26 June, 2009

Health is wealth really, today!

We were all born equal, right? Some of us, it would appear, are first among equals, in a pervertedly lopsided way.

If you happen to be unfortunate enough to step into a hospital and be fortunate enough to afford a Deluxe room, you should know & be prepared to pay much higher charges for every service that you avail, not just the room rent. Any medical procedures performed, services availed, doctor’s fees, operating theatre charges etc., will be considerably higher than in the lower category rooms/ general ward. So why’s no one protesting? The people in the profession won’t. Doctors don’t mind getting higher fees for the same work. They worked hard to clear their medicine course, remember? And the hospitals need the extra oil to treat the free patients, you know? Rob Peter to pay Paul. We are socialists and we idolize Robinhood, don’t we?

And the unsavoury aspect does not end there. Hospitals fudge the bills too, so that, it is advantageous to them. Last year, a relative of mine got admitted for a heart related problem in a Chennai Hospital. She was initially in the ICU and then was shifted to the regular ward. She had taken an A/c room. Since she was in the hospital for 5-6 days and was mostly under observation, the charges came to under Rs.40,000/-. But the problem surfaced when she put in a claim. A huge percentage of the per-day expenses were put under the head of “food”. It was not some gourmet food that the hospital dished out. The food, it seems, was so bad that it was barely palatable - It was sourced from some hotel nearby.

Apparently, the hospital saves on Service tax when it reduces the charges on it’s services and builds it in food instead, we learned later. But the insurance company excluded all food expenses and settled only the balance claim. Even later, when this was drawn to the hospital’s attention they nonchalantly dismissed it as their “regular” way of billing. This is not an isolated instance.

Recently, another relative of mine was admitted in ICU. When there, the doctor’s keep asking for medicines at regular intervals. We are supposed to be replenishing the medicines that they are administering from their store. But we did not again get a proper documentation on how many medicines were used. These things go on in good faith. But these medicines cost about Rs.8,000/-, in this case. Just one injection among them cost Rs.3,000/-.

Medical profession is based on complete faith of the patient in the doctor. The doctor’s has a fiduciary responsibility as the patient depends on their judgement, completely. In such cases, the responsibility increases. Hence it is imperative that there is a stringent legislation for the medical profession and provision for a proper recourse for the patients. Currently, there is none and patients are at the mercy of doctors & hospitals.

When there is a patient in the hospital, the last thing on the relatives mind is to question the doctor or hospital, on the charges. However, that needs to be done. For, it has a direct implication, whether one has medical insurance or not. If one has medical insurance, higher charges would reduce the amount available for any further treatments. If not, then one is anyway directly bearing the higher expenses.

What people need to do to protect themselves ?

Firstly, they should ask around regarding the hospitals, the doctors there, charges, facilities etc in their vicinity, before they avail the services. Secondly, after narrowing down, they should approach the hospital and find out from them about the charges ( approximate figures or at least the range ) for various procedures and find how & by how much the charges could be minimized. Had this question been asked, most will get an idea of how much will be the bill, if they admit themselves in various categories of accommodation. Also, in general, trust hospitals tend to charge less than the corporate hospitals. If the trust hospital has the appropriate facilities for the intervention under question, it would be a better option.

Still after all these, if there is over charging, one should bring it to the notice of the management. If that does not work, it could be brought to the notice of local health authorities. It should also be brought to the notice of insurance companies, who will investigate such practices thoroughly, as they are directly affected. Finally, in case of a serious breach, one should consider consumer courts.

There are several problems in medical service delivery, as it stands. Legislation needs to catch up in this vital area, which affects each and every citizen. Let us hope our new health minister focuses on substantive issues rather than on-the-surface issues like smoking in public/ movies, legalizing gay sex & indulging in political games at AIIMS.

Published in Moneycontrol.com in June 2009