Costly, demanding, negligent: Our hospitals are ailing

The Karnataka Private Medical Establishments (Amendment) Bill, proposed in 2017, met with much criticism from the industry. Without it, however, healthcare facilities function minus accountability, private hospitals charge the earth for treatment and bewildered patients go through a litany of tests without explanation. Meanwhile, government hospitals, many of which languish without adequate facilities, cannot offer a viable alternative to those who cannot afford private healthcare. Abilash Mariswamy reports.

Medical negligence is neither new or uncommon, but the stories continue to horrify. Recounts one disgusted and unhappy Bengalurean, Christanand Malagi, “My brother was admitted to a private hospital in the city and  following a procedure  lost the use of his limbs. The hospital refused further treatment unless the spiraling bill was paid and also refused to discharge him. He was held hostage without treatment until his death.”

Such cases are not the norm, people are fleeced with many hospitals  charging a heavy fee for treatments,, leaving patients bewildered and burdened with countless tests. The Siddaramaiah government did try to step in and rein in the private hospitals by introducing the Karnataka Private Medical Establishments (Amendment) Bill, 2017, which gave the government the authority to fix the rates they charged and also to penalize them for wrongdoing. But this set off a storm with doctors taking to the streets , forcing the government to introduce a much watered down legislation which did away with imprisonment for health professionals guilty of various offences and also lowering the fines they could be slapped with.     

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But even this new milder legislation has still not been implemented in toto 11  months later.  In the meanwhile the people continue to suffer. Says Akhila Vasan of Karnataka Janaarogya Chaluvali (KJC)  “Every day the struggle continues to grow. The main reason is that the private institutions are hogging the policymaker space.”

Dr. Sylvia Karpagam, public health doctor and researcher rues that the  health insurance in India today is such that the treating doctor has to make a choice every day on whether or not to prescribe a test or procedure. “Often it is a choice between making money and not doing unnecessary tests or procedures. If doctors have a fixed salary based on their seniority or experience, then this perverse incentive will be removed. Now it is not uncommon for doctors to put brain dead patients on the ventilator, or prescribe unnecessary tests and procedures without so much as physically examining them,” she laments.

Often patients aren’t in the loop and are asked to get several tests done without details of what ails them, she says. “The health system has no time to spend listening to a patient and his or her concerns and every action of the doctor is measured in monetary terms. This is very dangerous for the health of the country,” she warns.

Dr R. N. Tandon, secretary general of the Indian Medical Association (IMA) asserts that usually everything is above board in private hospitals. “It is certainly wrong and not acceptable if the hospitals are charging five times more than the MRP. Some hospitals charge more because they give certain facilities and services, and people are accepting it,” he reasons, protesting that the entire private healthcare system cannot be measured based on the doings of one or two hospitals.

Mr Pankaj Kumar Pandey, Karnataka Health Commissioner too claims that necessary action is being taken against hospitals that are guilty of violations and licenses have been cancelled. “A task force has also been  formed to take action in such cases,” he adds.

Govt facilities no alternative to pvt hospitals
While private healthcare is becoming increasingly unaffordable, there are no dependable alternatives either with the quality of government health facilities leaving much to be desired. Many government hospitals function in deplorable conditions, lacking in basic cleanliness, and beset with shortage of doctors,  instruments, and beds, making them  unattractive to most people, except the poor,  who have no option but to use their services.

The lack of knowledge about the various government health schemes  also leaves people at the mercy of private hospitals, rue health activists.  While there is no shortage of schemes under Arogya Karnataka the awareness about them and their reach is  poor, they lament. Some of the health schemes available in the state are the Rajiv Bhagya,    Vajpayee Arogyashree,  Santhwana Harish, Jyothi Sanjeevini,     Mukhyamantri Santwana Harish and  Janani Shishu Suraksha Karyakram,but its anybody's guess how many are actually aware of them and how they can be accessed.

Ms  Akhila Vasan of Karnataka Janaarogya Chaluvali (KJC) points out that there are different schemes for different people in the country. “With more than 10,000 different health schemes in the state, its not easy to keep track of them,” she notes, adding that that although Rs 1,000 crore is  spent on Arogya Karnataka, its impact is not far reaching.  “Nearly 98 per cent of the money allocated for the scheme goes towards subsidising surgeries performed by private hospitals to lessen the financial burden on  the patients to a degree,” she says.

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