills of private hospitals and directed the government to strictly implement rules like the Clinical Establishment Act.
Diseases hamper development and disrupt the world’s economy. The prosperity of any country is also measured by how healthy and happy the people are there. In India, the saying ‘the first happiness is a healthy body’ has been around since ancient times, but in the hustle and bustle of modern lifestyle, diseases have taken over the body like an eclipse. Worrying figures keep coming to light in the surveys conducted from time to time regarding health in India. Diabetes, blood pressure and heart related diseases are increasing rapidly.
The troubles that patients and their families have to go through during treatment in hospitals are no less than an incurable disease. Two years ago, regarding these problems, the Supreme Court had made a strong comment that private hospitals have become dens of loot and plunder. Complaints are common that private hospitals force people to buy medicines from their own shops. Arbitrary fees are also charged for tests, medical equipment, transplant etc. According to a report, treatment in private hospitals in India is seven times more expensive than government hospitals. The Supreme Court has recently directed the Central and State Governments to formulate policies to prevent exploitation of patients. But the government is not paying attention to this.
In fact, capitalism has transformed the medical sector into a major source of income. Medical profession was once considered synonymous with service to humanity as another form of God. But today the medical profession has started being counted among the leading professions competing for profit. The news related to this business of humanity being torn apart in the blind lust of amassing wealth keeps making headlines every day. Today, the endless hunger for money is visible in all those professions which have been considered pioneers in service, charity and welfare of humanity. But there are some professions which have been considered the guardians of humanity. This is the reason why the Supreme Court had to ask why the 51 hospitals in Delhi which were given concessional land and had promised to provide free treatment to a certain percentage of the poor, are not doing so? Actually, it is not just about Delhi, there is looting in private hospitals all over the country. The Central Government had taken a policy decision in the year 2012, in case of emergency, especially the victims of accidents, private hospitals will provide free treatment to all the patients. Even in 2018, the country’s top court had advised hospitals that had acquired concessional land to ensure that free treatment was provided to poor people. Besides, it was also asked to ensure accountability of those who were negligent in this matter. The irony is that despite warning by the Supreme Court, the hospital management did not take the issue seriously. On the other hand, the government departments that monitor this matter also keep a blind eye.
The most important condition for private hospitals built on government land at concessional rates is that they have to provide free treatment to EWS (Economically Weaker Section) and below poverty line patients. As per the Supreme Court order, it is mandatory for these hospitals to reserve 10% of their indoor beds and 25% of their OPD beds for the poor. Private hospitals, which acquire land at concessional rates, are obliged to provide beds, medicines, treatment, surgery and nursing facilities to poor patients free of cost. Dr. D.S.Rana, Chairman of Sir Ganga Ram Hospital Trust, says that in this hospital, instead of 10 percent, 18 percent of the poor patients are treated free of cost.
It is noteworthy that in the policy decision of the Central Government, there was a provision that the hospitals getting land at concessional price will have to provide free treatment to the poor at least ten percent in the in-patient department and twenty-five percent in the OPD. The apex court had also warned in 2018 to fulfill the accountability related to this. But despite this there was no major change in the ground reality. This is the reason why recently the apex court has sent notices to these hospitals. Also warned of contempt action in case of disobedience. There is no doubt that the first responsibility lies with the government to ensure that the poor get free treatment in these private hospitals. If the regulatory agencies of the government had shown strictness then what would have happened if the private hospitals would have gone back on their promises. As a rule, the government officials who show indifference in such matters should also be held accountable and action should also be taken against those who show negligence. Undoubtedly, due to these circumstances the general public loses confidence in the system. If the government system had shown agility in monitoring and fixing accountability, the lives of many poor patients could have been saved.
Today, medical facilities related to life saving have become so expensive that every year lakhs of people fall into poverty due to expensive treatment. Over the past three decades, the status of doctors and large healthcare providers providing tertiary care in India has completely changed, often facing the charge of ‘corporatization’ of the healthcare sector. After 1980, those who wanted to open large hospitals etc. were provided free land by the state, and huge tax concessions and benefits were given in return for providing free health care to the poor. This led to a huge surge in private, corporate, for-profit service providers. These hospitals combine the latest ‘state of the art’ technology to provide superior quality healthcare. All these expenses are borne by the patients.
Of course, this is not a malicious attempt to downplay the importance of scientific development of medicine, but there is definitely a point of sharp criticism regarding the high cost of treatment in corporate hospitals. Private practitioners, on the other hand, are subject to far fewer regulations regarding the fees they charge. Under the Clinical Establishment Act, 2010, it is expected to make the treatment provided to patients more transparent, but many doctor associations across the country have protested against the implementation of this regulation.
Cost of treatment in India is a complex issue due to lack of health budget, lack of private sector regulatory bodies, huge disparity in rural-urban health services and uncontrolled prices of medicines/tests. Due to their dependence on government hospitals and their limited capacity, private hospitals act arbitrarily. India spends very little of its GDP on healthcare, due to which government hospitals lack adequate infrastructure and doctors. Also, there is no effective regulatory body or statutory body for the private health sector, which prevents medical negligence and expensive treatment.
But on expensive treatment, former president of the Indian Medical Association, Dr. Vinay Aggarwal says that the salaries of doctors, cost of medical equipment and electricity expenses are so high that the hospital administration is helpless to bear it. If government hospitals work properly then patients will not go to private hospitals. He says that there is a huge shortage of doctors in government hospitals and even X-ray machines are not available. As a result, patients have to go to private hospitals for treatment. Dr. Aggarwal says that poor patients are treated in all private hospitals. Private hospitals provide treatment as per their own wish and not under government pressure. Dr. Aggarwal says that the government does not give any kind of subsidy to private hospitals. The government levies commercial charges on everything from electricity to property tax.
However, schemes like Ayushman Bharat provide treatment up to Rs 5 lakh. But, despite these schemes, many people are still forced to sell their assets and fall below the poverty line due to expensive treatment. Treatment is expensive due to the huge difference in prices of medicines made by pharmaceutical and medical device companies. There is a disparity between health facilities in rural and urban areas, and crowding in government hospitals forces people to go to private hospitals, which provide expensive services.
Expensive treatment in India is mainly due to increasing dependence on private hospitals, advanced technology (robotics, MRI), high prices of branded medicines, and low health insurance coverage. About 75% people spend out of pocket, and uncontrolled charges in private hospitals, unnecessary tests and high doctors’ fees make it more expensive. Due to lack or poor condition of government health services, most people turn to expensive private hospitals, which work for corporate profits.
Poor people abroad get treatment through universal health coverage, government schemes, subsidized insurance, and the help of NGOs. In many countries, treatment is made available to the poor through free public hospitals and health equity funds, where primary and emergency care is free. In Canada, the UK, and many European countries, the government finances health services for all citizens, giving the poor access to high-quality free or nominal treatment. In countries like the US, government schemes like Medicaid provide health insurance and free treatment for the poor and low-income people.
Researchers from America’s Brown University and London School of Economics have conducted a comprehensive survey regarding the expenditure on treatment. According to the data published in the Journal of the American Medical Association (JAMA) Health Forum, better treatment is no less than a dream for millions of people in the world. On top of that, expensive medicines make treatment beyond the reach of the common man. A new international study conducted in this series has revealed that low and middle income countries have to pay much higher prices for the same medicines than rich countries. This increases the burden of treatment on people in countries already facing economic challenges.
Researchers have also revealed that there is a deep gap of inequality in the availability of medicines. For example, where medicines are easily available in Europe and western countries. Whereas in Africa and South-East Asia, patients have to struggle a lot for this. If we look at the data related to availability of medicines, while only 41 percent of essential medicines were available in Kuwait, this figure was recorded at 80 percent in Germany. A large population in India does not have health insurance, due to which the patient has to bear the entire expense at the time of illness. Private hospitals charge arbitrary fees for testing, bed rent and other facilities, over which there is a lack of effective control. This dangerous game will be curbed only when ‘Prevention is better than cure’ will be made a mass movement. Along with making health facilities better and universally available, the government should also pay attention to how people should get an environment to live a healthy life. If people become aware of health then we will win the big battle.
(Author’s views are personal)
