Friday 21 September 2018

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Medical Practice or Malpractice?

 

Irrational investigations, unnecessary procedures and surgeries, as well as kickbacks ('cut practice') have completely eroded trust in doctors


On 28 August 2017, seven-year-old Adya Singh was admitted to Rockland Hospital in Delhi with a high temperature. Doctors diagnosed it as Dengue Shock Syndrome and referred her to the elite Fortis Hospital in Gurgaon. In Fortis, Adya was put in the ICU on a ventilator. No CT scan or MRI was done to check her condition.

After 14 days, doctors finally did an MRI and informed the parents that the girl's brain was damaged up to 80 per cent. Yet, they recommended a body plasma transplant, which costs around Rs16 lakh.

The family decided to take Adya away. Her father said that the hospital insisted they pay Rs900 for the hospital gown the child was wearing before discharge procedure could start. The hospital refused to give the parents a death certificate as the discharge was against medical advice.

The bill came to Rs15.79 lakh — more than a lakh per day. As many as 2,700 gloves (192 per day) and 660 syringes (44 per day) were billed!

According to 'India Today', sterilized gloves (powdered) are available to hospitals at an ex-factory price of Rs9.61 per pair, but MRP is Rs49. Sterilized gloves (powder free) have an ex-factory price of Rs20 per pair, while MRP is Rs75. Disposable syringes (5ml with needle) are ex-factory Rs1.40 to Rs1.80 plus 12 per cent GST, but MRP ranges from Rs6.50 to Rs23.00. Intravenous Sets ex-factory cost between Rs3.50 to Rs9.50 plus 12 per cent GST, but MRP is Rs35 to Rs115.

But even these super-high margins were apparently insufficient for Fortis. It charged Rs200 for glucometer strips to check blood sugar, whose MRP is Rs13 per strip.

Adya's case became widely known when an outraged friend put out a protest message on social media that went viral. The Haryana government has ordered an inquiry. The hospital says it did no wrong. The 'Alliance of Doctors for Ethical Healthcare' has called it an act of criminal medical extortion.

Similar incidents are happening everywhere at ultra-modern corporate hospitals. It is replicated at many smaller establishments. Nursing homes have undergone costly renovations to call themselves 'Multi-Speciality Hospitals'.

At 3.3 per cent of Gross Domestic Product (GDP), the private health sector accounts for more than double the government's spending of 1.4 per cent of GDP on health. National Sample Survey Office (NSSO) data shows that 68 per cent of hospitalisations in urban areas and 58 per cent in rural areas are at private hospitals. In 2014, 79 out of every 1,000 out-patients were hospitalised, up from 33 in 1995.

The cost of hospitalisation in both rural and urban areas has risen by almost 200 per cent from 2004 to 2014. Over 80 per cent of Indians do not have health insurance. Many private hospitals rip off insurance companies. The average cashless hospital bill is Rs45,000, compared to an average reimbursement claim amount of Rs25,000!

According to rating agency ICRA, the revenues of five big hospital chains — Apollo, Fortis, Narayana Hrudayalaya, Max India and Healthcare Global — touched Rs12,990 crore in the year ended 31 March 2017, an increase of 80 per cent since 2012. Profits grew by Rs770 crore to Rs1,890 crore, an increase of 68 per cent.

Irrational investigations, unnecessary procedures and surgeries, as well as kickbacks ('cut practice') have completely eroded trust in doctors, as seen in numerous assaults on even sincere doctors by angry relatives of deceased patients. This problem has now reached the political realm. Earlier this year, the central government imposed a price cap on drug-eluting stents and knee replacement implants.

The Karnataka government wants to amend the 'Karnataka Private Medical Establishments (KPME) Act' to crack down on negligence, harassment of patients, and inflated hospital bills. Private doctors across the state went on strike to protest provisions to imprison doctors for malpractice, cap prices, and to form a District Patient Grievance Redressal Forum.

The Maharashtra government has drafted the 'Prevention of Cut Practice in Health Care Services Act, 2017' to penalise kickbacks among doctors, pharmaceutical companies, diagnostic centres, pathology laboratories and hospitals.

Politicians move only when an issue becomes a matter of overwhelming public concern.

Doctors in corporate hospitals are under pressure because managements put stiff financial targets on them. The result is needlessly placing patients in the ICU, putting them on a ventilator without justification, recommending irrational tests, conducting unnecessary procedures and surgeries...

When a hospital is run like an industrial enterprise, where each department is a 'profit centre' — it must generate a 'healthy' surplus after paying for loan instalments on the expensive equipment, as well as property and staff costs — it can't be good for the health of patients.

First published on Sunday 26 November 2017




Blogger's Profile

 

Ashwin Tombat

Ashwin Tombat has been the Editor of Gomantak Times and Herald. Worked as an Associate Editor of national magazine Gentleman in Mumbai, before shifting to Goa. Loves sailing, also participates in Marathons. Has worked as an activist in students's union and trade unions in Maharashtra. Also an artist of Street Theatre during student days.

 

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