The Apathy of Delhi Hospitals Towards the Poor

The Delhi High Court has been after private hospitals in Delhi to honour their commitments regarding the treatment of the poor, but sadly to no avail. The hospitals are just not willing to treat poor for free, a condition that they agreed to while accepting land from the government at hugely subsidised rates. In-spite of the Delhi high court directing the hospitals time and again to fill up the beds for the poor, the hospitals are dragging their feet by hiding behind every legal loophole that they can find.

For the uninitiated here is the story. As many as 38 private hospitals in the city managed to get land at subsidised rates from the government under the condition that they will treat certain number of poor patients free of cost. The list of these hospitals today read the whose who of the hospitals in the city. However, once these hospitals commenced operations, they never honoured their part of the bargain. Thus the poor continue to be unwelcome in these hospitals, while beds reserved for them either remain empty or are filled up with full paying patients. This needless to say is criminal.

The reasons for this, however are not too difficult to fathom.  The business of healthcare is a capital intensive business and the cost of real estate in Delhi is a prohibitively high expense.  Thus, getting land from the government at very cheap rates against a commitment of treating the poor once the hospital starts, seems to be a good way of grabbing land. I seriously doubt that any of these private hospitals had any intention of treating the poor to begin with. This was just a ploy to grab land to build the hospital.

Now with the hospital up and running they had to find excuses to wriggle out of the commitment made.  Here is a sample of what the hospitals have been saying. A large 600 bed hospital sitting on prime land in south Delhi and part of the largest hospital chain in the country claims that they are unable to treat the poor because they can not find them! As per them the government needs to refer poor patients to the hospital, and since there has hardly been any government referrals, they can not fill up the beds reserved for the poor. They further claim that ‘free’ to them means a free bed and the patient has to pay for all other expenses, thus making the hospital out of reach of the poor. (Mercifully, this claim has now been thrown out of the window by the high court). Other hospitals too advance similar claims. Strangely many do not offer any reason for not filling up these beds.

A recent report in The Times of India indicates that 16 of these 38 hospitals have not even bothered to submit details of the status of their free beds to the government. Hospitals like Dharmshila Cancer Hospital and the Jaipur Golden Hospital have submitted that all their free beds are empty. The Times of India report also alludes to a nexus between the health officials of the government and these hospitals. The health officials refer their kith and kin or their political masters to these hospitals and they are treated free against the beds meant for the poor.

While all this has been going on for many years, some public spirited Non Governmental Organisations have moved the courts. The high court has made all the right noises but justice is yet to be done. While the cases against these hospitals meander in our courts, the poor, as always continue to suffer silently.

Pic courtesy http://www.flickr.com/photos/9019392@N08/552358084/

National Emergency Services-The Need of the Hour

The other day I was at the Delhi airport early in the morning waiting for the security check to get over, when I realised there was some commotion ahead in the queue. As I moved on, I saw a man flat on his back, and a lady, apparently an air hostess trying to revive him by administering the CPR. There were a bunch of people including some security men looking on. The lady was doing her best, but it was quite apparent that she would not succeed. She appeared to be going through the motions rather than making a desperate attempt to save a life.There was no one else to help her, while many watched idly. I did not see any medical personnel or the emergency medical paraphernalia, that one would expect  on such an occasion. The man had been without a pulse for almost 20 minutes, before CPR had commenced.

How can a busy airport (brand new to boot) be without adequate medical emergency back-up? Almost a year ago when I was working for Artemis, we had proposed to the authorities to allow us to set up an emergency service at the airport. Artemis is reasonably close to the airport, has an Advanced Cardiac Life Support (ACLS) equipped ambulance service and the hospital is fully geared to manage medical emergencies round the clock. Nothing came of our proposal and the last we heard was that Indraprastha Apollo Hospitals has been awarded the contract to manage the medical room at the airport. Apollo Hospital is all of 40 kms or more from the airport and with the traffic that one usually encounters on the way, there is no way that an ambulance can reach the hospital in less than an hour. That fateful day, there was no one for at least 30 minutes from Apollo or anywhere else, to help the unfortunate man.

India attracts scores of patients from across the world, most of them benefit from the world class healthcare services now available in the country yet we do not have an emergency service that can be remotely called world class. This is a serious concern.

The government must take the lead in establishing a centralised medical emergency service through a statutory body, let us say, Medical Emergency Services Authority of India. It can work out the details of how this service will operate, the nodal hospitals, the communication infrastructure and the logistics of transporting patients to these network hospitals. It should set clear guidelines on managing emergencies (who, what, where, how),  establish internationally benchmarked service levels and establish a monitoring authority to measure efficiency and service levels

The Medical Emergency Services Authority should be allowed to set up emergency handling outlets in high traffic areas like airports, on national highways and busy malls etc. The Authority would be required to invest in the communications and transport infrastructure including paramedical personnel, while the participating/network hospitals will be responsible for patient’s care once the patient reaches the hospital.

While all this and more is possible, the key question is whether we should have private participation in something like this. I believe we should not. This is a service that should be rendered by the government to its citizens in distress. It should be paid for by the taxpayers. The government can charge a small sum from the taxpayers annually to keep the service afloat. The real challenge for the government would be to maintain high standards in the face of crippling bureaucratic controls that underlie all government initiatives. Corruption, sloth and inefficiency so characteristic of all government organisations must not be allowed to eat at the vitals of this service.

Easier said than done. Maybe the government can find another Nandan Nilekani or an E Sridharan and give him a free hand to set this up. I would like to believe if there is a will and a burning desire to accomplish something as important as setting up the National Emergency Services a way can certainly be found. It is afterall the need of the hour.

Pic courtesy www.flickr.com

Compulsory Rural Postings after MBBS

The Hindustan Times reported on Friday that the Union Health Minister Dr. Anbumani Ramdoss has announced that young medical graduates, fresh out of medical schools will now have to mandatorily serve one year in rural and semi-urban centres in India.

Dr. Ramdoss believes that this will help in augmenting healthcare services in these parts of the country. It is well known that in the Indian hinterlands the availabilty of healthcare services is pathetic.  In villages, where more than 66% of India lives, it is rare to find a qualified doctor. In semi-urban centres too modern, good quality and reliable healthcare is largely unavailable.    

The Idea of a Healthcare Resource Centre

 Having worked in hospitals in Delhi for many years I am often required to help out friends and relatives when someone in their family needs medical attention. I am supposed to be the guy who can recommend a specialist, fix an appointment, advise on the choice of a hospital, help folks seek a second opinion and in general be the knowledgeable person around for matters medical. 

This has often made me wonder if there is a need and possibly a business opportunity in developing a large resource base of information and knowledge, which most people can access with ease and use without worrying about the reliability and authenticity of the information.  

The Terror in Mumbai

 I am shocked and bewildered at the audacity of the terrorists in Mumbai, who are holding the country to ransom. As the gruesome drama unfolds live on television channels going berserk, one is left wondering at what might be some of the consequences of this dastardly act.

I woke up this morning to the headlines in the Hindustan Times about terrorists striking in Mumbai and having killed more than 100 people in random firing at public places including the crowded Railway Station, busy hospitals, beaches and finally taking hundreds of people hostage in the landmark Taj and Trident Hotels in downtown Mumbai. Switching on the television, brought the tragedy and horror to ones bedroom.  

Healthcare for Those who can not Afford it.

Turning away a fellow human being from the doors of a hospital when he is ill and unable to pay the bills appears to be wrong. However, if one was to dispassionately examine the situation, setting up and running large hospitals require huge amounts of capital, which has to be recovered from those who use the services of the hospital. If the hospitals were not to charge for their services from those who cannot afford to pay, they will soon go belly up and that surely does not help anyone.

So what does one do?