Not hale, not hearty

Jayshree Sengupta

RECENTLY all of us were shocked when a private hospital charged Rs 15.7 lakh for the treatment of a child suffering from dengue who did not even survive. Unfortunately, most of us are forced to go to private doctors and hospitals when illness strikes us because public hospitals are terribly overcrowded and the quality of care is generally low. Unless you are a VVIP you are not likely to get special care in a public hospital.

First of all one must ask why are dengue cases on the rise and why hasn’t the government been able to control the disease through its much-touted Swachh Bharat drive? How is it that mosquitoes, which are the cause of the disease, are still breeding freely at all times, especially during rainy season? While there were 99,913 cases of dengue, with 220 deaths in 2015, there were 129,166 cases and 245 deaths in 2016. 

Like in the case of the child who died from dengue and was in the ICU for 15 days, private hospitals are often motivated to inflate the bill by charging excessive amounts for gloves, syringes and medicines used in the treatment. The bill is often crammed with items that are hard to comprehend and cannot be challenged by the patient. It shows utter lack of ethics in private healthcare today in big cities and something urgently should be done about it, like the speedy implementation of the Clinical Establishment Act, passed in 2010, by all states.

Not only seasonal diseases need to be controlled and eradicated, but also communicable diseases like TB, from which around 5 lakh people die every year. India has the highest number of TB cases in the world.  Non-communicable diseases (NCDs) are also on the rise. According to the Director-General, WHO,  Tedros Adhanom Ghebreyesus, “Bolder political action is needed to address constraints in controlling NCDs including the mobilisation of domestic and external resources and safeguarding communities from interference by powerful economic operators.” Indeed, big hospitals are like big corporations and are powerful economic operators. It is very difficult for an average person to fight and sue a hospital or a surgeon.

The result of this growing power of private hospitals and doctors is that the average person is burdened by the stress of impending healthcare costs. Anybody who does not have a health insurance hesitates to go to private hospitals. In India, only about 18 per cent of the urban and 14 per cent of the population has any kind of health insurance. Many people with low incomes are reduced to penury when they go for private treatment of a disease like cancer as they have to raise their own resources from family or friends, and in many cases, the moneylender. Around 63 million people are pushed into poverty due to healthcare costs, increasing income inequality further.

Since the burden of non-communicable diseases is on the rise, what is the government doing? Cancer, diabetes and heart diseases alone account for 55 per cent of the premature mortality in India in the age group of 30-69. More and more people are suffering from cardio-vascular diseases which are the highest killer in India. In years to come, the respiratory diseases will increase manifold due to the increasing air pollution. Chronic obstructive pulmonary disease (COPD) claimed 3.6 million lives in 2015. More people are likely to die from it in the future. 

Public health is the worst spot in India’s economic path under the NDA government despite a recent rise in GDP growth. Without a healthy population and labour force, India cannot hope to compete with countries in the West or ASEAN. Yet scant attention is being paid to the state of public healthcare where thousands are forced to go for treatment. People with limited budgets are also reluctant to go to private hospitals because they are asked to undergo a number of unnecessary tests which burn a hole in the patients’ pocket. Even though similar tests take a long time in public hospitals, they are often free. Private hospitals, on the other hand, are run on profit motive and each doctor has to contribute to the total revenue earned by the hospital. They are incentivised to push patients into the ICU and also fill hospital beds. Their performance and promotion depend on whether they fulfil such criteria.

There have been cases where unnecessary and costly surgeries have been performed in private hospitals and, sometimes, it has resulted in death. The overuse of antibiotics has led to their resistance in India in a big way and the appearance of superbugs.

The solution lies in the government becoming more vigilant regarding malpractices by hospitals but there is no substitute to having better public hospitals and reliable healthcare. Private hospitals should be told to charge according to the actual cost of the treatment plus a small profit margin that can be ploughed back into the hospital’s improvement. And in order to have better public healthcare, there is no option for the government but to increase the budgetary allocation on health. Yet the percentage of GDP allocated for health by the Union government in the last Budget was only 1.9 per cent. It has not been increased to 2.5 per cent despite the recommendation of several expert committee reports headed by renowned doctors. In India, the out-of-pocket expenditure by a person is one of the highest in the world, where 82.2 per cent of the expenditure for treatment is borne by the patient.

Thus while the government is very keen on promoting medical tourism, there is scant attention being paid to the needs of the common person through improvement of public healthcare. While it is true that many Indian doctors are world class and can perform complicated surgeries for a fraction of the cost charged by hospitals in developed countries and many foreigners are, indeed, coming for joint replacements and bypass surgeries, the Union Health Minister ought to improve the precarious state of public healthcare. It is strange that in a country with so many super-speciality hospitals all of us are worried about the quality and reliability of healthcare.