The Hospital Loot - A doctors perspective

Lots of posts have been on putting the entire medical system in negative light in current context of Covid 19 pandemic. Here is a doctors perspective:

With the now established community spread of the Covid19 pandemic in India, tertiary care hospitals in the worst affected cities of Mumbai and Delhi find themselves in a situation hitherto unseen. As the number of patients affected by Covid19 increase the government has tried its best to provide more hospital beds for its citizens, pulling in 5 star hotels and railway coaches to add to the number.

However hard the government may try, it is unlikely to be able to match the quality of care at a private hospital. Politicians and even chiefs of designated government hospitals for Covid-19 treatment have been regularly getting treated in private hospitals, while beds in government hospitals lie idle. There must be something about private healthcare providers that draws nearly every patient who can afford them. Private tertiary care hospitals maintain cleanliness, hygiene, efficiency and provide world class infrastructure and care. Understandably, providing all this costs money.

Talking of costs, there has been a buzz in social, print and televised media about how private doctors and hospitals have started to demand hefty advance amounts from patients wanting to get treated for covid-19 and its related illnesses. The amounts being asked as advance range from Rs.50,000/- to upto 5 lakhs in some cases.

After evaluation by a consultant physician the patient is informed if he needs admission. And the problem starts when the physician has to provide a cost estimate. Clearly the family wants to know about the duration of treatment and what they might have to pay. The physician decides this based on illness, co- morbidities, potential investigations and probable duration of stay in hospital. The physician also has to keep in mind the odds of worsening in the clinical condition of the patient and potentially a longer stay with cost overruns. All this information also needs to be given to the family for them to take an informed decision .

As soon as a figure is quoted to the patient’s family, it is assumed that the money is being pocketed by the physician. Sadly, this is far from the truth. But the lack of trust in care givers is a big issue today. Every test and investigation that the physician or the treating team orders is looked upon with suspicion.

But lets take a moment to understand the true picture.

Since the patient is managed in isolation and strictly no visitors are allowed it is expected that no family member would visit the hospital till the patient recovers and his Covid tests turns negative. This can usually take more than a week. And this unique situation in Covid treatment necessitates advance billing.

The average expense for treatment of Covid per day in the private ward of the top corporate hospitals in Delhi is about Rs 30,000 to Rs40,000 per day. It is undoubtedly a big amount, but how much of this amount is pocketed by the treating doctor? The answer is about Rs 2000 per day - yes that is the amount your doctor gets for putting his life on the line on a daily basis. So next time you frown upon your physician for charging you a consult please be mindful.

Most private hospitals do not provide free treatment to their own doctors. They are at best offered discounts or a limited insurance coverage. No wonder nearly ever doctor in the corporate set up has to buy his own medical insurance.

What about the nurses you may ask. Well, a young nurse with 2 years of experience employed with a Corporate hospital and working in a Covid ICU gets paid about Rs.21,000/- per month. A nurse needs to undergo a 4 year BSc nursing course after school to qualify to provide life-saving ICU care and gets paid less than a driver who works for the government. To qualify to be a driver with the government, one needs to only pass class 10!

Private hospitals designated as Covid treatment centres by the government have been forced to provide more beds for Covid patients and have had to discontinue or reduce work in other specialities. Outpatient clinics have fewer footfalls, planned and routine surgeries have stopped. With restrictions on travel, incomes from medical tourism have completely dried up. Operation theatres, non-Covid hospital beds and non-Covid ICUs lie underutilised with rising maintenance costs. However, the government mandates salary to be paid to all and no retrenching of staff. With no financial package being offered they are left in the lurch. This has resulted in a sharp decline in the salary of medical staff, upto 40 % in some hospitals.

But the cost structure continues to be high. Most sensitive equipment, labs, blood bank and operation theatres require optimal temperature for functioning, which in turn requires hospitals to run air conditioning units with engineering back up round the clock. Electricity and water bills, being charged at commercial rates run into crores. To put matters into perspective the chief Engineer of a large corporate hospital informs us that the electricity bill of a 10 bedded ICU runs up to nearly 2.4 lakhs a month. As per international standards for Covid care, ICU patients require 1 nurse for every patient on ventilator and 1 nurse between 2 non-ventilator patients. Assuming 4 ventilator patients and 6 non ventilator patients in this ICU, a total of 7 nurses would be needed in each shift. This is alongside 2doctors and 2 ward boys. A total of 11 PPE kits would be required for each shift of 6 hours. This would translate to a requirement of 44 PPE kits each day. Assuming the hospital procures average quality kits costing Rs.1,200/- per PPE kit, the cost of PPE kits alone for the ICU staff would be Rs.52,800/- per day. There after each staff member is expected to shower before retiring for the day to minimize the chances of carrying infection. The entire staff goes into mandatory quarantine for 7- 15 days after completing a 15 day period of Covid duties. The hospital has to arrange boarding and lodging at a hotel or guest house for the staff under isolation at the hospitals cost.

Despite this , private hospitals have not changed their pricing structure to tackle the Covid crisis. The nature of disease mandates strict infection control protocols and regular sanitisation of hospital areas. However, the charges for hospital beds, ICU, medications, ventilator and doctor visits remain the same. The only additional charge to patients is for the PPE kits , this seems reasonable.

To help reduce costs, the government would do well to reduce GST on ventilators, sanitisers and PPE kits. Currently, the GST rate on masks is 5 %; on ventilator, testing kits, and PPE it is 12 % ; on sanitiser, it is 18%.

Quite a few patients are initially stable enough to be treated in a ward but may deteriorate a few days later needing ICU care - such is the nature of the disease. Patients may come with an expectation to return home within a week of treatment and budget a treatment cost accordingly, only to see the cost escalate out of control as soon as the condition worsens necessitating ICU care, and a further rise in cost if ventilator support is needed. Since Covid patients are treated in isolation wards, family members do not visit the hospital and all updates regarding the patients progress are provided over the phone. The financial burden on the family along with the heightened uncertainty creates emotional stress.

Hospitals do not find it easy to ask for payments on a daily basis from a patient’s family members who are already reeling under emotional turmoil. To make matters worse, god forbid, incase the patient’s condition deteriorates or the patient becomes unresponsive to treatment, many families stop making further payments. But the care never stops. Doctors, nurses and support staff in the hospital never reduce the intensity of their efforts for want of funds and are seldom found lacking in their sincerity and dedication towards patients. And yet, contempt for corporate hospitals and doctors rises unabated and the illusion of the cruel hospital loot continues.

Isn’t this a sad state of affairs? more