JOIN USTime for doctors to introspect
A silver lining amidst the dark clouds that have enveloped the country is an improvement in the general health of the people. It may seem an irony that while on the one hand, the number of COVID-19 cases continues to rise, there is a fall in the number of heart attacks, strokes and even deaths. According to BBMP data, the number of deaths in the city due to medical causes during March 2020 was 4,716, compared to 5,400 in March 2019, and 3,327 during April 2020 compared to 4,806 in April 2019.
What accounts for such a trend? Possible explanations could be reduced pollution, thanks to clean air, less work-related stress, spending relaxed time with family, and not eating out, thereby avoiding junk food. And, of course, not to forget, the forced holiday from that beloved addiction, the bottle. According to a senior consultant in a private hospital, trauma cases, respiratory diseases, gastrointestinal and pancreatic cases triggered by binge drinking have come down. So have infections flaring up from communicable diseases because of physical distancing and frequent hand washing. Emergency admissions to hospitals have reduced by 50%.
It’s time for doctors to introspect and reflect on the entire system of healthcare. There is no doubt that the medical community is doing a commendable job in combating COVID-19 and providing relief to the afflicted. Exposing themselves to risk, doctors, nurses and other paramedical staff have risen to the occasion to serve the people. However, questions need to be asked about the type of procedures followed and the cost of providing services, particularly in private hospitals.
According to a recent survey, COVID-19 patients admitted to a private hospital across the country generated claims worth Rs 42,200 on an average per patient per day while a Deccan Herald survey in Karnataka revealed that the cost per patient in COVID-19 designated hospitals ranged from Rs 10,000-20,000 per patient per day for non-ICU treatment, and in respect of ICU, an additional 55%. A Gurgaon hospital billed Rs 6.7 lakh for a particular patient, but the insurance company cut it down by 50% as it found many expenses avoidable. In another shocking case, a hospital submitted a claim for 1,300 pairs of gloves for a single patient for a period of one week. When the insurer brought this to light, the hospital withdrew the claim with a request not to publicise it. A PIL has been filed in the Supreme Court regarding overcharging for COVID-19 patients in private hospitals.
Many attempts have been made by various state governments to regulate the functioning of private hospitals. In 2000, the Andhra Pradesh government enacted the Clinical Establishments Act, but it took five years to frame the rules and was never able to enforce the law. Karnataka passed a law in 2017 to deal with medical negligence and overpricing. After a strike by 60,000 private sector doctors, the law was restricted to only those covered by government-sponsored health insurance schemes.
It is heartening to see that Public Health Foundation of India president Dr Srinath Reddy has called upon the medical profession to introspect, with a pertinent observation that “in the lockdown period, people are not coming to us and seem to be doing better.” He goes on to add: “We were overdoing with our medicine, soliciting patients and looking for disease. Performance-linked payment in large hospitals was driving overtreatment.” That aptly sums up the state of affairs in the sphere of private medical care in India.
This is not to suggest that private hospitals should not make profits or to underestimate their investments in health infrastructure, modern equipment, professional manpower and other requirements to provide services. But a line has to be drawn between making a reasonable profit after meeting costs, and overcharging. How can one explain a hospital charging Rs 4,500 per set of PPE (personal protective equipment) when the prescribed cost is Rs 2,000? Subjecting patients to unnecessary procedures reflects lack of human consideration, apart from being a clandestine method of overbilling.
Looking ahead, it is important to take note of the fact that technology will play an increasingly important role in processing medical information, diagnosing diseases and perhaps prescribing medicines, too! Artificial Intelligence and biometric data may monitor our health 24/7. Yuval Noah Harari, the noted Israeli historian in his latest book ‘21 Lessons for the 21st Century’ makes an interesting observation: “People will enjoy the best healthcare in history, but for precisely this reason, they will probably be sick all the time. There is always something wrong somewhere in the body…By 2050, diseases may be diagnosed and treated long before they lead to pain or disability. As a result, you will always find yourself suffering from some ‘medical condition’ and following this or that algorithmic recommendation.”
The future of our health seems to depend a lot on how doctors harness technology. More the machines and more the tests, higher the cost. Medical insurance companies will play a significant role in determining costs, along with doctors. Government’s intention may be to provide affordable and quality healthcare for all. The central and state governments have introduced a number of schemes in this direction. However, given the inadequacies of our public health system and the huge resources required to meet the health requirements of a vast population, it is inevitable for the private sector to play a vital role.
The challenge before the medical community is to move from a system that overemphasises curative services to one that promotes prevention and well-being. As a learning from the COVID-19 crisis, doctors may like to recall the following parts from the Revised Hippocrates Oath: “I will apply for the benefit of the sick all measures required, avoiding those twin traps of overtreatment and therapeutic nihilism…I will remember that warmth, sympathy and understanding may outweigh the surgeon’s knife and chemist’s drug.”
(The writer is a former Chief Secretary, Government of Karnataka)