Last week I came across a piece by Sopan Joshi in Tehelka. The story titled ‘No Place to be Sick’ (http://www.tehelka.com/story_main48.asp?filename=Ne050211coverstory.asp) appears to be a shallow piece intent on maligning private healthcare in India. Mr. Joshi’s central point ‘even if you could afford it, a private hospital may be the last place you would want to be in’ is completely flawed. While Mr. Joshi, cites a case of a cancer patient, who died at Max Hospital in New Delhi, after receiving chemotherapy, quotes the relatives and employers of the deceased, who believe that the hospital knowing well that the patient was unlikely to survive went ahead with chemotherapy and ran a bill of close to Rs. 8Lacs, which coincidentally was close to the insurance limit enjoyed by the patient. Basically Mr. Joshi is saying that Max Hospital unnecessarily treated a dying man because they wanted to make money.The hospital of course has denied the charge.
Now here is my point, who decides whether a patient should be treated or not? Isn’t it the job of his doctor to take this call? Isn’t the patient and his caregivers supposed to trust their doctors and if they do not trust the hospital or the doctor, isn’t it best that they find another doctor or a hospital for their treatment. In my many years in hospitals, I have seen patients and their attendants asking the doctors to do whatever they can to save a life of a loved one, they beg and plead that the doctors do something, anything to prolong a life. Now if the doctors, try something and the outcome turns out to be negative, how correct it is to say that the hospital deliberately over-treated just because it is a commercial enterprise and making money is in its DNA. Suppose in this particular case, had the doctor turned away the patient, wouldn’t that have left him open to the charge of not admitting and treating a seriously ill patient because no hospital wants a high mortality rate. From the hospital’s perspective this really is a catch 22 situation.
It is not my case that private healthcare services in India are perfect. They are not. However, by highlighting stray cases of wrong diagnosis and hospital borne infections, Mr Joshi can hardly make a sweeping conclusion that all private healthcare in India is driven by greed and little else. While, I would be the first to admit that there are many hospitals, who try to fleece patients it certainly does not mean that most private healthcare service providers are out to rob the patients blind. In fact corporate hospital chains like Max, Apollo and Fortis (to name a few) are trying hard to provide world-class healthcare services and while they are expensive by Indian standards, they still are amongst the cheapest in the world.
The problem with private healthcare in India is that it is completely amorphous and unregulated. While there is world class medical services being offered by some hospitals, there are millions of mom and pop shops, usually owned by a doctor and his family, which also provide healthcare services. These so-called nursing homes usually have very basic facilities and since they are completely unregulated, they get away literally with murder. This huge underbelly of private healthcare in India is the soft spot, which the government needs to fix immediately. To make matters worse, the average Indian consumer knows very little about his rights as a patient and is too overawed by the highly educated, English sprouting doctors to ask too many questions and ends up getting a raw deal. What we really need is a much more organised and accountable healthcare services.
Let us now look at what the government has to offer. In the city of Delhi, the government owns many hospitals, which are all large tertiary care centres. These are incredibly filthy, overcrowded (often two patients on a bed), stinking and staffed with callous government employees, who care two hoots about a patient. The doctors, while extremely competent, are under such a huge workload that its is just not humanly possible for them to provide good quality care to so many. My words may seem harsh, but the reality is much worse. Most people seeking care in the government-run hospitals use their ‘contacts’, with the powers that matter, to secure a bed and a surgery for themselves. In smaller towns and cities the situation is much worse, with the district hospitals being poorly equipped, saddled with obsolete equipment and with doctors who consider their responsibilities as punishment postings.
The solution really lies in a Public Private Partnership and increased regulation. We must have a healthcare services regulator (pretty much like the insurance or telecom regulator), who should lay down guidelines and rules for private and public hospitals and ensure that these are stringently followed. Hospitals outcomes, its systems and processes and its people must be periodically audited for quality. The regulator should be empowered to act without fear or favour to weed out the laggards and the unscrupulous.
And now to revert to Mr. Joshi again, let me ask a simple question, God forbid if he or someone in his family needs a hospital, where will he go-to a private hospital or to a government-run public hospital? To me the answer is quite obvious, we need more Max, Fortis and the like.