Footing that hefty health bill

Cornered by the high cost of healthcare, lakhs are Bengalureans are in a quandary. They are forced to part with big money, surrendering to the dictates of a system that demands expensive surgeries, lab tests and a dozen procedures not always necessary. Is there a middle path between this commercialisation and a culture of genuine care?

Dozens of big, corporate hospitals in the city have hi-tech equipment that promise to deliver advanced healthcare. But a big chunk of the city's population cannot afford these facilities. Yet, they queue up for want to alternatives and end up in debt.

Hi-tech, low-affordability

"Technology-wise, we are second to none. They are available to patients here at a fraction of the cost abroad. But even then, almost 15% of our population may not be able to afford it," says Dr H Paramesh, Pediatric pulmonoligist and advisor, Rajiv Gandhi University of Health Sciences.

Studies have indicated that nearly 5% of patients sell their entire assets to avail modern healthcare. But, as Dr Paramesh points out, hi-tech treatment is not always necessary. Rare surgeries through hi-tech equipment are promoted and advertised by most hospitals. Patients are given an impression that such equipment offers the ultimate cure.

Relatives of terminally ill patients are often at the mercy of hospitals that show ventilator as an option to keep their dear ones alive. But doctors say that decision has to be taken after much thought. In reality, it may not be prolonging a life, but prolonging the misery. This decision would end up making the patient's near and dear ones emotionally and financially bankrupt.

Double-edged insurance

So, what about health insurance? Does it really give patients freedom from inflated medical bills? The poser is tricky, since many patients complain that hospitals overcharge them once it is known that the case is insurance-covered. Firms that levy a high premium pay up, but not those who have a mechanism to verify each claim.

Cases are aplenty where the patient is caught between overcharging hospitals and bargaining insurance firms. A patient, who had a facial surgery at a super-specialty hospital on Bannerghatta Road, was clueless when his insurance agent refused to approve the inflated bills. Since the patient had no attendant around, he had to literally run up and down floors with bandages, negotiating a deal.

Health professionals agree that insurance cover is a good thing. The proportion of insured patients is increasing. But they caution that insurance also ends up making patients queue up for medical investigations that are entirely unwarranted.

Private sector,
charitable?

The private health sector is changing, offering charitable beds for the underprivileged, contends Prof Elizabeth Cherian P, board member, Alliance for Health Promotion attached to the World Health Organisation (WHO). "Many private hospitals are now doing their best to change the impression," she says.

She emphasises the need to boost health literacy among patients. "They will not be then easily taken for a ride. Besides, for any surgery, they can always go for a second or third opinion," Prof Cherian elaborates.

But the government had to play a supporting role. Many smaller private hospitals, she says, are forced to shut down because they cannot afford the high cost of equipment and maintenance. "The only option would be to hike their treatment costs."

A business, with profit

Many doctors spoken to for this feature contends that providing quality healthcare is a business that offers service and runs for profit. They are categorical that charity is not the objective.

Preferring anonymity, a senior consultant from a reputed hospital explains: "We have targets for every two months. We are to fill a fixed number of ICU beds or are supposed to do a particular number of surgeries a month. Our salaries are based on the completion of the targets."

Another doctor is frank enough to admit that they fear losing their jobs if the monthly targets are not met. But the general justification for the high rates are these: Running a multispeciality hospital is about spending crores of rupees on electricity bills, water bills, loans, expensive equipment that are imported. These can be compensated only through the medical bills, they say.

Opposition to Bill

Now, this is precisely the reason why the state government's push to regulate hospital rates is being opposed by thousands of doctors from private medical institutions across the state. The Karnataka Private Medical Establishment's Bill proposes to regulate or cap the prices of procedures and add accountability.

Here's Dr R Ravindra, secretary of Private Hospitals and Nursing Homes Association (PHANA) articulating the doctors' point: "They cannot fix rates of procedures. We are running a business too. How are we to pay our dues if rates are fixed?"

But there seems to be hope. Slowly, a middle path is now being explored. Pushed by global best practices, health professionals are now readying an internal code that advises against laboratory investigations for minor ailments.

As Dr Paramesh explains, "The radiation from a single CT scan is 400 times that of an X-Ray. Now, for instance, a CT scan is not advised for sinusitis unless there are complications. Even an X-Ray is not advised for adenoids swelling. This way, the costs can be reduced by almost 2/3rds."