Opinion: Paid medica

Blame it on the prevailing culture of our times. The supremacy of the profit motive is well established, and its reign extends to all areas of human life — including health. A recent British Medical Journal report revealed that India’s “profit-driven” private hospitals are under pressure to carry out “unnecessary” and “risky” tests and procedures to meet “revenue” targets.

Dr Arun Gadre, gynaecologist with Pune-based non-governmental organisation SATHI (Support for Advocacy and Training to Health Initiatives), interviewed 78 doctors across the length and breadth of India to expose unethical practices prevalent in the field which he has documented. “It all started after 1990 when we embraced privatisation in the medical sector without keeping any control over it.

Today, 80 per cent of patients go to private hospitals. It is sad that the medical profession has become an industry and profit is the main agenda,” said Dr Gadre. “Annually, healthcare expenditure pushes 30 lakh people in Maharashtra below the poverty line. Several reports on farmer suicides mention catastrophic healthcare expenditure as one of the main reasons behind rural indebtedness and stress leading to suicides,” he added.

Dr Vijay Surase, cardiologist with Jupiter Hospital, said, “There is corruption in the medical profession, just like every other profession. However, in a field related to human lives, it is condemnable.” According to him, the highest number of unethical practices occur in cases of joint replacement, followed by cardiac treatment, abdominal treatment and eye surgery. “Taking undue advantage of the fear and helplessness of patients, some doctors prescribe joint replacement, angioplasty and stents when there is no need for it. There are some cities in the country where people, after a certain age, have organs such as uterus and appendix removed for no reason,” said Dr Surase.

He pointed out that doctors are not always at fault as some hospitals get kickbacks from pharmaceutical and surgical instrument companies promoting their own products. “Hospitals sometimes get concessions on certain medicines from companies but still charge patients to earn profit,” he added.

Raigad-based Dr H.S. Bawaskar says he received a cheque of Rs 1,200 from an imaging and diagnostics centre based out of Mumbai and Pune as “professional fees” for referring patients to it for MRIs. Not only did he never refer any of his patients to the centre or cash the cheque, he lodged a complaint against the centre alleging corrupt practices.

A case against the centre is pending before the High Court. “It is difficult to stop unethical practices because they occur at a very personal level. One has to keep a clear conscience. Health insurance for all could resolve these problems as patients would not pay directly to hospitals,” he said. “The government should ensure that more hospitals are built and doctors and technicians are appointed in proportion to the population,” he added.

Yet another whistleblower, Dr Mini Khetarpal, epidemiologist with Brihanmumbai Muncipal Corporation, revealed how patients are unnecessarily asked to undergo H1N1 tests and charged very high sums for the same. “There are certain guidelines where symptoms for prescribing H1N1 tests are mentioned. Also, the minimum charges for these tests are about Rs 2,500. I can understand labs charging Rs 3,000 but imagine charging up to Rs 8,000. With number of patients increasing, the charges should come down but in this case, that hasn’t happened,” she lamented.

The picture is no different in rural areas where medical officers many a times go missing from primary healthcare centres and government hospitals. Dr Satish Gokulwar of Jan Arogya Abhiyan said there was need for strict action against doctors who did not do their duty and engaged instead in private practice. “The government recently increased non-practice allowance by 10 per cent however the situation has not changed. The government should terminate services of such doctors but provide a new set of doctors at the same time so that patients don’t suffer,” he said.

Conscientious doctors aren’t the only ones with stories of the rot within. Hospital staff have shocking tales but refuse to be quoted for fear of losing their jobs. A staff member from a private hospital, on condition of anonymity said, “Multi-specialty hospitals mostly earn profit in the first two days of admitting patients as a lot of tests and treatments are forced during that period. There is a 20 per cent service charge added to the final bill which cannot be questioned. Also, there is this new concept of ‘short stay’ where patients are admitted just for a day but charged almost double. What is bad is the impression given to the patient that he/she will be cured in a day’s time. Besides, hospitals always charge more than the MRP on stents, pacemakers etc.”

Former health minister of Maharashtra Suresh Shetty admitted it was difficult to deal with the sprawl of malpractices in the profession. “Today, patients do not know how much they will be charged while being admitted to private hospitals. There is a commercial approach. I was told platelets were being sold for Rs 8,000 when dengue had become rampant. Youngsters donate blood for social causes while private players make profit out of it by exploiting patients. We tried to bring in Clinical Establishments Act to control the private sector but that has not been implemented. We also need more PG doctors in the state,” he observed.

For patients, the realisation of having been cheated is frustrating but prospects of redressal of their grievances are few. Consumer forums do help patients tackle cases of cheating and medical negligence but the evidence  required to prove that the doctor or hospital is guilty is hard to come by. Consumer activist Vivek Patki says, “We receive complaints about medical negligence which we pursue in the consumer courts. But sometimes, it is difficult to prove with the help of documents that patients possess. Doctors also get time to cover up,” he says.

A clutch of individuals and organisations are working towards improving the situation. Dr Anant Phadke of Jan Arogya Abhiyan, Pune, who is fighting for Universal Health Coverage (UHC), says, “Doctors can get good fees even by providing reasonable services to patients. There is no need to exploit patients. UHC involves providing cashless quality healthcare for every person who requires it, irrespective of economic status or capacity to pay, urban/rural or geographic residency, caste, religion, social status, gender, social or personal background. It includes government and private providers in a publicly-managed single payer system.”

Kishor B. Taori, chairman, Maharashtra Medical Council, which is working to curb unethical practices in the medical field, said, “We are working towards curbing unethical stunts like cut practices. But when it comes to tests which seem essential for determining how vulnerable a patient is, doctors are left with no option. Over-investigation is a necessary evil that is ailing the private sector but we cannot cap the number of tests a doctor feels are important. BMJ has blown the issue out of proportion when the need of the hour is bridging the gap between doctors and patients. Patients are free to take second and third opinions from various doctors before deciding the best way for themselves.”

HEALTH CARE COSTS PUSHING PEOPLE INTO POVERTY, FARMERS INTO SUICIDE

• According to the government’s draft health policy 2015, over 63 million persons are faced with poverty every year due to health care costs alone. People have no financial protection for the vast majority of healthcare needs. An increasing number of households are facing catastrophic expenditures due to health costs. The numbers rose to 18 per cent of all households in 2011-12 from 15 per cent in 2004-05.

• “Annually, healthcare expenditure pushes 30 lakh people in Maharashtra below the poverty line. Several reports on farmer suicides mention catastrophic healthcare expenditure as one of the main reasons behind rural indebtedness and stress leading to suicides,” says Dr Arun Gadre, gynaecologist with Pune-based non-governmental organisation SATHI