Sumeet Saigal an upper middle class executive just couldn’t get rid of his whooping cough. A few consultations with doctors and some tests later, he landed in a ‘five star hospital’, referred to him by his family doctor. He was diagnosed as having double pneumonia. Timely intervention saved his life. But two weeks on came the bolt from the blue, a stupendous Rs 1.50 lakh bill at the time of discharge. Not covered by insurance, Sumeet had no means to pay his bill and landed in debt. Sumeet exemplifies millions of Indians for whom the mere thought of being admitted to a hospital isn’t forbidding enough. What’s a bigger nightmare today is forking out money to pay those endless hospital bills. And add to this the fact that a majority of people still don’t know the average costs of healthcare for key procedures, except perhaps a cardiac bypass surgery. More importantly, few people know which cities are lighter on the pocket.
Emergence of the Corporate Health-Care Giants:
Health care in India has undergone some significant structural changes in recent years with the increasing involvement of the corporate sector. While private health care, in the form of small and medium enterprises like nursing homes, has been prevalent for several decades, the entry of the corporate sector is relatively new. The first corporate hospital in India was set up at Chennai in 1987 by the Apollo group. This venture was the first of its kind in the country since all other large; speciality hospitals in Mumbai and other cities were essentially promoted as trusts. Historically, big business groups had established hospitals as trusts or societies and not as corporate entities. This was mainly because companies funding charitable trusts could secure tax exemptions while being seen as contributing to welfare. The Tata group and the Hinduja brothers had established hospitals in Mumbai, and more recently the Modis, Nandas, Goenkas, Singhanias, Chabbarias and Oberois have also invested in the health care business. Apart from the big business houses, several regional business groups in the southern states of Andhra Pradesh, Tamil Nadu and Karnataka have also entered the health care market. All these hospitals are multi-speciality institutions and essentially offer tertiary care. Most of the corporate hospitals in the three southern cities of Hyderabad, Bangalore and Chennai are promoted by local doctor entrepreneurs in collaboration with non-resident Indian doctors. The establishment of Apollo marked the entry of non-resident Indian doctors into medical care and signalled recognition of a hospital as a corporate enterprise. This generated pressure from the private sector in favour of government subsidies for such enterprises in the form of subsidised sale of government land and duty-free import of medical equipment. It marked a change in the organisational form of private investment in health care, the shift-taking place from single owner enterprises and nursing homes to corporate enterprises. This phenomenon has triggered changes in other areas such as medical equipment import policy and health insurance. These trends have clearly had an impact on the structures of health care provisioning, both in the public and private sectors. They have also redefined consumer perceptions of what constitutes good quality care and altered preferences in terms of services desired. In the absence of accessible government clinics and hospitals, private health care is not the privilege of the rich but often the only option of the poor as well. Studies of household expenditure have shown that health care can use up to 40 per cent of a poor family’s budget. Even using public services costs money: fifty per cent of the patients in Mumbai’s public hospitals spend more every day than the daily income of their entire household. In private hospitals, average costs for medicines, doctors’ and hospital fees can amount to twice a family’s monthly income. No wonder health care is becoming the second most common cause of debt in rural areas.
The increase of the corporate hospitals, with all its glory and benefits has also bought about an increase in unethical practices, such as unnecessary investigations , kickbacks for referrals etc.. Many private and corporate health facilities tend to perform unnecessary inspections, tests, consultations and surgeries; they also overcharge and over prescribe. Due to the fact that surgeries are profitable, many are conducted without any regard for the patients’ well being. A study revealed that 31% of deliveries were by cesarean section. More significantly 70% of the hospitals where cesareans were routine were privately owned. A committee in Maharashtra found that the average rate of cesarean childbirth in private hospital was 30 % as compared to government, which was only 5 %. Ultrasound investigations, amniocentesis, epidural anesthesia etc. are also done unnecessarily more frequently in order to recover investment costs.
Though medical services were recently brought under the Consumer Protection Act, there are no enforceable standards for private hospitals. Regulatory bodies such as the medical councils are unwilling to fulfil their responsibilities, the legal system is ill-equipped to handle the burden of medical litigation, and aggrieved patients and their relatives cannot afford the costs and long delays of the battle
Another factor affecting the health care system in India, and popularising the corporate hospitals is the promotion of India as an ultimate destination of Health and medical tourism. This is perceived as one of the fastest growing segments in marketing ‘Destination India’ today. Many foreigners from the western world are turning to India, where these corporate hospitals offer a five start like approach to medical procedures. Though all this is great for the economy as a whole, the big question here is how is this affecting the health of the ‘Indian’ really.
Serviced or Duped- To ‘Heal’ or not to ‘Heal’:
Picture this: A middle-aged man clutching his chest in pain, is advised by his doctor to go in for a new technology, hi tech scan. At that point in time the patients only concern is an accurate diagnosis of his problem. Ignorant to the cost of this ‘new technology’, he gives the doctor a green flag to go ahead and provide him with the most accurate diagnosis he can provide. But a quick glance at the bill after his consultation would be enough for him to realise that he’s been taken. Did he really need a high tech scan? Couldn’t the existing CT scan have provided him with just the same diagnosis?
Just a comparison of certain treatment might answer those questions. In Hyderabad the median costs for hysterectomy is between Rs 14000 to Rs 23,000 in the corporate sector while it is in the range of Rs 4000 to 6000 in smaller nursing homes. Similarly, corporates charge between Rs 10,000 to 12,000 for a caesarean section, while the cost is around Rs 6000 in the smaller nursing homes. For other specific surgical interventions the cost in corporate hospitals is roughly twice those prevailing in trust run hospitals and smaller nursing homes
So are the corporates cheating the common Indian of his hard earned money? The answer to this question is a matter of debate. On one hand, there are several facts to prove that Corporate Hospitals are taking us for a ride by prescribing unnecessary tests, hidden costs etc on the other hand they claim their costs are justified. They do after all provide a five-start service, boast of latest technology. This means a squeaky-clean hospital environment with well-spoken, polite staff and well-qualified doctors working with modern equipment. But most corporate hospitals go even beyond these ‘basics’ and work towards providing patients amenities that are tailor-made for their lifestyles. The Ruby General Hospital in Calcutta has a lifestyle floor catering to NRIs and corporate heads who can’t afford to be away from work for long. Hence, the floor has eight apartments complete with Internet-connected computers, fax machines and microwave-armed kitchenettes. It even offers secretarial services. The spacious apartment can accommodate a couple of family members too — all for Rs 3,500 a day. So the prerogative is ours, accurate and preventive diagnoses and treatment or luxurious, high-tech treatment and a big hole in the pocket.