Dr Mandeep Singh Azad
Max Hospital in Shalimar Bagh, Delhi, whose licence was cancelled by the Delhi government, resumed its operations from Wednesday after it got relief from the Court of Financial Commissioner. The Delhi government cancelled the hospital’s licence earlier this month after the hospital declared one of the twins born dead. The child survived for a week and subsequently died due to medical complications. What it infers was the Delhi government wrong or max hospital like private hospital are more of a business centre then a health care centre for public service. Indians spent eight times more on private hospitals and twice as much on transporting patients compared to costs in government hospitals, according to the National Health Accounts (NHA) Estimates for the financial year 2013-14. The estimates say that households spent Rs. 64,628 crore on private hospitals compared to just Rs. 8,193 crore on government hospitals. A total of Rs. 18,149 crore was spent on patient transportation services, like use of an ambulance. Considering all revenue sources, including government funding, expenditure on private hospitals – Rs. 88,552 crore – was double that on government hospitals – Rs. 41,797 crore. Private hospitals are making a killing by buying medicines and devices in bulk at huge discounts and selling them to patients at the marked maximum retail price – accounting for 15-35% of their profits. Patients, as a captive market, have little choice but to bear the inflated costs.
Most Indians consider doctors as next to God if not God. We still have many doctors with impeccable ethical records. However, there are many others – not so ethical, and their number is on the rise who don’t think twice before taking their patients for a ride. On an average a hospital admission would be more than three times as costly in a private hospital as in a government facility. In some cases, like eye diseases, private hospitals can cost up to 6.5 times more than government ones, and for an obstetrics or neonatal case, seven times Childbirth costs eight and a half times more in private hospitals compared to government ones. These findings are part of the latest survey report put out by the National Sample Survey Organisation (NSSO). Private hospitalization costs have been increasing continuously. The only reason people go to private hospitals is because government hospitals are so few and under so much pressure In rural areas, about 58% of all hospitalization cases go to private hospitals. This is up from about 56% in 1995-96. In urban areas, only 68% cases go to private hospitals, up from 57% twenty years ago. About 86% of the rural and 82% of urban population is not covered by any kind of health expenditure support, whether government funded or private insurance covered. This means that the high hospitalization costs would substantially affect the family’s budget in a majority of cases as incomes are not very high. The report found that the main source of meeting hospitalization expenses was savings from income. In rural areas, a quarter of households borrowed money to meet hospital related expenditure. The source of borrowing was not found out. In urban areas too over 18% people had to borrow money to meet hospitalization costs. The only way to bring down private healthcare costs is to have a robust public healthcare system at no or nominal cost to the people. Healthcare has become one of India’s largest sectors both in terms of revenue & employment. The industry is growing at a tremendous pace owing to its strengthening coverage, services and increasing expenditure by public as well private players. During 2008-20, the market is expected to record a CAGR of 16.5 per cent.The total industry size is expected to touch USD160 billion by 2017 & USD280 billion by 2020
Health and policy experts in India almost unanimously agree that the abysmally low investment by government has hit public health hard over past decades. Many of them advocate a role for the private sector, but the nature of that engagement is what divides the experts.Some advocate an increase in public health spending each year, combined with a strictly regulated private sector that provides specific services or technology that the public sector does not offer at the moment. Others advocate handing over a much greater strategic control of the health systems to private players. This often comes coupled with the admission that government investments in health care are unlikely to rise soon. Moreover, though health spending by the government is rising every year in absolute terms and on a per-capita basis, there is no significant increase in the percentage of money allocated to healthcare. For instance, per-capita spending on health by the government rose to Rs 973 in 2015 from Rs 621 in 2009 but government expenditure on health as percentage of GDP did not see a significant change in the five year period between 2009-2014.The health ministry finds that over the years, the Centre’s share in health spending has been declining steadily even as the share of states in total public health expenditure has been increasing. For 2017-’18, the Centre is expected to fund 28% of the total public expenditure on the health while the remaining 72% will comes from the states. India’s total public health spending outlay for the current financial year is expected to be Rs 1.80 lakh crore.
Genesis of the problem
With profit making being their main motive, private hospitals are pushing doctors through a system of incentives and disincentives to over-bill using whatever means – ethical or unethical – they can think of. With seats in the subsidized government medical colleges being limited, many medical aspirants opt for private medical colleges that charge hefty capitation fees. This makes doctors vulnerable to the whims of private hospitals that pay good money to their empanelled doctors – needed to recover high investments in medical education.With seats in the subsidized government medical colleges being limited, many medical aspirants opt for private medical colleges that charge hefty capitation fees. This makes doctors vulnerable to the whims of private hospitals that pay good money to their empanelled doctors – needed to recover high investments in medical education.This makes doctors vulnerable to the whims of private hospitals that pay good money to their empanelled doctors – needed to recover high investments in medical education.
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