Late last month, the government of Delhi announced price caps for the treatment of Covid 19 patients in private hospitals. This came around the time, when the disease was rapidly peaking in the city and there was panic all around. The media went to town highlighting the horror stories being played out in public sector hospitals and running stories about rampant profiteering in the private sector. The ordinary patient seemed to be caught in the middle, poor medical services on one hand and unaffordable ones on the other.
The government intervention cited two pressing reasons for imposing the price caps. One, it wanted to make good quality healthcare available to patients at ”affordable” prices and two, it was aiming to come down on alleged ”profiteering” rampant in the private sector.
These are indeed laudable objectives but the medicine prescribed unfortunately does not work and also has wholly undesirable side-effects.
Let us first address the issue of ”profiteering”. The government has been accusing the private sector of profiteering without any evidence whatsoever. Yes, the impression of profiteering comes from high prices being charged by private sector hospitals for Covid treatment. The high prices, however does not necessarily imply,”profiteering”. High prices are a direct consequence of high costs involved in the treatment of Covid 19 patients. The costs emanate from a slew of factors related to the complete unpredictability of the disease and its highly contagious nature. Doctors treating Covid 19 patients agree on one point – that the disease behaves differently in different people and it is impossible to predict its course. Thus, the treatment options cannot be standardized and different patients need varying treatment over a long period of time. Many do not need any treatment at all and many, particularly those with co-morbidities and the elderly need long stay in the hospital, often in intensive care.
Moreover, because of the highly contagious nature of the disease the safety of healthcare workers assumes paramount importance. They are indeed our most precious resource in this battle and if they become sick, we have no way of fighting the scourge. Realizing this private sector hospitals made elaborate arrangements to protect their healthcare workers. The healthcare workers were provided with expensive personal protective equipment; they were housed in hotels near the hospitals, kept in quarantine after their duty periods and treated free if they acquired the infection. All these are additional and significant costs. The private hospitals had no choice but to pass these on to the patients, leading to higher bills reinforcing the impression that hospitals were minting money and profiteering from the crisis.
Now, with the price caps on, private hospitals have no option but to cut back on some of these, making their staff work longer hours at greater risks and resort to salary cuts. This will demotivate healthcare workers and affect patient care and employee productivity. The hospitals will also look at standardizing and straitjacketing clinical care, for a disease, which we know is completely unpredictable. This too will lead to compromised outcomes. These are inevitable steps to make ends meet. Many private hospitals will be forced to either curtail services or simply shutdown. This at a time, when every hospital bed is a precious.
To make matters infinitely worse the price-caps on the private sector have been imposed when thousands of beds in the public hospitals are lying vacant. These beds are free, yet have no takers. While, the price caps have made the service ”affordable”, there is a very high cost attached to this.The government instead of improving medical services at its own hospitals will end up with effectively diluting the high quality of care offered by the private sector hospitals. This would be an inevitable and somewhat unintended consequence of arbitrary price-caps in the private sector.
The reason for this madness is not far to seek. The politicians running the city want to look good to their electorate. One sure way of doing this is to threaten ”big bad private enterprise” into submission. The electorate loves to see the governments of the day championing the underdogs, the poor and the disadvantaged who unfortunately can not afford private healthcare. Thus, bringing in price-caps to tame private healthcare helps them get more votes when the elections come around. The electorate will not remember the sorry state of public hospitals but will certainly remember the ”stern” action of the government of the day.
This is rather unfortunate. Instead of price-caps on private enterprises, what we do need is much higher levels of investments in public healthcare. We need better paid and better trained staff with far more empathy at our public hospitals. This will inspire greater confidence in these hospitals, encourage citizens to choose them over the ”profiteering” private sector hospitals.
We must remember that the responsibility of providing affordable healthcare to the citizens who can not afford private healthcare rests squarely with the government. This is true during a pandemic as much as in any other time. That the governments have chronically under-invested in public healthcare and failed to provide adequate and affordable care, does not mean that private healthcare providers should now be forced to provide these services at prices that do not even cover their costs.
There is no doubt that in times like these, profiteering in any manner must be viewed harshly. The government must ensure that they come down heavily on those who aim to maximize profits through other people’s misery. At the same time, they also have a duty to ensure that they don’t drive private healthcare, the only ones delivering world class Covid care, to an early grave.
The views expressed are personal