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the i-value

HPHR Fellow Javaid Sofi

By Javaid Iqbal

The Urgent Need to Regulate Private Hospitals in India

Even before people can comprehend the loss of their loved ones, they are already worrying about inflated hospital bills. The next of kin do not know what to do, fight over the bill or grieve the person as private hospitals refuse to release the dead body until all dues are cleared. This pattern of exploitation is witnessed all over India. Due to the absence of regulation and government subsidies, many private Indian hospitals have a margin of more than 1700% on drugs and consumables.

 

India’s second wave of coronavirus has exacerbated this situation, completely overwhelming the healthcare sector, and left the people gasping for oxygen in the hospitals. India is looking at a world record of 400,000 cases per day, and a staggering 215,524 people have died so far due to COVID. Experts fear the actual number of deaths is four times higher. The devastation caused by covid has melted the crematoriums due to the extra pressure, and many people call it the “greatest tragedy since India’s partition.”   

 

India’s suffering is due to a lack of political initiatives and a long-beleaguered health policy primarily focused on providing healthcare in the private sector and ignoring the public sector. About 66% of Indians visit a private hospital for treatment, with 80% paying from their pocket due to poor infrastructure, unequal doctor-to-patient ratio, and lack of facilities at public hospitals with rural areas especially poorly served. 

 

India has nearly twice as many private hospitals as public ones—an estimated 43 487 versus 25 778. Private hospitals in India are also unequally spread with highly fragmented and fluctuating wildly in quality. The Medical Council of India’s ethical codes is followed by less than 20% of the doctors, with the MCI itself marred by corruption charges. Only 11 of India’s 36 states have adopted the Clinical Establishment Act, which sets the standards for quality and transparency of medical care. Though the Act is about setting standards for clinical establishments, it does require the accountability of private healthcare providers by asking them to display prices prominently. India’s health budget is currently one of the lowest in the world, and it spends less than $100 per capita per year, which hasn’t changed in a decade. Every year, 50 million Indians go bankrupt due to medical expenses. India has a booming medical tourism sector where people from around the world come for treatment. However, the same level of care is unaffordable for millions of Indians. Nearly 120 people are pushed into poverty every minute – a situation that has been exacerbated by the COVID-19 pandemic, according to OXFAM International.

 

In the last two decades, healthcare has increasingly become privatized, commercialized, and profit-oriented, influencing doctors’ and patients’ conduct towards each other. India’s system for training doctors is dogged with fraud and arcane teaching practices. 

India is one of the few countries where students can officially buy their way into medical school. Fees for training in Radiology can cost upward of US$100,000. The ability to pay is more important than merit, resulting in patients bearing the brunt. Many of these doctors indulge in unethical practices to make money as they have spent vast amounts of money on their education and now want a return on their investment. Transparency International ranked healthcare as the second most corrupt institution in India after police. In 2017, the whole country was shocked to hear that two families had to pay nearly INR1.6 million(US$20000) each for the two weeks of inpatient care of their children for the treatment of dengue-related complications.

 

According to one survey, 92% of the citizens do not trust the healthcare system, including doctors, hospitals, pharmaceutical companies, and diagnostic laboratories. The hospital administration’s main aim is to generate profits for investors due to healthcare’s increasing corporatization. Corruption in the healthcare system destabilizes the quality of healthcare services disproportionately, making it costly for the poor and the marginalized people and resulting in poor health outcomes, and increasing their spending by 10-25%. A significant concern with diagnostic labs is that they prescribe more tests than necessary to be done only at preferred labs for substantial commissions. However, due to poor infrastructure, unequal doctor-to-patient ratio, and lack of public facilities services, they have no other alternative. 

 

Health insurance companies have received more than 100,000 claims for covid in the first six months of 2020, with patients having insurance charged higher amounts than patients who did not have insurance.

Hospitals that get land and subsidies from the government are obliged by law to provide 30% of their beds to the poor for free of cost. However, that is rarely the case. Many pharmaceutical companies bribe doctors to prescribe their drugs with foreign trips, expensive smartphones, and in many cases, cash to prescribing their medicine. The chances of getting a helpful prescription at the doctor’s office in India are no better than a coin toss, with patients having about an 80% chance of getting tests or drugs they do not need.

 

The average time one doctor spends with a patient is only 2 minutes, leading patients to spend more at pharmacies and having a poor relationship with the doctor. India needs to increase its GDP spending on health by at least 5% to strengthen the public hospitals to compete with private healthcare providers and increase the number of doctors in these institutions.

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