CHENNAI: When 42-year-old Rajesh* came down with cold and fever in July, he blamed it on the cold drink that he had recently consumed. But, his condition deteriorated rapidly. He started experiencing breathing difficulties.
As Rajesh had a history of diabetes and kidney ailments, his family decided not to take a chance with home care.
“We were not sure about the quality of care provided at government hospitals, so we went to a private facility,” says his wife Sumitra.
Rajesh tested positive for Covid, and was admitted in the ICU. The family had to shell out Rs 4 lakh at the very beginning, of which just Rs 2 lakh was covered by insurance.
In a matter of five days, Rajesh looked better. His health was improving. The family was relieved. But, the relief did not last long.
After the initial progress, his health started to deteriorate. Rajesh was put on a ventilator. Meanwhile on the side, the financial pressure started to grow, like a towering dark shadow.
“I was asked to pay another Rs 10 lakh,” says Sumitra. Rajesh’s business had been hit badly due to the lockdown, and the family had very few means to source that much money.
“Sumitra pledged her jewels. It still was not enough,” says her brother-in-law Suresh. The bill had crossed Rs 16 lakh.
“As we did not have that kind of money, Sumitra had no options but to sell her house,” adds Suresh.
Meanwhile, they also approached a family friend for help, who pointed out that the hospital was overcharging, way beyond the government-stipulated norms.
The family then began negotiating with the hospital management. Even as they were requesting for the cost to be reduced, the hospital management kept increasing the bill with every passing day.
The family friend then intervened, and threatened to initiate official action against the hospital for overcharging.
Simultaneously, the medical team treating Rajesh kept lowering his chances of survival, from 50 per cent to just 20 per cent.
“We had paid Rs 8 lakh until that point, of which Rs 6 lakh came from our pocket and the balance from insurance,” says Sumitra.
It was at this juncture that the hospital told the family that Rajesh had suffered multiple-organ failure. They had to initiate dialysis.
The next day, Rajesh passed away.
The hospital, threatened with official action, did not collect the balance money that they had charged.
But the damage was already done. Sumitra and her two children – daughter studying in college and son in Class 10 – live in a rented house now, wondering how they will financially support themselves after losing their sole breadwinner.
The single mother’s hopes are pinned on the money she got from selling the house, to educate her children and help them settle down. At least a dozen families Express spoke to, had similar tales to tell.
They had lost their loved ones after spending lakhs of rupees from their lifetime savings at private hospitals, trying to save them.
World over, the impact of the Covid pandemic has been higher on countries that have ignored to strengthen and develop their public healthcare systems.
The cost of treatment has also been drastically high.
In India, Tamil Nadu is among the few States that have a robust public healthcare system.
The government here also fixed a price chart for the private healthcare units to follow. Yet, stories of the poor and the middle-class approaching private hospitals being fleeced, are galore.
Fixed rates, but conditions apply
As per the government mandate, top private hospitals (in grades A1 and A2) can charge non-critical patients Rs 7,500 per day and critical patients up to a maximum of Rs 15,000 a day.
Several patients and their family members, however, tell Express that in reality, they are charged anywhere between Rs 50,000 and Rs 70,000 per day.
Many of those who could not afford the incremental costs anymore, shifted out and went home, or to government facilities.
The private hospitals justify their sky-high rates citing the challenges that they have to face, including an alleged shortage of manpower. “Earlier, we used to pay Rs 15,000-Rs 18,000 for a staff nurse. Now, we have to pay Rs 30,000,” claims doctor TN Ravisankar, founder of a private hospital in Chennai.
“Doctors are paid up to Rs 1 lakh. We cannot blame them as they are risking their lives, treating Covid patients. If we do not pay them that kind of salary, how will they come to work?”
So, are nurses being paid better now? Global Nurses’ Association of Tamil Nadu secretary Raja, who is also a member of Basic Pay Committee, claims the payouts have increased for nurses attending to Covid patients.
“Prior to 2017, an entry-level nurse was being paid Rs 8,000 as monthly salary. This was revised to Rs 11,000 after we organised a strike. This was the pay nurses got even in big, established hospitals in the city. Now, they have hiked the salary to Rs 30,000 apart from free food and accommodation.”
Thanks to Covid, the wages of sanitary workers and ward boys have also doubled, from Rs 7,500 to Rs 15,000 in city hospitals.
“The increase is considering the ‘risk factor’. But, we are still concerned as we have no insurance cover. Only a few hospitals are offering insurance for their sanitary workers,” says one such staff member of a private hospital. The increased payouts have shot up overall operating cost for private hospitals.
The cost of drugs required to treat Covid is also high, claim managements.
“The cost of Remdisivir is around Rs 5,000 while Tocilizumab costs Rs 30,000 for a vial,” says Dr CN Raja, President of Tamil Nadu branch of the Indian Medical Association.
“Medium and small private hospitals cannot survive if they function under the rates fixed by the government. We have been requesting authorities to revise the treatment costs. We are even ready to surrender the hospitals to the government and let them run it with their manpower and infrastructure. Let them pay us the rent alone,” adds Raja.
“We have overheads to pay – for instance the maintenance costs, which can be substantial. Ventilators need regular maintenance. But cost factor aside, service providers are not willing to come to the hospital and fix the ventilators, as they are scared of contracting the virus.”
The ‘pricey’ doctors
There obviously, is another side to this story. Even government officials are astounded by the new ways through which patients are being fleeced at some hospitals.
“There is no problem if a hospital charges reasonably and then explains to the patient what the expenses were,” says a senior official in the Directorate of Medical Services.
“But in the case of many hospitals, a hefty amount goes towards doctor consultation itself. At least 50 per cent of doctors in any hospital are regular staffs, who are paid nothing but monthly salary. Hospitals get consultants only if they have to treat comorbidities such as diabetes or kidney ailments.”
The official goes on to say, “One hospital recently charged a patient Rs 45,000 for just the consultation. This is apart from the charges levied for consultants who were called for advice. Another hospital was found charging Rs 3,000 for phone consultation, that too for a non-Covid patient. They cannot do that. It may be different if the hospital was providing special amenities. But consultation fees cannot be this high.”
Anant Jain’s* family believes it’s this ‘corporate greed’ that took the sexagenarian’s life while leaving them poorer by several lakhs.
“My 61-year-old uncle Anant used to run a small business in Sowcarpet,” says Devesh.*
“He was admitted to a private hospital in the city on May 30 for a bypass surgery. He was tested for the virus upon admission and the results came negative. But, they could not perform the surgery as he had high fever. Finally, we discharged him on June 4 as the bill was shooting up and the surgery was not happening. On the day of discharge, too, another test was taken. Again, the results turned out to be negative.”
“The very next day my uncle suffered a cardiac arrest. We admitted him again and the surgery was successfully performed on June 6. We were relieved that he was recovering and would be discharged soon, when the hospital told us that his kidneys were failing. They shifted him to the ICU and put him on the ventilator. By June 26, we had already spent Rs 12 lakh. We decided to take him home, when, on June 27, the hospital said he had tested positive for Covid. This came as a big shock for us. Did he get it from the hospital?”
The hospital kept him on the ventilator till July 4, and then declared him dead.
“They wanted us to pay another Rs 8.72 lakh to claim the body. We refused. Finally, the hospital took Rs 1.5 lakh in cash and Rs 5 lakh through medical insurance and released the body. My aunt is a cancer patient. With uncle gone and most of their money spent on his hospital bills, her situation now is sad.”
Investment returns, the root cause of higher costs?
The Planning Commission of India, in a report titled “Healthcare in India - Vision 2020, Issues and Prospects”, authored by R Srinivasan, states: “There is the compulsion of returns on investment whenever expensive equipment in installed as part of practice. Increasingly, this has shifted the balance from individual practice to institutionalised practice, in hospitals, polyclinics, etc. This conjunction explodes into unbearable cost escalation when backed by a third party payer system. This in turn, induces increases in insurance premiums making such cover beyond the capacity to pay. There is a distinct possibility of such cycles of cost escalation periodically occurring in the future, promoted further by global transfer of knowledge and software, telemedicine, etc., especially after the advent of predictive medicine and gene manipulation.”
(* names changed)
With inputs from Sinduja Jane and C Shivakumar