Corruption is ingrained into private healthcare system to such an extent that the Government urgently needs to formulate strict rules to cure the malady or else it will produce many Avinash — the six-year-old dengue victim whose parents committed suicide after their only son died for want of medical attention after he was denied admission by as many as six private hospitals
The recent incident in which the parents of a seven-year-old boy, who died of dengue on September 8, jumped to their death from the terrace of the four-storey building in South Delhi where they were staying on rent after they failed to get him admitted to a hospital in time has compelled the Delhi Government to issue notices to two private hospitals.
The couple’s only son, Avinash, died of suspected dengue after allegedly being denied admission at six prominent private hospitals. Union Health Minister JP Nadda expressed anguish over the denial of admission to the child and the subsequent tragedy. He has assured action against those found guilty.
What is more appalling is the replay of the same medical negligence and apathy in form of Aman’s death just after a couple of days Avinash lost his life. Aman, a six-year-old child, succumbed to dengue when denied immediate admission in hospitals.
In another shocking case on September 22, a private hospital in Paschim Vihar in the national Capital allegedly refused to hand over the body of a PhD scholar of Centre of West Asian Studies of Jamia Millia Islamia, Prahlad Gouro who died of dengue, for seven hours until the victim’s kith and kin coughed up Rs 35,000 out of the Rs 60,000 bill for the “futile” 36-hour treatment of Prahlad in the hospital. Incidentally, these cases are just a few examples which have come to light.
The incidents have exposed the growing commercialism and disintegrating ethics in the world of healthcare. It also exposes the audacity of the reputed private hospitals and their insolence towards the Government laws. Hence a few questions need to be answered: For whom are these hospitals madeIJ What are the forms of corruption in healthcare and medicineIJ Why did the parents commit suicideIJ Who is responsible for the tragic incidentIJ
For whom are these hospitals madeIJ
The five city hospitals that refused admission to Avinash are Moolchand Hospital (lagpat Nagar), Askash Hospital (Malviya Nagar), Saket City Hospital, Max Hospital (Saket) and Irene hospital (Kalkaji). Surprisingly all these elite hospitals claim to be philanthropic in nature.
The website page of Moolchand hospital reads, “Moolchand’s legacy of philanthropic endeavours has spanned more than 80 years. Moolchand Trust was created in 1928 at lahore, present day Pakistan, and was started with an initial endowment of Rs 4 million.”
Interestingly, the hospital which takes pride in its “philanthropic endeavour” went to the High Court against the imposition of the Supreme Court order which made it mandatory for the city hospitals, getting benefit from Government, to treat 10 per cent of indoor and 25 per cent of outdoor patients belonging to BPl free of cost. The hospital claimed that it didn’t receive land on concessional rates and hence was not obliged to provide free services to poor. However, the fact is Moolchand hospital had bought approximately one acre of land at a very nominal rate in 1949. If it didn’t receive the land exactly at concessional rate, it definitely got it at an incentive rate.
The transition in the ideology of the hospital, which started on philanthropic principle, is reflected in its endeavour to excel, “In the 1990s, Suresh Talwar, Sardari lal’s son helped restructure Moolchand so that it could compete in a world of corporate healthcare.” The ambitious agenda goes against the ethics of healthcare. Charity doesn’t involve competition.
Manipulating the technical terms such as “concessional”, “discounted”, “incentivised”, “institutional land”, private hospitals try to wash their hands off their responsibility.
What are the forms of corruption in healthcare and medicineIJ
The problem of corruption in healthcare is multi-dimensional. Hence one needs to analyse corruption in public and private hospitals from different perspectives. In public hospitals, corruption is involved not only in construction of health centers/hospitals, purchase of instruments, supply of medicines and goods but also in the appointment of healthcare professionals. Another facet of the problem is the involvement of multiple parties, such as policy-makers, ministers, economists, engineers, contractors, suppliers, and doctors, which give rise to infinite covert and besmirched dealings among various stakeholders.
Often public assets and instruments in Government hospitals are deliberately damaged so as to make them unavailable to patients, with the ulterior motive referring to the services of private clinics in return for financial incentives or “commission.” Absenteeism has been another major concern in Government hospitals.
Whereas the allegations against private hospitals are of different nature, generally in private hospitals, physicians have contractual obligations to admit a fixed number of patients to allotted beds and prescribe a number of laboratory investigations, even if unnecessary, to generate revenues. Hence the patients are not only charged exorbitantly but are also made to undergo innumerous tests. Taking advantage of the ignorance and helplessness of the patients, the corporate medical sector cheats people.
In the Voice of Conscience from the Medical Professions, released at the prestigious All India Institute of Medical Sciences (AIIMS), 78 doctors practicing in Mumbai, Pune, Delhi, Kolkata, Bangalore and Chennai have explored corruption in India’s private hospitals. According to the testimonies of the physicians, the private medical sector is highly commercialised; instead of focusing on the medical practice and the treatment of patients they look forward to profits. The stories include physicians reprimanded for not persuading enough patients into surgery or other unnecessary procedures or the grasp that big pharma has on medicine dispensation.
Doctors claim that the growth of corporate hospitals is affecting all physicians, from general practitioners to specialists. According to Sanjay Gupta, a Pune-based gynecologist and former national president of the Federation of Obstetric and Gynecological Societies of India, corporate hospitals only want doctors who can help them make fortune. Gupta asserts, “As a result, doctors who practice ethically cannot last here. I know of a hospital where if a patient is charged Rs 1,50,000, the doctor gets a mere Rs 15,000. Ninety per cent of the income goes to the corporate office.”
The reports manifest that corporate culture sets goals for younger doctors and pressurises them to have high “conversion rates” from outpatient to operative departments, which means that from the beginning itself, doctors are given perverse incentives in order to progress in their careers and/or to even save their jobs.
Profit-driven private hospitals benefit from maximising the number of surgeries and procedures they conduct. Hence the private hospitals generally deny admission to the patients belonging to the weaker section. Innumerous incidents testify the apathetic attitudes of these private hospitals. Even in the most infamous incident of the Nirbhaya case, a famous hospital of the city refused admission to her. A lot of unattended accidental cases become the responsibility of the Government hospitals.
Why did the parents commit suicideIJ
It may appear that the parents could not bear the shock of the death of their child, and hence committed suicide. But if we analyse the whole episode, this is not just a case of suicide but a murder committed by the helplessness of the poor parents who were unable to deliver their duty as parents. Had the parents of Avinash been able to save their child, they wouldn’t have committed suicide. It might have occurred to the parents that if they can’t even get admission in a hospital to get their child treated from a curable seasonal disease like dengue, there is no point of living anymore.
Is this a lesson for all of us who are not well off enough to provide proper food, treatment, education, and security to our kidsIJ Should we not have kids if we are not rich enoughIJ Should it be the right of only the high and mighty to have kids as they are the only ones who can provide good education, food, shelter and treatment to themIJ
Who is responsible for this tragedyIJ
No doubt the unwritten policies that we are often obliged to follow become norms. Poverty compels the mass to avail free Government healthcare and hence the Government hospitals always remain overcrowded. Thus long queues, unhygienic environment, and congestion remain some of the prominent complaints which work as a detriment to the reputation of Government hospitals. Consequently, those who can afford private treatment generally avoid Government hospitals. Government hospitals thus are reduced to mere places where the poor and filthy gather. Unless and until the private hospitals refuse to admit critical patients due to either lack of proper medical equipment and resources or the risk involved in such cases, well-off people try to avoid Government hospitals. Thus consciously or unconsciously, we have created two separate healthcare systems — the Government for the poor and the private for the rich.
Government hospitals are thus not only bearing the burden of treating the poor, who do not have resources to care for their health, follow dietary advices, buy medicine and get necessary test done to detect the problem but are also dealing with complicated and critical cases where chances of survival are too bleak.
Hence the success ratio of private hospitals remains impressive whereas despite giving best efforts in the treatment the success ratio of Government hospitals goes down.
The lack of empathy among medical professionals as upheld in the television programme —Satyamaev Jayte — compelled the Government of Rajasthan to initiate a policy to empower Government hospitals and provide free medicine to all. This is one of the most popular schemes of the Rajasthan Government. The Government was so annoyed with the rotting healthcare system which promoted private lab and hospitals that it issued directions to all Government hospitals to send a photo copy of prescriptions to the Chief Minister for further scrutiny. The doctors of Government hospitals have been instructed to prescribe only generic medicines that are cheaper than the medicines produced by branded companies.
Corruption is ingrained into the healthcare system to such an extent that the Government needs to formulate strict rules to curb it or else many Avinash would die for want of treatment.
(Anish Gupta and Aaleya Giri teach Economics and English respectively at Delhi University. They can be reached at pioneer.article@gmail.com. Views expressed here are personal.)