Home > Musings > Regulating the private health care providers

Regulating the private health care providers

December 15, 2012

A few days ago, a watchman at the apartment that I live in Mysore approached me and consulted me on his son’s illness. He wanted me to refer him to a good physician. I immediately told him to go to a doctor that I knew in the Government-run KR Hospital at Mysore. He did not appear convinced and politely asked me if I knew of any doctor in the private sector. My explanations that a Government hospital was as good or better than many private hospitals that I knew did not seem to impress him. This may not be an isolated story. Most of us today have lost faith in the public system, whether it is a school or a hospital. We are convinced that we cannot expect ‘quality’ in the Government system and that ‘private’ always means better. Is it always true? I can specifically remember a few incidents that left me further convinced that we not only need an efficient public delivery system, but they do serve a valuable societal function in the Indian context.

Dinesh (name changed) was a young 20-year-old living with his parents, brother and sister in Mysore. Coming from a poor family meant that he had to discontinue his studies after completing PUC and start working as a server in a hotel to support his family. He was one day traveling with two of his friends on a two-wheeler and unfortunately met with an accident. Not wearing a helmet meant a severe head injury and his skull was badly fractured. He was admitted to a private hospital in Mysore and was kept there for more than two months. After getting his family to spend more than 8 lakh rupees, the hospital authorities informed them that the treatment was still incomplete and that they would need another 1.5 lakhs for the same. The poor family felt cheated, angry, let down and helpless. Not only did they not have the money, but they had also not received the complete and appropriate treatment. The family turned to everyone for help and the CM’s Relief Fund granted them Rs 30,000. The hospital was adamant that no treatment could be initiated with partial payment and insisted on receiving the full amount before starting treatment. A local NGO provided palliative care to Dinesh who was now bed ridden and kept at home itself. On his condition becoming serious, they took him to a teaching hospital locally who advised the family that his condition was serious and that he would not live more than a few weeks. Dinesh died in October this year, a victim of poverty, callous attitude of medical personnel and the indifference of a heartless private health care system that is not truly regulated and held accountable for delivering quality health care.

While this example may seem extreme, Raghu (name changed) a 32-year-old poor farmer had a different kind of experience. He had fallen from his bullock cart in his village in Mysore district and suffered a spinal injury. He was bedridden for the past 3 years and was also receiving palliative care from the same NGO. A year ago, the staff of the NGO noticed that he was developing bedsores and they took him to the Government run KR Hospital. The nursing and medical staff at the KR Hospital provided full support and took care of this patient with compassion and with no expectation of any ‘out of pocket’ fees. Having worked in the Lok Ayukta, investigating complaints of corruption and mal-administration in the Government healthcare system, I did not believe that this could be possible. I decided to dig deeper and understand what was happening. This was when I realized that the patient was in the hospital for the past 7 months and had 4 surgeries. The doctors felt that he would fully recover after one more surgery. Most of his sores had healed after the plastic surgery that was done on him. This NGO had trained his wife in making small handicraft articles and the hospital authorities did not mind her preparing them beside the bed of her husband itself. Raghu is now more confident that he can return home fully recovered from his sores and the rehabilitation therapy that he is now getting will make his life more livable. All this would not have been possible without the constant support, treatment and compassion that he and his family have been receiving from all the staff at this Government-run hospital.

These are not just isolated incidents. Many years ago, I had referred an eight year old tribal child with a treatable heart condition to a famous private hospital at Bangalore. They were claiming to offer free heart surgeries to poor and deserving children. Hopeful of getting high quality care at no cost, this child had been referred to this hospital. Sadly, they sent the child back to its tribal hamlet without any surgery and I never really learnt the reason why. All that I know is that this child died untreated a couple of months later. Last year, the field staff of SVYM had identified six tribal children who needed surgery to correct their heart anomalies. Having been bitten once, I decided that I needed to explore other equally good and cheaper options. I spoke to Dr Manjunath, the Director of Jayadeva Institute of Cardiology. He simply asked me to send these children to his center at Bangalore. Within 10 days, all these children were back after receiving the highest possible care and not a single rupee had been spent. One only needs to visit this hospital at Bangalore to be convinced that it is no different from any of the other private hospitals offering similar services. Only difference is that it is very affordable and even free for poor and deserving patients. This hospital in my view is truly a ‘heart hospital with a heart in the right place’. It is such hospitals that lend credibility to Government hospitals across the state and one must recognize the silent work that they do for the millions of poor who approach them for care.

While I am not claiming that all Government hospitals are good and live up to the required standards nor am I saying that all private hospitals are not good and heartless. I am sure that there are good government and private hospitals across the state as much as there are poorly run hospitals in both these sectors. What I am trying to point out is that we cannot carry a stereotypical impression that all Government hospitals will not be delivering quality care as much as private hospitals will be giving them. We need to also be concerned at the number of people using the public health facilities. Surveys show that in Karnataka, more than 80% of the health infrastructure is in the public sector while only 34% of patients use them. While we need to worry about this poor utilization of Govt facilities, we also need to ask ourselves how can private hospitals with a mere 20% of the total health infrastructure in the state cater to 66% of the state’s population. Government run institutions hire and appoint only qualified personnel unlike the private sector where personnel need not be appropriately qualified. There are several nursing homes that run with nursing and laboratory personnel not having the required qualifications. Merely wearing a white saree or an apron does not necessarily bestow the required qualification on a person. Very few private hospitals have a rational and well-defined pricing policy. Many of them do not provide and disclose information about the services that they are expected to render to patients. Most patients are not aware of their rights and very few of them demand to know all this. Despite notifying the Karnataka Private Medical Establishments Act in 2009, one is unable to enforce either quality or cost regulation on many of these private hospitals. The Govt which is also supposed to play the role of the regulator sees this Act as merely registering these establishments and collecting the required fees. This means many private hospitals get away with poor and unethical practices and charge exorbitant sums of money for services that need not cost so much. This severely restricts access to the middle class and the poor who have no recourse but to seek out Government facilities.

People need to understand that quality need not be directly proportional to the money we spend. As Dr Noshir Antia, the famous surgeon remarked, “Things expensive need not necessarily mean the best”. Patients have their rights and they need to be more discerning and empowered with the information that can help them make the right and appropriate choice. We need to have a Government that not only ensures that standards in the private sector are followed but also enforces them on its own hospitals. This will help build faith amongst the common people in the Government health care system. Only when the Government walks the talk can it demand accountability and performance from the poorly regulated private health sector. Only then will the interests of the patient be protected.

Balu

Categories: Musings
  1. December 15, 2012 at 5:48 pm

    Very nice article balu. Govt hospitals have long been mismanaged and have lost the brand value. History shows us that Brand value can be rebuilt, simply by delivering. Many institutes in Bangalore such as NIMHANS, Jayadeva and KID (Karnataka Institute of Diabetics) are better than any private hospital. I would trust them more than any other in those specialities. May be the best way to rebuild a brand is to refocus on “a single speciality” rather than all in one attitude with which govt bodies used to function before. Very nice article. Another approach is to stick to “protocol” based treatment rather than fully empirical or fully evidence based. Will cut down costs and negligence.

  2. December 15, 2012 at 2:33 pm

    Loss of faith in government hospitals, schools, or anything managed by the government is sad. The services remain unattended as well as under-utilised while spending big amount.

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