60% middle class patients don’t have medical insurance
There is a growing demand to streamline the admission procedure in hospitals and health insurance.
By : uma kannan
Update: 2013-11-24 14:59 GMT
Chennai: For a middle-class family without any health insurance cover, paying Rs 3 to 4 lakh medical expenses from their own pockets is not easy. While the underprivileged make use of insurance schemes available for them, elites always have the luxury of getting treated in corporate hospitals, but it is the middle class who sell their assets and borrow money to pay for treatment, point out insurance experts.
“On the whole, perhaps 20 per cent of beds in private hospitals are filled with patients who are covered under health insurance and another 20 per cent are those who have some form of cover, for instance, from a company. The remaining 60 per cent pay from their pockets,” says Chandrasekhar, executive director of Global Hospitals, who has 15 years experience in healthcare and health insurance. He says that we do not have the mindset to take health insurance when we are healthy. “We take insurance to protect against future risk and not when diagnosed with some problem.
We need to create a lot of awareness for insurance penetration. A retail shopkeeper purchases a shopkeepers’ policy and hardly thinks about family insurance. We insure our cars and two-wheelers but our health always takes a back seat,” says Chandrasekar, suggesting that health insurance can be made mandatory when a person opens a bank account or registers a car.
On an average, 25 to 30 per cent of patients admitted or undergoing treatment at Fortis Malar Hospital possess health insurance and use it. “Most claims come from gynecology and then from cardiology, followed by gastrointestinal (GI) surgery and orthopedic,” says Vijayarathna V, zonal director of Fortis Malar hospital, adding, When health insurance started, only two per cent of the entire population was covered, whereas currently, the penetration is about 12 per cent, predominantly covering the urban and semi-urban population. Health Insurance in India is yet to reach the rural household which comprises 70 per cent of the Indian population.”
Next: Need a prescription
Need a prescription
When doctors in a nursing home asked N. Muthukumar to take his grandmother immediately to a multi-speciality hospital near Velachery to save her life, he called an ambulance and rushed to the private hospital. She was not immediately attended to until he paid Rs30,000 as admission fees. “I will never forget that day as I was struggling to cough up the entire amount. I paid Rs4000 to the nursing home and with just '6,000 in hand, it was very difficult to arrange the remaining amount. Luckily, a relative came forward to give his card and she was taken to the ICU,” said Muthukumar.
Nearly a month ago, 11year old Sakthivel died of snakebite in the city. His relative took him from one hospital to another until he was admitted to the Institute of Child Health in Egmore. The private hospital demanded Rs 75,000 as admission fees and his family rushed him to the Egmore hospital, thereby losing the golden hour. Later he died in the hospital.
In a similar case, a security guard Karim died as his friends could not pay Rs 35,000 to a private hospital. “Emergency cases should be immediately attended to and no case should be denied. While on the one hand, we talk about private hospitals fleecing patients and not treating them, on the other hand we also have to consider the situation of private hospitals.
If a private hospital is located in the city, they are probably handling fewer emergency cases. What about those hospitals near accident-prone areas? They see so many cases that there’s a chance of patients leaving without paying fees or they may not have any relative or attenders,” said Dr G.R. Ravindranath, general secretary of the Doctors Association for Social Equality. When contacted, spokesmen of corporate hospitals echoed a similar view.
“Any private hospital immediately attends to patients, whether it’s emergency or non-emergency, and begins first-aid. In case of non-emergency that is not life-threatening, we inform the attender about the approximate treatment amount and it’s their choice to take the patient to a government hospital or continue treatment in the private hospital,” said a senior hospital official.
Law favours life over money
Law favours life over money
J. Stalin
Chennai: Legal experts are clear that doctors cannot turn away patients in need of emergency care under the Code of Medical Ethics drawn up by the Medical Council of India. If they don't give the medical attention called for, patients or their relatives can complain to the authorities concerned and move the consumer forums for relief, the say.
Going by the Law Commission of India report on “Emergency medical care to victims of accidents …,” the ‘Golden Hour’ is the first hour immediately after the accident in which emergency medical care is necessary and most victims die if no such care is available or is not given soon enough, they note.
A. Sirajudeen, author and leading lawyer, recalls that Clause 13 of the Code of Medical Ethics says while a physician is free to choose whom to serve, he should respond to any request for his assistance in an emergency.
The code also insists that no fully registered medical practitioner should willfully commit an act of negligence that may deprive his patient of necessary medical care, he observes. “This clause can be interpreted to mean that the private hospitals are obligated to admit the accident victims immediately irrespective of payment and give them first aid before allowing them to be shifted to another hospital. The treatment has to be continued till they are moved and reasonable time given for the arrival of relatives and friends to arrange for the shifting. Otherwise, the concerned doctor can be held liable for professional misconduct,” Sirajudeen warns.
Recalling the case of Sumanta Mukherjee, an engineering student who was knocked down by a bus from behind while on his motorcycle and rushed to a private hospital, he says the passerby, who took him there, paid Rs 2,000 for immediate treatment. But after admission, the hospital demanded another Rs15,000 and when he could not give it, refused to treat the student who died on the way to another hospital. “The National Consumer Disputes Redressal Commission held the hospital guilty of medical negligence and awarded compensation to the parents of the student,” he points out.