Until a few months back, friends and family members would often describe Narendra Ram, 35, a resident of Durgapuri in Barabanki district of Uttar Pradesh, as the ‘most happy-go-lucky guy’ they knew. “He was so jovial and won’t show any distress even about things that everyone else will worry about. But, then destiny took a cruel turn suddenly,” said Narendra’s sister-in-law Jamvanti Devi. “Now he barely even smiles.”
On July 4, his wife Soni Rani fell from the roof while trying to save their one year-old child who had got dangerously close to the edge, and immediately slipped into coma. She was taken to the 20-bedded Aastha Hospital in Barabanki, where she spent 20 days in the intensive care unit (ICU) before being declared dead on July 24.“The doctors kept saying that she had severe internal bleeding in brain but discouraged us from shifting her to a hospital in Lucknow, saying it could be fatal,” recalls Narendra, who works as an auto-repair mechanic and earns Rs 7,000-8,000 per month.
If the shock of his wife’s death was not enough, he got another one just as the bad news was broken to him. “I was handed over a bill of Rs 2.7 lakh for those 20 days she spent in the ICU. They refused to hand over the body until all dues were cleared,” he says. Narendra scrambled to arrange for the money and was forced to sell his small farmland at a throwaway price, before he could get to cremate his wife. What he found problematic was that the hospital did not provide the detailed breakup of the bill. “In addition, I was always forced to buy medicines and other consumables from the pharmacy within the hospital,” says Narendra.
“I then suspected that maybe my wife was already brain dead when she was taken to the hospital. But the hospital exploited us by keeping our hopes alive and made good money in the process,” Narendra who later petitioned the district health authorities to probe the case, says, while still reeling from the shock of losing both his wife and half ‘biswa’ of land he possesse.The doubts that Narendra has are dismissed by Aastha Hospital’s director Dr Birendra Patel, who said that the hospital tried its best to save Soni. “What we charged them for was totally genuine and included doctors’ fee, medicines and other consumables for such a prolonged period,” he said.
Flip-flop on regulating healthcare sector
As this particular case was never probed by the officials, it cannot be proved whether this indeed was a case of inflated bills and medical malpractice. But a large number of patients routinely experience this malaise in India’s healthcare system.It was for this reason that when the rules were framed under a legislation to standardise and monitor hospitals in the form of Clinical Establishment Act, 2010 in 2013, a provision was included to “define range of rates of the procedures and services”. Subsequently in 2014, the Union Health and Family Welfare Ministry formed three special committees, one each for listing procedures and services, reviewing of existing rates and devising a methodology of costing.
Dr Arun Gadre, an activist-doctor from Jan Swasthya Abhiyan, Pune, who has long fought for enforcing ethics in healthcare industry in India, was tasked with coming up with a ‘rate calculator’ that could work as guiding principle for private hospitals across the country and be used to decide what cost could be charged for a particular procedure at a particular hospital.
“I was excited at the prospect as it meant of contributing something so significant that could help billions of patients and their families across the country,” says Dr Gadre.After long brainstorming and studying models in various hospitals, Dr Gadre came up with a basic framework for working out rates of various medical services in different types of clinical establishments, which he felt could further be refined through discussion among key stakeholders.
Hospitals need profit but can’t fleece
“Realising that hospitals also need to make some profit in order to be sustainable, my calculator even left room for earning a certain profit for hospitals. However the main aim was to ensure that rates are standardised and gross overcharging by hospitals is eliminated,” said Dr Gadre.What he strived to achieve was that patients and their kin know about the expected broad cost of various procedures in advance and can plan accordingly, thereby reducing the likelihood of a ‘surprise’. That, however, was not to be!
In 2016, the government changed its earlier stand and told the members of all three committees that healthcare being a state subject, the Centre should not tread into the territory of “trying to regulate private hospitals in any way”. The panels were disbanded and their recommendations thus far, chucked.A query to the Union health minister Harsh Vardhan probing this turn of events has remained unanswered, but a senior government official said that the U-turn was due to resistance by the states.“We tried to push our rules but the states said they want to adopt the CE Act as per their own requirements and we had to stop many things midway,” he added.
Dr Gadre, now 62, meanwhile, has been writing to the ministry and Niti Aayog on the need to adopt the rate calculator. His pleas and efforts, however, have proved futile.Dr V K Paul, Member, Health, Niti Aayog, while conceding that there was need to better enforce the CE Act, added that “many things are on our radar but will take time”.
The government may be in no hurry but those working on the ground realise how big the problem of overcharging during hospitalisation is, especially as millions of poor people get pushed into poverty every year due to out-of-pocket health expenditure.“Overcharging by private hospitals across the country — and mainly by corporate hospitals is something that needs to be addressed urgently but nobody seems to be willing to bell the cat,” said Y K Sandhya of NGO Sahyog, which works for patient rights in Uttar Pradesh and some other parts of India.
She points out that the government also realises the problem.
Overbilling rampant all across In late 2017, a report by India’s drug price regulator — National Pharmaceutical Pricing Authority — after dissecting bills of treatments of four patients, at four different hospitals, against whom overbilling complaints were made, had said that hospitals had made up to 1700% profits on many consumables and drugs. This included the highly publicised case of 7-year-old Aadya Singh who underwent treatment for dengue at Fortis hospital in Gurugram and died of the illness. Her family was billed nearly Rs 17 lakh.
“The problem of exploitation of patients by hospitals won’t stop until provisions of CE Act like regulating establishments is implemented by the Centre and states in the true sense,” said Sunil Nandraj, a public health researcher and a former advisor to the health ministry.In Uttar Pradesh, where the act was adopted in 2012 but is yet to be implemented, Narendra, meanwhile, has given up after putting up a brief fight against the hospital he thinks wronged him. But to him and many like others, all that Jai Paratap Singh, the health minister of the state, seems to be offering, sounds like a hollow promise.
“We are trying to fix many things wrong in the healthcare system as a result of years of misrule by the previous governments and enforcing CE Act is on our agenda,” Singh says.(The author has received support in the form of grant from Thakur Foundation, USA to write this report as part of an investigative series on CE Act, 2010)