Recently, a gynaecologist in Rajasthan committed suicide. She was charged with murder after the unfortunate demise of her patient due to a postpartum haemorrhage. Led by a local leader, the relatives of the unfortunate woman created a stir, and the police charged the doctor with murder. As tragic as this event is to everyone concerned, it is also an indicator of how rotten our medical system has become.
The trust between doctors and patients has broken down irreparably. Being a doctor has become a thankless profession. It is also true that many doctors prefer to satiate their greed for money than gratitude from their patients. India has one of the lowest doctor-patient ratios in the world. We don’t even have the exact count of doctors practising in India.
It is estimated that around 20 percent of doctors on the Indian medical registry site have either died, retired, stopped the practice, or migrated. We have approximately 13.01 lakh allopathic doctors registered in the medical directory. So the missing doctors are around 2.6 lakhs. That makes the doctor-patient ratio of 0.74 for 1,000 people against the WHO recommendation of 1:1,000. Most of these doctors are concentrated in urban areas, making rural India a fruitful hunting ground for quacks.
The corporatisation of the medical profession is the greatest tragedy that occurred to Indians. The coronavirus pandemic laid bare the fangs of this monster for all to see. The private hospitals made a killing, literally and figuratively, during the pandemic, while the government hospitals gasped for breath. Most Indians are one medical crisis away from abject poverty, and the pandemic medical bills of both who survived or were dead stripped many of their life savings.
Every PPE kit, every injection syringe and pills were used as a means to suck out money. It wasn’t that such exploitation was happening for the first time. Anyone who had the misfortune of being a patient or a patient’s relative would have experienced such heartless avarice from private hospitals at least once in a lifetime. The pandemic presented an opportunity for a windfall for private hospitals. It was a bumper crop season, where they made money irrespective of whether the patients survived or died.
Many doctors have now become no better than salesmen struggling to meet their monthly and quarterly revenue generation targets for the corporates who employ them. Every possible test is forced upon the hapless patients, whether they require it or not. Though rules and laws exist, and our country has no dearth of well-meaning laws, most hospitals do not exhibit their rates for different tests and consumables.
This is in a country where even a roadside dhaba has to display its price list or have its licence revoked. The hospitality industry would give an arm and an eye for the premium the hospitals can charge for the sort of substandard rooms and beds they provide and get away with it.
One can always argue that it is only those who can afford would go to such hospitals. However, it is missing the woods for the trees. Hospitals are not a place of recreation for even the rich to go and spend their leisure time. It is a compulsion forced by destiny. The five-star hospitals that have mushroomed in many cities suck the best doctors out of the system by offering them huge salaries. In turn, they have to earn profits for their employers by finding ways and means to generate revenue from each patient.
This drives the health premiums for those who can afford health insurance. For the vast majority, who cannot even dream of insurance, the only refuge is the government hospitals. It would require loads of idealism for the harried government doctors, striving under the duress of overwork, fighting the system, dealing with the shortages and medicines to keep going without a nervous breakdown. Sooner or later, the lucrative private practice will tempt many of them. This vicious cycle is growing into a cyclone of social crisis.
We have rules and regulations and inspector raj for every aspect of our lives, but private hospitals are left scot-free to exploit patients. It is high time hospital rates were standardised. Like how hotels are classified, hospitals could be classified into two or three categories. The room rates, consumable rates, procedure rates and medicine rates need to be standardised for each category across the country. Health can remain a state subject, but a Central law is required for this classification and standardisation.
The doctors and hospitals need to justify each medical test done on the patients. Clinical audit statutory bodies should be formed to conduct random audits to see whether the hospitals are misusing these tests as a tool for profiteering. A central medical board with a district-level regulatory body is the need of the day.
Anand Neelakantan
mail@asura.co.in
Author of Asura, Ajaya series, Vanara and Bahubali trilogy