A prescription of ethics for hospitals

We know that our private hospitals exhibit a saintly detachment to the larger socio-economic realities at the high altar of profits

In recent weeks, I had to make frequent hospital visits, which led me to some reflections upon the way our hospitals function. However, I am not concerned in this article with the larger challenges that our national Indian health systems, public and private, suffer from.

For instance, I am not concerned here with the class character of the Indian ruling elite — aka VIP culture — which plagues even our health systems, private and public, so thoroughly and deeply, that an average Indian patient can hardly hope to get a fraction of the attention the elite get. Government hospitals like All India Institute of Medical Sciences (AIIMS) and the like are, for all practical purposes, meant for the political and bureaucratic elite. Even in private hospitals, an ordinary patient can hardly expect the same quality of care as a 'VIP’ patient, even if the former is paying the same charges as the latter.

I am neither addressing the problems of medical negligence in our hospitals — public and private alike — whether wrong diagnoses, delays in diagnoses, unnecessary surgery, bloopers in surgery, childbirth and labour malpractice, wrongful administration of anaesthesia, or long-term negligent treatment, and such. Our laws place the burden of proof of such negligence at the hands of the complainant, which is typically beyond the capacity of an average Indian patient — even if we disregard the cost and time taken to get ‘justice’ in what passes for our judiciary.

I am also not discussing the unhealthy alliance between doctors, hospital administrations, and pharmacies. Even though this problem has been glaring in the public domain for long, neither the government nor the Medical Council of India (or its new Avatar, National Health Commission) has shown the slightest inclination to penalise either the pharmaceutical companies or the doctors for their role in this unethical practice.

My key aim in this article is modest. We know that our private hospitals exhibit a saintly detachment to the larger socio-economic realities, higher principles of social justice, and loftier values of service to humanity at the high altar of profits. They are least concerned that such care as they do dispense has become unaffordable to most common people, as much due to the policy framework governing the health sector in the country, as due to an entirely indifferent and heartless system practised by hospitals themselves. Consequently, the common man is shot by a double-barrel gun; again at the same hospitals’ mercy.

Let me share my frustration with the more mundane concerns involving doctors and hospitals:

a. It is not uncommon for a doctor to prescribe a high-powered antibiotic by its brand name that burns a hole of ₹150 per capsule in your pocket with a dosage of 14 capsules over a week, which the pharmacy sells only by the strips of 10 each. This means you will have to buy two strips for your dosage of 14, and take a knock of ₹900 on those six extra capsules. Whatever happened to the old practice of pharmacies cutting out six of those capsules from the second strip? Who changed the practice?

b. In the good old days, a doctor's consultation fee included a follow-up visit. Now, every hospital charges consultation charges for each visit, including immediate follow-up visits! Say, you pay ₹1000 to consult with a urologist for ten minutes. Obviously, the doctor is unable to have a detailed chat with you in that short time and happily asks you to report back in three days. And then you are charged ₹1000 for each follow-up visit. I had four such visits for a single malady.

c. Look at any medical invoice you get, following hospitalisation, and it has billings for consumables ranging from gloves, to cotton, to gauge cloth, to bandage, to blank plastic injections, needles, et al for a three-day stay at the hospital, and you find that the bill runs into tens of thousands of rupees, while the fair market price ought to be a thousand or two, at best. There seems to be no accountability at all for such gouging by a hospital. True, you can go to court and probably get a refund after a dozen years (if you are lucky) of litigation costing several times your losses with the hospital, with the judge paying you a pittance in compensation for your ‘mental anguish’.

d. Why doesn’t the law demand that doctors hang their degrees with the names of the college they graduated from, in plain sight, along with their percentile position among the doctors graduating that year in their specialisation nationwide? Surely with today’s technology, the National Health Commission should be able to ensure that, with the threat of serious penalty for violations?

e. Is it not reasonable that estimates of hospital treatment are given before and not after asking the patients whether or not they have insurance, and if so, with what limit? The inherent problem in this line of questioning is obvious. The practice incentivises the hospital to levy charges as close as possible to the insurance limit, and on those atrocious overheads too. One would think, it is in the interest of the insurance companies to exert pressure to dissuade the hospitals from this practice, rather than routinely short-change the patients from paying them their benefits.

f. Most hospitals have ratios like ‘outpatient to inpatient conversion ratio; 'consultation charges to pathology charge ratio’; ‘consumables charged per day’, often doctor-wise, for monitoring their profitability. Such ratios are obviously detestable and the underlying reason why every single doctor sends every single patient to at least a dozen different tests.

We talk long of corporate social responsibility for the industry in general, but are such practices in line with the corporate social responsibility of the hospitals? We have a stringent CSR Act in place, but it fails to recognise that CSR first and foremost is about fairness, transparency, and good governance. How do we make a beginning?

(The writer is an academician.)