Profit in times of COVID-19: Is it time to take over private hospitals?
Horror stories from Delhi’s private hospitals run for profit were not uncommon. Nor were anecdotal evidence of employees sacked for declaring a patient brought dead instead of admitting into ICU
Rs 25,090, Rs 53,090
Rs 75,590, Rs 5,00,000
Rs 6,00,000, Rs 12,00,000
These are not random numbers. These are the per day costs and cumulative two-week costs for a bed in private hospitals in Delhi if a person gets infected by Coronavirus. Add to this the price of personal protection equipment, RT-PCR tests, and medicines. The cumulative bill is more than what at least 94% of the people in the country earn in a year.
Now, that Delhi has been insisting on home care for most people infected with Coronavirus, hospitals have come out with home care packages as well.
*Medanta Hospital’s Covid-19 care package begins at Rs 5,700, exclusive of taxes and goes up to Rs 21,900
* Saroj super speciality hospital charges Rs 1,850 per day
* Fortis Escorts’ home care package is Rs 6,000.
This does not include the cost of the Covid-19 tests. This is not a situation unique to Delhi alone, both Chennai and Mumbai have been struggling with an errant private sector.
In the time of the Covid-19 pandemic, it is pertinent to remember that right to life enshrined in Article 21 of the Constitution includes the protection of health and access to health care, which cannot be denied on financial grounds.
“When the Covid-19 crisis began to unfold, there was a lot of talk that we have a strong private healthcare system and that would take care of the problems. Niti Aayog officials said that Covid-19 is covered by the PM’s Jan Aarogya Yojana. But we saw poor reaction from the private sector. This is because we are insensitive as a society to the needs of a large majority of people. This is connected to how the private sector performs. It has been left unregulated and allowed to function in a manner that is unethical. Covid-19 has magnified it,” underlines Indranil, who teaches public health and health economics at OP Jindal University. He is also the co-convenor of the Jan Swasthya Abhiyan in Delhi. JSA is a people’s health movement aimed at enabling equitable health care.
A petition was filed in the Supreme Court to regulate private hospitals. Alarmed, an association of private hospitals across India (Association of Healthcare Providers) and FICCI member hospitals said they would self-regulate.
They suggested that the fees for general wards per day should be capped at Rs 15,000 per day, in wards with oxygen it should be Rs 20,000 per day and for intensive care unit treatment at Rs 25,000 every day.
AHPI also proposed that rate per day for ICUs with ventilator support can be fixed at Rs 35,000. FICCI’s rate card was even higher – they suggested fixing rates from Rs 17,000—Rs 45,000 per day.
Patient groups such as All India Drug Action Network slammed them as PR stunts. A doctor with experience of working in both government and private hospitals found these prices exorbitant.
“From my experience of bills in pre-Covid days even of patients who required ventilator support, I find these prices exorbitant. Hospitals are incurring losses compared to what they were earning prior to Covid-19 in similar months. But we cannot keep the same profit baselines during the pandemic,” said the doctor, who did not want to be identified.
“Private hospitals have never been transparent about their billing heads. “They don’t provide department heads with real profit earnings, the mark up that private hospitals have on consumables are never shared. There are so many unnecessary and unaccounted for heads in Bills,” said the doctor.
“During the pandemic, Personal Protective Equipment (PPE) has become a new extra billing source. Most manufacturers I have spoken to say that hospitals buy them at rates between Rs 375 – 500,” said the doctor, in most private hospitals patients are charged between Rs 3,500- 6,000 for them.
Vikas Bajpai, Professor at the Centre for Social Medicine and Community Health at JNU, points out that private hospitals began to offer services only after they adjusted their logistics to make huge margins during this time. “They take admission of only those patients who can pay and their first response is to play it hard,” asserted Bajpai.
In the light of these exorbitant costs at private hospitals, a new petition has been filed in the Supreme Court seeking directions to audit Max, Fortis, Manipal, Apollo, BKL, Primus, Holy Angels and other private hospitals which are run by charitable trusts on land allotted to them either free of cost or at concessional rates in Delhi.
The petition underscores the dire need to audit these trust-run hospitals which are commercialising healthcare. The petitioners, Shubha Gupta and Rajesh Sachdeva, claimed no free treatment was being provided at these private hospitals, contrary to terms of their land lease.
K Srinath Reddy of Public Health Foundation of India says that though governments have vast powers to regulate, the question was whether they were willing to regulate hospitals.
“There is likely to be an increased demand for hospital care in Delhi in the coming days. All private hospitals will have to co-operate and the charges will have to be definitely kept under control. It is for the government to regulate. The government has many options. The government can do very strict price control; extend insurance scheme etc.,” says Reddy.
If the Government finds private hospitals reluctant to admit patients or if beds are found to be in short supply, the government could always exercise the option of taking over the management of these hospitals, he points out. Partial or full take-over of hospitals was in the domain of the government.
Reddy reminds that PHFI has been asking for universal health coverage for years. “The current government had committed to sustainable development goals in 2017 and one of those goals was universal health coverage. It is also a part of the National Health Policy laid down in 2017. But, the question is if there is a political will to implement it,” rues Reddy.
It was evident that the Delhi government knew the magnitude of the issues even before the pandemic. A Delhi Assembly committee report of 2017 found that the then health principal secretary, DGHS director and all the liaison officers posted by the government in these private hospitals were in cahoots with the management.
“The committee, which was chaired by Saurabh Bharadwaj, reported that the principal secretary (health) tried to sabotage the functioning of the committee. They had recommended strict disciplinary action and despite all of this what is Arvind Kejriwal waiting for,” asks Bajpai.
Bajpai believes a situation like this is not the time to experiment. “The government keeps saying they will talk to private hospitals, cap the costs, charges. There is a long case history of corporate hospitals failing the people and in fact using a time like this to extract their pound of flesh. That has been their attitude,” he says.
In 2015, Bajpai recalls, there was a dengue epidemic in Delhi and there were media reports of a young boy whose parents took him to five private hospitals which denied him admission and finally he was admitted to Safdarjung Hospital. He died and the very next day, in despair his parents also committed suicide.
Delhi Chief Minister Arvind Kejriwal is on record saying that private hospitals were holding patients to ransom. “If they are holding patients to ransom, then why can’t he say that we are nationalising healthcare for so long as necessary until this pandemic is under control,” asked Bajpai.
In a pandemic, the government should be able to ensure that every person who requires medical care be provided that care irrespective of their ability to pay.
“If her treatment is incumbent upon her ability to pay, how are you going to check the transmission from stopping? It is a house of contradictions. This is criminal governance on display in the worst form,” observed Bajpai.
The whole system is complicit. The Supreme Court facilitated that a test which could be done for a few hundred Rupees, would be charged as high as Rs 4,500 in private labs and hospitals.
“Addressing Covid-19 is a question of supreme national interest. We have a government which keeps swearing by nationalism, then why is it so paralysed? Why are they saying they will cap it? If I don’t have the paying capacity, am I not eligible for health care? Will I be left out and go about spreading the disease?” asks Bajpai.