Once upon a time, you sensed an earnest urge in the doctor to check your pulse, empathise with your illness and prescribe medicines, with your welfare in mind. You trusted that genuine interest. No longer. Step into a corporate hospital, and the billing counter dominates, sending you the message loud and clear: Be rich or remain sick!
Today, you are bound to run into doctors who will not even touch you but would reel out a list of diagnostic tests. Of course, to make sure that you are doing fine.
This remark from Harish, a private company employee, is telling enough: “I recently went to a hospital attached to a diagnostic centre to check on my two-day-old fever. The doctor asked me to go through a series of tests which showed nothing. Eventually, my fever disappeared a few days later, but only after burning a deep hole in my pocket.”
So, even a common cold or fever is reason enough to trigger the big hospital loot. There are big corporate hospitals in the City, accused of keeping the IV fluid pouring into a dead body in the ICU. As a source in a leading multi-specialty hospital put it, in one instance, a dead patient’s relatives were asked to run around for blood tests adding to their agony.
“There is a big nexus between the hospital, doctors and the paramedic staff. Even after the patient’s death; the news is not given to the family. In order to increase the bill amount, all sorts of tests and treatment are given,” the source explains.
Misery tax
Threatening to further push the cost of healthcare upwards is the Centre’s recent announcement of a five per cent service tax on air-conditioned private hospitals. This is particularly so in a country where over half of the population approaches private healthcare, and nearly 70 per cent of the expenses are borne by people from their own pockets. After all, the budgetary allocation for healthcare is under three per cent of the GDP.
The healthcare delivery system has undergone a lot of transformation in the last two decades, and this has invariably increased the cost of healthcare, be it drugs, consultation fee, treatment, equipment or insurance.
In Karnataka, a survey has found that 66.8 per cent of the medical expenses are borne by patients. Out-of-pocket expenses exist even in government hospitals, where the State is supposed to provide free or concessional treatment. The 60th round of the National Sample Survey has highlighted that 60 per cent of the admissions in rural areas are in the private sector, where the family spends Rs 7,918 per admission on an average. In government hospitals too, the average payment is Rs 2,610 per admission, according to a status report prepared by Jana Aarogya Andolana Karnataka.
The pinch is felt even more by senior citizens, who fear the introduction of the service tax would be a double whammy. With many having no pension or insurance cover, even a hospital visit for minor niggles becomes difficult. Take the case of 72-year-old Nagaraja H S, who had to pay Rs 68,000 for a 10-day stay at a private hospital. After undergoing various tests, the doctors finally concluded that Nagaraja was suffering from a fungal fever. With no insurance to take care of the hospital expenses, Nagaraja’s children funded the treatment cost. “It is a humiliating experience for us. Nobody is worried about our plight,” he laments.
Health insurance concerns
Echoing his concern, B S Das, vice president of the All India Non-Pensioned- cum-Senior Citizen Retirees’ Association, notes that only about five per cent of the people he knew had some sort of medical insurance. “None of the four government insurance companies or private companies extends medical insurance to people beyond 60 years of age. While one private insurance company does provide one till 80 years, the premium is extremely high,” says the 72-year-old.
Das used to pay a government insurance company an annual premium of over Rs 7,000 for a Rs 5-lakh health cover for himself and his wife. However, all the government insurance companies hiked up the premium amount by 100 per cent for senior citizen’s category. So now, for the same premium, Das’ cover has reduced to Rs 1.5 lakh. He is helpless: “What kind of treatment can I get for that cover? Even a mere doctor’s consultation, which would cost not more than Rs 150 a few years ago, is nothing less than Rs 450 - Rs 500 now.”
No control over drug pricing
It is not just the cost of treatment and tests. The drugs prescribed to patients from small clinics to big hospitals are all over priced. The cost of some life-saving drugs has increased by 100 per cent. “Every doctor has a tie-up with some pharmaceutical company and makes sure he prescribes drugs manufactured by those companies only. Drugs like Nice tablets and a few paracetamols, which are harmful to the liver, are banned in countries such as Bangladesh, but our country has still not taken any such decision,” observes Ravindra Kumar, secretary, Karnataka Chemists’ and Distributors’ Association.
The National Pharmaceutical Pricing Authority monitors the pricing of drugs in India, but there is no proper governing authority to investigate. “There is also a strong foreign pharmaceutical lobby which works in India,” reveals Kumar.
Health insurance
A recent TV advert on health insurance shows a doctor telling his patient that the latter has a lung problem. The patient immediately requests the doctor to change his diagnosis to either a heart problem or cancer, since his insurance company did not cover lung-related diseases. This starkly brings out the fate of most patients and relatives, trapped in health-related financial woes.
Shantha had to spend nearly Rs 10 lakh at a private hospital where her husband Krishnakumar had to undergo multiple surgeries. “My husband was a dialysis patient and was in a critical case. He had some problem in his neck and had to undergo several surgeries. Since we did not have a health insurance, the bill came up to Rs 10 lakh,” she says. Even if she did have insurance, none of the firms actually pays the entire amount.
Most insurance firms claim they provide ‘cashless’ service to patients. But that is only partially true. Says Preethi, whose mother had to undergo hysterectomy since she had fibroids in her uterus: “Although the surgery is not considered an emergency, such surgeries cannot be delayed. I approached my insurance company before admitting her to the hospital. But the agent told me that only 25 per cent of the cost would be paid as cashless, the rest of the amount will have to be paid by the policy holder.
A chastened Preethi says: “You need to do a thorough check before buying any policy.”
Seshadri, a health insurance agent, advises a policy buyer to go through the policy rules completely before buying it. “There are two types of health insurance companies, one which directly cater to the policy holders and others which outsource the work to TPA (third party agency). Many a time, the TPA will not do a good job in helping the policy holder during crisis,” he says.
But he hastens to add that there are health insurance companies which work directly with the policy holders and the hospitals. This enables better coordination, he says.