The ills of corporate medicine in India
SIVAPRASAD D. MADDURI
OUR LAST trip to India was far from being uneventful. Chikungunya, a viral infection transmitted by mosquitoes, was rampant in India, more so in Hyderabad, the city I visited. My 86-year-old father was one of the victims; high temperature that lasted for two days was followed by a spell of vomiting. He collapsed in the bathroom and needed to be taken to hospital in an ambulance.
He was taken to a well-known hospital in the city managed by a group of non-resident Indians (NRIs). As soon as the patient's stretcher was rolled into the emergency room, he was taken to a `waiting room.' We were asked to deposit Rs.10,000 and bring the receipt before the patient could even be seen by any doctor. It took us 30 minutes to deposit the amount and return with the receipt. Only then the medical personnel started seeing our father!
Business-like attitude
This business-like attitude shocked me. I have been practising medicine in the United States for 30 years. I knew that the insurance card is the passport into any American health care facility. But, if some one was sick enough to be brought to the ER in an ambulance, the patient would be attended to first, not till the `deposit' was paid.
We experienced the same attitude during the three days of my father's stay in the hospital. Every morning we were reminded to go and take care of the hospital bill. We got more acquainted with the business office personnel than with the doctor and the nursing staff that took care of my father! Even on the day he was released, the discharge papers or the prescriptions were not given to us till all the bills were paid!
This experience reminded me of another incident — not any more pleasant — that happened about 10 years ago when my mother passed away after two weeks in an intensive care unit at another prestigious hospital in Hyderabad. After she expired, we were asked to `clear the bills' before the body could be released. We — my brother and I — went to the business office and paid all the bills and showed it to the morgue before her body was released.
The incident haunted me for a long time and even today makes me infuriated when I think about it. There was absolutely no respect or concern for the feelings and suffering of the patient or the family, even in times like the death of a loved one. The hospitals in the United States, as I have seen, treat the families with much better concern and respect. I have never seen an American hospital where the body was not released because the hospital bill was not paid.
India has a vast health care system, costing an estimated Rs. 108,732 crore in 2002 (US$24 billion) representing 4.8 per cent of gross domestic product (GDP). India at present operates on a two-tier system of health care: public and private. Universal access to health care is the norm in India as in most of the developing countries. However, the public sector is under-financed, overly centralised, bureaucratic, inflexible, and poorly managed. The public system is rapidly dwindling, not being able to provide services to its billion plus population. At present it accounts only for 20-25 per cent of total health care expenditure.
In contrast, the private sector has grown at a rapid pace in the past 15 years and has become a fertile ground for profit-seeking entrepreneurs. More than 20,000 private hospitals operate in India, which is a 75 per cent increase in the last 10 years. Corporate medicine no doubt improved the quality of health care; it brought new and advanced technology that the public sector could not afford. Some of the corporate hospitals in India are regarded highly as quality care centres. They are helping to attract patients from all over the world, including Canada, the U.K., and the United States.
Largely unregulated
However, the private care sector has many shortcomings. It is largely unregulated with very little control as to what kind of services can be provided by whom, without standardised protocols to assess the need and quality of those services. Profit making is the main theme even at the expense of the patients' health and lives.
India needs private health care and private hospitals need to make profit to survive and improve. However, there should be a balance between economics and the quality of health care, between cold-hearted money collection practices and concern and respect for the patients and their families. When these basic principles of health care are ignored, the very foundations of medicine are at risk.
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