The Supreme Court of India, yesterday, asked the government that why should private hospitals not be asked to provide free services to patients suffering from covid 19. In an earlier bizarre judgement (which the court had on reconsideration modified) had ordered free testing for covid 19 at private labs. The court must realise that there is nothing called a free service in the world. The service is free to the user only because someone else is picking up the tab. When government delivers public goods free of cost, essentially it is the government and the taxpayers who pay for the service. In the case of private healthcare providers it would mean the investors in the enterprise who pay for it.
The investors in a private enterprise expect a reasonable return on their investments over a period of time. They also do not have unlimited resources to fund the battle against a pandemic. A global scourge of this proportion has to be primarily fought by the government with help from all other stakeholders. The epidemic has exposed the pitiable state of our public health. Sadly, the public sector healthcare spending in the country stands at a measly 0.9% of the GDP and has been sliding over the years. However, this is not the time to quibble over these numbers.
If the courts impose these kind of arbitrary decisions on the private healthcare providers, we will see hospitals closing down for want of resources to keep the enterprise running. That is hardly a solution, in a crisis, where every available bed counts.
This leads us to addressing the charge of excessive greed and profiteering by private sector players in these extraordinary times, to which the courts are ostensibly responding. It cannot be gainsaid that private healthcare must not charge excessively and profiteer from the misery surrounding us. Most responsible private sector healthcare companies understand this quite well. Yet, the media outlets in the country have gone to town highlighting two contradictory strands. One, private healthcare companies are aiming for excessive profits and two; they have not been adequately supporting the efforts of the public sector hospitals in fighting Covid 19. Now assuming that Covid 19 is an unprecedented opportunity to make huge profits, why the allegedly profiteering private healthcare shying away from stepping up and joining the fight against Covid 19? The fact is that both these allegations are false. Covid 19 is a tough disease to fight. We have seen how it has brought far more advanced healthcare systems to their knees in far more developed markets. The private sector healthcare in India is mostly unorganised ”mom and pop” small hospitals and nursing homes, who have very limited capability to fight the epidemic. Even the more organised corporate healthcare players have struggled to put together a cohesive response to the disease. While, many have become organised and learnt on the go, they have made sizable investments and have seen their running costs go up significantly. This causes price escalation, which leads to false allegations of profiteering.
Let us deconstruct some of these costs. The ones, which are visible, are of course, the Personal Protective Equipment (PPEs), worn by healthcare workers, while working in the isolation wards. Simple arithmetic shows that in a typical 10 bed ICU, the consumption of the PPE’s is at least 8 units per day per patient. Priced at INR 1000 per suit, this adds Rs. 8000 per person per day of stay in the ICU. Not understanding this, we have seen media houses going to town with wild theories of profiteering, accusing private hospitals of selling a Rs 800-Rs 1000 PPE unit for Rs 8000. This is sheer ignorance or worse.
Let us now examine some invisible costs that are peculiar to managing Covid 19 patients. The healthcare workers looking after Covid 19 patients need to stay either on the premises of the hospital or in a quarantine facility (a hotel or a guesthouse) near the hospital. This is to prevent the high risk group of HCWs returning to their own families and communities and putting those at risk. The hospital bears their stay, food, travel and other day to day expenses. These expense easily go up to INR 3500 per person per day.The HCWs after finishing their 14 day duties have to be rested for another 14 days in a secured isolation facility. This too entails a similar cost.
Since the healthcare workers work only 14 days in a month against the usual 25 days, the productivity nearly halves. Additionally, the HCWs serving in covid wards do a 6-hours duty instead of the usual 8-hours as it is impossible and inhuman to have them working longer hours wearing the suffocating PPEs. Thus, a higher number of HCWs are required to manage a Covid 19 ward leading to higher manpower costs.
There is another element of cost often missed out, while looking at the Covid 19 costs. This is of the treatment and care of HCWs who catch the infection, while treating patients. These HCWs are provided free medical care by the hospital and are also supported by way of paid leaves during the period of their illness and quarantine post recovery. This is quite a significant cost as well and often remains invisible.
These are just the operational costs. Hospitals handling Covid 19 patients also need to reconfigure a large part of the hospital into isolation areas, which are completely segregated from the rest of the hospital. They need to source more ventilators and supportive equipment to handle large volumes of patients. Renting or buying these add to the cost.
The need of the hour is for the concerned governments to enrol private sector healthcare providers as partners in the effort against Covid 19. They need to understand and keep in mind their operational as well as financial concerns as they formulate policy. The private sector is not asking for profit and many are even willing to work at no profit no loss basis. They are not an adversary in the fight against Covid 19 but valuable allies. However, they themselves need to survive the Covid 19 onslaught to be effective in the battle against the pandemic.
Views expressed are personal