The Demonizing of Private Healthcare in India

The demonizing of private healthcare services providers in India seems to have reached a fever pitch. Everyday the social media is agog with how private hospitals, mostly in the quest of unhealthy profits are compromising with patient safety, recklessly using expensive medicines, over-charging and generally not treating patients well.

This is rather sad and generally a very one-sided view.

Private Hospitals in India invest heavily in hospital infrastructure. The cost in building the infrastructure, installing cutting edge medical equipment, hiring experienced and statured clinicians and managing the enterprise is high. The patients who prefer private healthcare providers also demand world-class services. There is nothing wrong in this. However, this also means that the healthcare costs are going up. Most patients do recognize the fact that a private hospital is a for-profit enterprise and the investors do need a return on their investment.

Thus, the quest for profits by the investors is legitimate. However, this must not deteriorate into blatant profiteering. This is clearly understood by most of the corporate hospitals. Even a casual glance will indicate that the EBITDA margins of most of the large healthcare chains in India are below 15%. At these levels the hospitals can hardly be accused of profiteering, particularly when the up-front investments are high and the profits emerge usually after 5-7 years of operations.

It is also a fact of life in India today that most people who can afford to pay prefer to go to private hospitals.  The subsidized government hospitals are over-crowded, filthy and callous. The accountability of the care being provided is very limited, the clinicians are over-worked and under-paid. Industrial disputes with the government are rampant and often some or the other section of the employees are on strike. The private corporate hospitals in sharp contrast to the government hospitals provide high quality care in state of the art hospitals. The clinicians are paid much better, they are also held accountable for the quality of care being provided, peer reviews are regularly done and hospitals are run on processes and systems that rival the best in the world.

Now, with this being our reality, it is rather unfair to blame private hospitals for ‘over-charging’, which is often confused with being expensive. That the hospitals use expensive branded drugs can hardly be held against them. If we expect great patient outcomes, the hospitals have to use the most appropriate and efficacious drugs and these are expensive. In India, where there are more than 30000 drug manufacturing units, some of them manufacturing spurious or barely efficacious drugs, the clinicians will tend to use drugs manufactured by large well-known drug companies and one will have to defer to their judgement. After-all, they are squarely accountable for the clinical outcomes and we can hardly ask them to produce great outcomes, while working with their hands tied behind their backs.

Pretty much the same applies for everything else that happens in a hospital. Infection control, IT system led processes to reduce medical errors, high-end diagnostic equipment and world-class OT’s all cost a lot of money.

The problem seems to be that, while the patient expectations in terms of care and outcomes has significantly gone up, they are just not reconciled to pay for these services as much as they cost to deliver.

The Role of the Media

The sad truth about media in India today is that in search of TRP’s, they have lost objectivity and even probity in what they report. The media is no more interested in facts or for that matter the truth. Most viewers want to see an individual patient, maybe a grieving father, take on the big hospital, which “killed” his daughter. This is clearly high drama and the media just loves it. The images are just too compelling and it is so easy to paint the big hospital as the ogre. The TRP’s are there to be had.

This kind of vilification and sensationalism, with very little care for truth or fairness is unfortunate but in today’s times, inevitable. While, a sustained onslaught is mounted for a few days, the hospitals run for cover, it is great spectacle for the mass viewer. And then a new story comes along and we all move on.

Sadly, while the media moves on, this kind of reporting causes long term loss of trust between patients and hospitals. This is a catastrophic and an insidious loss as trust between a doctor/hospital and their patients is usually the bedrock of  the relationship itself. In the absence of trust, things between clinicians and patients start going wrong right from the beginning.

The media must realize this and play a more non-partisan and balanced role in this dialogue. It should certainly highlight the shortcomings of the hospitals, however it should do so in a balanced and judicious manner.

The Role of Social Media

Social media has empowered patients and customers. It has given a voice to the ordinary man, who can at the push of a few buttons air his grievances to many and watch others join in, sharing in the anguish or narrating their own past woes.

However, here too rampant abuse is visible. It has become fashionable to troll service companies be it an airline or a hospital. Yes, sometimes front line service staffers may behave rudely, particularly when provoked, but is that a reflection of the organisation’s culture and ethos?

In cases involving hospitals and death, which unfortunately cannot be avoided in hospitals, it is common for the grieving relatives to take to social media airing all kinds of issues related to the quality of service and billing deficiencies. Most of these issues emerge only with hind-sight. Many of them, sadly are a matter of perception but are always aired as indisputable facts. The doctors working hard to save a life suddenly become merchants of death. While the patient is in the hospital, the usual demand is “do whatever to save my baby”, suddenly the hospital starts being accused of callous behaviour, ill-treatment and criminal negligence. In a recent case, I even heard an argument that the hospital charged so much, yet they couldn’t save the child. If only, we could buy a precious life, by spending money….

To make matters worse, we than see the proverbial mob arrive. Everyone here has a past tale to narrate about the horrors they suffered at the same or even other private hospitals. This becomes the pre-dominant narrative, and if the hospital tries to respond with facts, they are showered with the choicest and the nastiest abuse. The hospital decides to usually cop it and wait for this to blow-over.

Sadly, this too causes a serious erosion of trust between doctors and patients. It simply helps no one.

So What needs to be done

The hospitals need to acknowledge that there might be some bad eggs among their fraternity. These need to be weeded out. They also need to acknowledge that patient communication is not their strongest suite and they need to work on it more diligently. They also need to show greater empathy and take care of the “small things” that can so easily be fixed yet cause serious consternation among the patient community. They also must set up Patient Grievance Committees to help patients reach out and complain if they are not satisfied with any aspect of care or have an issue with billing.

The patients have to realize that private healthcare in India is becoming more and more expensive (while it still remains the cheapest in the world). This is only natural as Indian hospitals aim to deliver better quality healthcare across the board. If they choose to go to private hospitals in the hope of receiving world-class care, it is bound to be expensive. As responsible citizens they must have health insurance to protect themselves in medical emergencies. Running down hospitals and doctors on social media does not help in any manner. On the contrary it does immense damage. Patients and their care-givers must also realize that hospitals cannot guarantee a particular outcome, they can only try. By being dismissive of their desperate and perhaps ”expensive” efforts later on, they are only encouraging doctors and hospitals to hold their horses in their battle against disease. Let us not do this.

As far as media is concerned, they must stop playing to the galleries. Individual lapses must not be generalized to vilify hospitals and clinicians in general. While one understands their love for the TRP’s (after-all everyone needs to make a living!!!), they must carefully ponder the kind of damage they are doing to the sacred relationship between doctors and patients. Do highlight lapses as human errors, negligence as failure of an individual or a system but do not call everyone crooked and corrupt. The majority and by far the majority of clinicians try their best to cure without causing any harm.

Sadly, in the polarized, binary world that we increasingly inhabit, this is perhaps too much to ask.

The views expressed here are personal.