Healthcare: Are you getting what you pay for?

While public hospitals in India are in tatters, overflowing with patients, crowded and claustrophobic, private hospitals on the other hand appear like international airports, replete with ‘lounges’ and soft music. While we blame the government for poor upkeep of its hospitals, do we delve deeper into the problem or care, unless a catastrophic casualty strikes our own and burns deep holes in the pocket? 

A few months ago, while I was in a high-class corporate hospital of Delhi, I saw a group of migrant labours weeping near the emergency ward. A 23-year-old construction labourer had fallen off the first floor while making a kothi, and was admitted to the nearest hospital with many broken bones and heavy internal bleeding. The contractor had deposited nearly Rs 1 lakh and disappeared. shunning the responsibility of care. The hospital asked for a deposit before they even touched the patient. Government hospitals were running full. The ‘Government Ward’ in the hospital had close to forty beds. Some were empty. I believed the treatment there would be free. The nurse quipped, “Madam, only the bed cost is waived off. The bed is free. But the diagnostics, medicines, surgeries, doctors’ fees, all of it has to be paid for”. What purpose does a “Government Ward”, in a plush private hospital serve?

When an 80-year-old lady from Mumbai got admitted to yet another plush corporate hospital’s ICU with a life-threatening pneumonic infection, her bill ran up to nearly Rs 1.5 lakh in a week. She had health insurance coverage of Rs.2 lakh that her family thought she is eligible to withdraw. As she was being wheeled inside the ICU, her son was trying to get a pre-approval from the insurance agency on the expenditure it would cover. While the ICU costs of the hospital exceeded Rs 10,000 per day, the agency would approve not more than Rs 6,000 a day. Every little thing was billed exorbitantly in the ICU including wet wipe tissues, costing Rs 400 per day. The insurance agency said they would not approve over Rs.75,000. The remainder costs had to be borne by the family. The fine-print of rules and reading between the lines, when it comes to health insurance, can leave the even the most literate in a lurch. And all this while you pay a large premium every month or year. And while a patient doles out lakhs to ensure survival, the per capita public health spending is just a few hundred rupees. According to a Brookings India report, Bihar spends around Rs 348.45 per person on health expenditure. The highest per capita expediture is by Himachal Pradesh at Rs 1,830. And by the way, only 15 per cent of Indians have any insurance cover at all according to National Sample Survey Organization data. 

Depending on the test that you want to get done, costs vary and run into thousands in any private pathology lab today. Which private pathology laboratory can be depended upon, when a patient does not know, who is testing the sample? Is the machine calibrated well to provide appropriate accurate results? How can we take the lab results to be the gospel truth? Those unlucky to get struck by diseases of the kidney, heart, liver or lungs, where the organ drastically fails and requires a transplant are in for some serious trouble. Private hospitals charge close to Rs 30 lakh or more in a ‘package’ for giving you a new lease of life. This defies all logic, where a transplant at the All India Institute of Medical Sciences can be done at close to a lakh. But then again, long waitlists and volumes ensure that a patient may either shell out thirty times the amount or never see the light of another day.

(The author is a health correspondent with dna and tweets at @dawalelo)