No health without wealth here?

Ashok, 35, wanted to provide his wife with the best that he could during her first delivery. A factory worker from Bihar, he little knew that he could seek free treatment at a private hospital in the capital.

“My neighbour told me that poor patients can get free treatment in some hospitals,” he recalls. So he went to Delhi government's Directorate of Health Services (DHS) to get an undertaking, that he is poor, approved by the nodal officer there.

Poor patients, who come under the economically weaker section (EWS) category, can seek treatment at 43 identified private hospitals in Delhi – instead of queuing up at the more crowded government hospitals.

In theory, all they need to do is to flash their Below Poverty Line (BPL) card or show their income certificate – stating that their monthly income is less than that of an unskilled labourer – and get free treatment at the private hospital.

Or they can get that piece of paper from a nodal officer at a government hospital or from the Directorate of Health Services (DHS), essentially certifying that they cannot afford the treatment otherwise.

The identified private hospitals are supposed to reserve 10 per cent of indoor patient department (IPD) beds and 25 per cent outdoor patient department (OPD) slots for these poor patients.

The hospitals have to do this because they they were given land at concessional rates by the government. A Supreme Court directive in 2011 makes this clear.

But in April 28, 2014, Delhi High Court exempted four hospitals from this condition. Moolchand Khairati Ram Trust, St Stephen's Hospital, Sitaram Bhartia Institute of Science & Research and Foundation For Applied Research in Cancer were let off the hook.  Later, the Rajiv Gandhi Super Speciality Hospital and B L Kapur Memorial Hospital also claimed they were not bound by the condition.

Hospitals cannot be held accountable if there happen to be no free  beds available at particular time, and the patient is turned away. The DHS website provides a link to real-time data on availability of free beds under the EWS quota in each hospital.

Also, all the identified private hospitals are supposed to display detailed information on notice boards on the availability of free beds throughout the day.

But poor patients are often not tech-savvy, and miss out. Some hospital authorities also take advantage of this ignorance and do not divulge information on the scheme.
The government has taken some measures to set things right.

“In October, we created the post of patient welfare officers (PWOs) in all government hospitals. In addition, a nodal officer was appointed. Their role is to identify EWS patients in government hospitals, sign referral forms and send them to the private hospitals. Recently, an online booking facility of free beds was launched. PWOs can directly coordinate with nodal officers of private hospitals and send patients,” says a top DHS official., requesting anonymity.

But patients who land up on their own at private hospitals feel “harassed” most of the times.

“I went to get a check-up at the OPD in a private hospital. I was asked to pay for medicines and blood tests. They deliberately harassed me,” says Manjula Devi, who sought orthopaedic treatment at a private hospital in east Delhi.

Even if the hospital gives out free treatment, they often charge patients for peripheral expenses like medicines or diagnostic services.

The EWS department in the DHS can do its bit here, as it has the medical details of the case. “We randomly call up the family and ask if they are being forced to pay for medicines or blood tests. Besides, there are officials who go and monitor the situation in respective hospitals,” says the DHS official.

Unwelcome

Government hospitals often bear the brunt when patients come back feeling unwelcome or dissatisfied from private hospitals. “Our PWOs try and facilitate a smooth transfer of patients. However, there are some hospitals which turn away patients even when they have free beds. Patients come and lash out at us saying they were only harassed by being referred to a private hospital,” says Rajesh Kalra, medical superintendent of Hedgewar Arogya Sansthan.

The nearby Shanti Mukund Hospital often turns away patients in spite of having free beds, says a source at the hospital. According to data available with the DHS, Shanti Mukund has provided only 4.79 per cent IPD beds to EWS patients in the year 2013-2014. When contacted by Deccan Herald, the nodal officer at the hospital refuses to comment.

While bigger government hospitals have higher number of welfare officers, some 100-bed government hospitals often manage to refer a significant number of patients to private hospitals.

“We manage to send at least 60-70 patients to nearby hospitals on a monthly basis. These patients are mainly sent to PSRI, Max Saket and Saket City Hospital, which are near us. They usually never turn away patients,” says Dr Ramesh Chugh, medical superintendent of Madan Mohan Malaviya Hospital.
 
PSRI and Saket City Hospital are among the few hospitals which have exceeded the 15 per cent free EWS quota for indoor patients in 2013-2014.

“Bhagawan Mahavir, Sir Ganga Ram Hospital, Jaipur Golden Hospital, Action Cancer Hospital, Balaji Action Medical Institute, Saroj Hospital & Heart Institute and Sunder Lal Jain Charitable Hospital along with a few other hospitals have achieved more than 15 per cent IPD,” says the DHS official.

In the past few months, Max Balaji, Patparganj has also been regularly turning away patients, allege welfare officers at government hospitals. “They do no even receive the patients. They simply refuse them entry even in the OPDs,” says a welfare officer on condition of anonymity. 

Meanwhile, hospitals like Rockland, Dwarka, Primus, RLKC Metro Hospital, Fortis Vasant Kunj, R B Seth Jassa Ram, Guru Harkrishan Hospital have offered free treatment to only between 0.05 per cent to 4.80 per cent of their patients, according to data accessed from the DHS.

However, hospitals claimed that patients were unaware till last year as there was no attempt from the government to push this arrangement.

“There were no referral cases till last year. Patients are usually not aware of the scheme on their own. The little we could do to fulfil the condition was because we identified patients as poor and treated them for free. Now that there are PWOs in hospitals, we are regularly getting patients for both OPD and IPD. In fact, we are getting a significant hunk of OPD patients from jhuggis nearby. Our reserved IPDs are also mostly full,” says Dr Prabhat, nodal officer at RLKC Metro Hospital.

The hospital had treated free only 0.77 per cent of patients admitted there last year.
 
A  DHS official says the department has repeated issued alerts to private hospitals which have not met met the mark. Sometimes both the patients and the hospital authorities are called.

“If a free bed was available and the poor patient was still turned away, the hospital has to refund the money. In a recent case, a private hospital had to refund Rs 1.5 lakh,” says the DHS official.

“It is not very difficult to identify poor patients. It is sad that these patients are being denied their basic rights,” the official adds.

Central law

The official feels that there should be central legislation making it mandatory for hospitals built on land given at conessional rates to provide free treatment to the poor.

There are at least 10 more hospitals which contend that there were no conditions attached in their land lease deeds. The official fears if they successfully argue their case, the city's poor may lose out on 250 more beds now set aside for them.

The department cannot penalise the hospitals for not adhering to the quota.

“Since they were given land by the government agencies, only the allotting agencies can cancel their lease deeds. We have repeatedly written to the agencies giving the figures of the low performance so that they alert the hospitals and also penalise them,” says the official.