With Doctors’ Day falling this Sunday, July 1, we thought it timely to focus on a dilemma faced by the community of doctors: the pressure they face from members of the public who possess health insurance policies.
Patients walk into a clinic or hospital with a request to be admitted as they need the right documents to take advantage of the health insurance scheme they have invested in. The decision the medical community has to take is this: Should we permit the same while simultaneously benefiting ourselves monetarily or refuse to do so bearing in mind the nobility of the profession?
"The private health insurance sector is accelerating the deceleration of ethical values of doctors," charges one doctor.
An NRI doctor who once worked in a private hospital here, says, "Insurance companies are putting doctors attached to hospitals to great risk. I have come across patients who rush in and insist they be admitted into speciality wards because they need to produce some documents to claim their health insurance money. This is forcing us to take professional risks and we do end up not having any say in the matter at all.”
Dr Anil Kumar, secretary of Indian Medical Association (IMA), Bangalore, says, “Unscrupulous hospitals are definitely bowing in to pressure from people for monetary gains.”
IMA president Dr V S Shanmugananadan is of the opinion that healthcare should be made the responsibility of the State.
Senior interventional cardiologist at Mallya Hospital, Dr V K Srinivas, gives another angle to the issue. “Patients who are covered by health insurance know that it is the company that will meet the expenses of the patient.
“Hence, they demand that we carry out many tests on them. The faith a patient places in a doctor and the cordial doctor–patient relationship that existed earlier has deteriorated to some extent.”
Insurance is definitely welcome as many are benefited but the ideal situation will be one where the entire population is covered by insurance which is the case in many countries, he added.
Pressure from          patients
So how are doctors coping with this kind of pressure from patients? Dr Yogesh Bithwa, consultant spine surgeon at Hosmat says, “We do get unjustified requests at times from patients to modify their history. But it is upto the doctor to turn them.
“I believe that health insurance has more advantages than disadvantages, specially for the middle class, as it is becoming a costly affair.” 
On the other hand, health insurance providers are also keeping their eyes open. Shubhra Singh Pathania, National Head for Account Management and Health, United Health Care, a leading health insurance provider for corporates says, “We do understand that misuse can take place and our checks are in place. We have a team of doctors to monitor these aspects. When we feel that hospitalisation is not required in certain cases, we refuse to sanction the bills for it. If we detect any kind of misuse, we bring it to the notice of the HR department of the company the individual is working in.”
A government doctor holds out this frightening warning: “Health insurance companies in India are pretty liberal now since it is the budding stage for them. It will not be long before they wake up to the fact that the claims are too high and will become very strict. In future, it could resemble the scenario in the United States where insurance companies dictate to doctors the investigations and kind of treatment they can handle.”
 S Lalitha