A little girl was admitted to a super specialty hospital in Gurgao for treatment of severe form of Dengue fever. The girl was transferred from Rockland Hospital in Dwarka to Fortis Hospital in Gurgaon. Girl passed away after 15 days in intensive care unit. Her medical bill was close to 16 lakh rupees. Girl’s father said he objected to the insensitive manner the hospital dealt with him. For example, dead body was not released till all formalities were completed including full bill payment. Parents had to wait 8 hours to get access to the body of their daughter.
The story as it emerged, set the media on fire. Of the two issues such as (a) insensitive treatment and (b) high hospital bill, media probably could not make a great story out of administrative indifference. As a result, media houses latched onto issue of high medical bill. Media highlighted how many gloves were used, how many syringes were billed, what was the cost of medicine, how much fee was paid to physician and how much to dietician etc.
Under relentless media pressure, central government and state government of Haryana has promised to look into the issue of high medical bill. Haryana government has formed a high level committee to investigate and will in most liklihood share its report with central government. There is also suggestion to create a mechanism to regulate private hospitals. West Bengal government has initiated such a mechanism by ensuring passage of a bill in state assembly.
It cannot be denied that many corporate hospitals operate for profit. More than patients, these hospitals probably own their allegiance to share holders. That is why doctors are given target to suggest expensive procedures. Doctors who meet targets are given a percentage of business accrued. This could be the reason why father of the patient was suggested plasmapheresis, even after doctors gave up hope. Still, I think media is barking on the wrong tree when it accuses hospital of inflated bill, for the following reasons:
- First, though generally self curing, in some cases in children under 10 year of age Dengue fever can take serious turn. As in the present case, the child was suffering from septic shock syndrome. To treat such a serious condition she had to be admitted in intensive care medicine, and kept there for fifteen days. Charge of a day’s stay in intensive care unit may be close to one lac rupee, depending upon seriousness of condition.
- Fortis hospital is a corporate hospital. It usually follows standard operating procedure for every action and maintains a record for the same. Because in case of a lapse, hospital may get sued and definitely it will get bad publicity.
- Even in the present case, hospital has supplied a 16 page bill with break up of professional fees and consumables. As it has emerged through discussion on TV, hospital had informed parent / guardian of patient every evening of days medical bill incurred. According to Dr. Narottam Puri, an advisor to Fortis Hospital, in all likelihood signature of patients parent / guardian was taken on medical bill of the day.
- Media houses that are complaining about use of so many gloves and syringes, will probably turn around and claim negligence if the same patient had developed an infection for not using fresh pair of gloves.
- Compared to many government run hospitals, likes of Fortis, Apollo, Medanta etc., are comparatively high end hospitals. These hospitals cater to upper middle class and rich Indians and to overseas clients. High hospital charge may be to maintain exclusivity as well as to maintain a standard of efficiency in medical, surgical and diagnostic procedures and to execute in an orderly fashion administrative processes like cleanliness, hygiene, security, cafeteria and housekeeping etc.
- Instead of asking why hospital is charging high fee for specialist physicians, which they deserve based on their expertise, one may question could the hospital have supplied generic medicine compared to branded products?
Instead of blaming Fortis Hospital, opinion makers must direct their attention towards (i) creation of better government hospital and that charge less and / or (ii) creation of a system of universal insurance card for every citizens. Such that any individual can be treated in any hospital without worrying about buying a hole in his pocket. In many developed nations, citizens are issued a health insurance card, free of cost or for a nominal charge. Such basic Medical insurance, Medicare, takes care of hospital admission cost for certain illnesses. Over and above Medicare, people are free to purchase private insurance, that cover more extensive coverage.
There are several commercial insurance policies available in the market. Most of them are beyond the reach of poor people of India. Dr. Devi Shetty of Narayana Hridyala had created a health insurance for 3.4 million farmers of Karnataka by paying Rs. 20 per month. The insurance will cover procedures for more than 800 common surgeries.