The medical fraternity has deservedly been lauded for its continuing service during the biggest human crisis of our times. Private enterprise is business, after all, and making money is a rightful endeavour which cannot be looked down upon. However, there can be no justification for what is unfair and unscrupulous either. This perhaps is an opportune moment for serious introspection and course correction. The captains of industry have always stepped in to do more than their bit when the situation demands. A new code of ethics is the need of the hour, and a professional audit of what is acceptable and what is not.
For far too long, the brazen avarice neatly structured in their bills and rates by a large proportion of private healthcare operators has gone unchecked, and unquestioned. Now, as the authorities grapple with the misery and tragedy that Covid-19 has unleashed, complaints of overcharging and undue demands by medical facilities are not only being taken seriously, but also acted upon promptly and stringently.
The limited efforts by state governments at price regulation and capping are reportedly being sidestepped by corporate hospitals.
A Online Survey by the Federation of Hospital Administrators on billing of covid patient in corporate hospitals of major cities of the country was conducted from April 2020 to April 2021 and thereafter analysis of bills from surveyed corporate hospitals in four metropolitan cities shows this.
Even prior to the pandemic, overbilling in private hospitals (Private Health Operators) has been a commonly accepted phenomenon.
In fact, the National Pharmaceutical Pricing Authority had documented the trend of profiteering by private hospitals in respect of more than 1,700% margins on drugs and consumables.
Unfortunately, not only has this trend continued into the Covid-19 pandemic in 2021, but there is also evidence to suggest that overcharging may have intensified with private hospitals (Private Health Operators) treating the pandemic as open sanction to loot patients.
In the absence of billing transparency, hospitals are just able to freely inflate charges. Some hospitals have levied charges of Rs. 10,000-15,000 per day for just PPE, without providing any breakdown of quantity or price. Even though the costs of PPE should be shared across multiple patients admitted in the same ward, patients are being billed for the same PPE individually.
A number of arbitrary charges have also appeared in bills such as RMO [Resident Medical Officer] charges, biomedical waste disposal, admission charges, medical history assessment charges, equipment use charges, universal precaution charges and even parking charges.
Federation of Hospital Administrators have also observed disturbing conduct on the part of private hospitals which have since the beginning of the pandemic, been rampantly administered a variety of experimental treatments – favipiravir, HCQ, tocilizumab, lopinavir+ ritonavir, remdesivir, etc – without taking informed consent of the patient.
Now, helplines are being set up in several states and inquiries are being ordered, the hospitals have been asked to prominently display rate lists, the laboratories and diagnostic centres are under watch, and even a cap is being put on how much can be charged.
There is much to the argument that the only way to confront the fleecing of those in distress is by drastically augmenting government facilities, but the budgetary support and vision required for such a defining change have always missed the targets by wide margins. Hence, innovative ideas such as paying medical bills to employees only if they get treated in government facilities prove to be meaningless. The private sector is here to stay, and its role is crucial. The regulatory mechanism has been a letdown, and the loopholes have been exploited at the cost of patients. Covid-19’s one big lesson has been that empathy is the biggest asset.
(Dr Naresh Purohit is Executive Member, Federation of Hospital Administrator. He is also advisor to the National Communicable Disease Control Programme. Dr. Purohit is also Advisor to six other National Health Programmes. He is visiting Professor in five Medical Universities of Southern India including Thrissur based Kerala University of Health Sciences. (The views and opinion expressed in this article are those of the author)