Stories about the mercenary approach of hospitals are appearing with greater frequency in magazines, newspapers and the Internet, and are indicative of the rapidly declining values of healthcare in India. These may be passed off as incidental but are significant enough for the medical fraternity to perk up and do some serious thinking. On the verge of releasing a new healthcare policy, the Central Government too needs to pay heed to the hidden messages in these symptomatic stories.
The fundamental change in the philosophy of healthcare delivery in India is that it is no longer a ‘service’ but a ‘business’. Expanding at 18 per cent annually, healthcare is the fastest growing ‘industry’. Given the burgeoning population and increasing levels of ill-health in India, the ‘return on investment’ (ROI) factor is safest and the highest for healthcare. Is it any wonder then that hospitals and health are preferred destinations for business houses, multi-national pharmaceuticals, medical-implant manufacturers and construction industry? While private corporate hospitals are mushrooming in metro cities, doctors are being pressurised by the management to lavishly investigate, order scans and recommend what may be called preventive surgery. The doctor-patient relationship, traditionally one of trust, has been redefined into a salesman-customer equation, devoid of any human values or ethics. Hospitals have become shopping malls where health can be bought at a price which only the rich or the insured can afford. Profit-making remains the primary motive for the many corporate hospitals. The public, press and political machinery remain silent spectators to this tectonic shift, the detrimental effects of which are beginning to show.
That the government is also being influenced by the money power of private healthcare lobby is evident from the pages of the National Health Policy Draft 2015. Page 36, para 4.3.11.3, line 13 reads, “given that the private sector operates from the logic of the market and that they contribute to the economy through their contribution to the growth rate and by the national earnings from medical tourism, there need not be any major effort to persuade them to care for the poor, as long as their requirements and perceptions do not influence public policy towards universal healthcare”. If translated to policy, this could sound the death knell for caring for the poor in the expanding footprint of private healthcare and the shrinking space of public health.
The evolution of private healthcare over the last 30 years in India is a good case study of how the public mind can be systematically brainwashed into accepting health at a high premium. Deluxe suites in some hospitals can rival the ambience of five-star hotels. A night in the ICU can cost up to `50,000. Packaged with tourism, India has become a favourite healthcare destination for overseas clients. The poor Indian patient stands on the sidewalk watching the ambulances zoom past, all lights flashing.
There are various sections of the business world that have laid claim to healthcare—the mighty pharmaceutical industry whose reach extends into the corridors of power are able to effect policy change and block local competition in their favour. The media has also played a part in the escalation of healthcare costs by hyping up the blessings of technology. Last year, a leading weekly magazine brought out an edition which prophesied that applications, software and gadgets would define healthcare excellence in future.
The trajectory of healthcare in this country is, I am afraid, skewed in favour of the rich and insured, promoted by businessmen, silently supported by the government and endorsed by the media. Beneath the galaxy of star hospitals lies a world of unseen misery parasitised by the modern system of healthcare. The National Health Policy Draft proposes to purchase care from select private hospitals enlarging the scope of their business. Lowly hospitals in the Indian backyard where physicians and surgeons work beyond the call of duty and attend to the needs of the poor, find no mention in any of the magazines of our country. Good clinical practice—personalised and cost effective—is becoming extinct in the glamour and glitter of corporate private care. Healthcare in India needs to be simplified, not glorified. It has to be service, not business. It has to be also for charity, not for-profit alone.
The darker side of India’s health status can been seen in the pitiable status of health in Bihar with an infant mortality rate at 55/1,000, the highest in India. Amidst the abundance of private corporate hospitals lies the sad reality of children losing their lives because of inadequate and improper treatment of simple diarrhoea. With the editorial ending in “…India can ill-afford to continue with its indifferent attitude to healthcare in rural areas,” can we still afford to say “... there need not be any major effort to persuade them (private healthcare) to care for the poor?”
The author is the director of CMC Vellore