On May 14, Tushar Jindal, 40, a kidney patient, tested positive for novel coronavirus and the family made calls to Sir Ganga Ram Hospital. The private hospital allegedly asked for an advance deposit of ₹5 lakh for admission.
As the amount was too high for the family, following advice from his nephrologist, they admitted him at Max Hospital in Saket, where an advance of ₹2.5 lakh had to be paid.
“While I was admitted there, I barely received any treatment as my condition was stable. I was discharged within four days, but I was handed an exorbitant bill of ₹1.98 lakh,” claimed Mr. Jindal. He has sent a legal notice to the hospital contesting many of the items charged for and claiming that the bill issued to him was “faulty and fake and carries a lot of unnecessary and unreasonable charges”.
Mr. Jindal’s notice states that medicines and drugs which were not administered to him have been charged for in the bill and a charge of ₹71,000 for “investigation” offered no other detail.
Specifically, the notice states that being a kidney transplant patient, Mr. Jindal takes a particular brand of medicine prescribed by his nephrologist and he has been charged for a medicine he “can never take, as it belongs to another company”. He claims he consumed his nephrologist-prescribed brand but has been charged for an alternative at four units, six times a day.
Mr. Jindal was also charged ₹8,900 per day for PPE kits amounting to ₹35,600, hospital bills show. He was also charged ₹52,000 for “other charges”, which the notice terms “irrelevant and fake”.
Responding to queries, a Max Healthcare spokesperson said: “A patient’s attendants are counselled about the estimated cost of treatment at the time of admission itself, and they are required to sign an informed consent form for all treatment and procedures. Bill updates are also shared on a day-to-day basis on registered mobile numbers of attendants for any immediate concerns. The attendants of the patient were explained the overall consumption of PPEs during a 24-hour cycle, which is approximately nine PPEs per day per person in the COVID ICU, and the costs charged to the patient are in line with the costs incurred by the hospital in sourcing the PPEs.”
D.S. Rana, chairman of Sir Ganga Ram Hospital, said the upfront payment is to tide over issues such as the family of a COVID-19 patient not being allowed to come to the hospital due to fear of infection. “How will they make payments? We ask for ₹5 lakh as advance from COVID-19 patients and refund the money if the bill is less than that,” he said.
Dr. Rana said the hospital follows a similar process for non-COVID-19 treatment too.
“There is nothing to hide. Our expenses have gone up since the virus outbreak. Our hospital is just meeting expenses, not making any profit. The government can audit our accounts if they want,” he said.
Cases one too many
Tushar Jindal’s is not a stray case as the pandemic grips the Capital with increasing ferocity. The Hindu interviewed six persons who said that they were either asked to pay an advance deposit ranging from ₹2 lakh to ₹6.5 lakh or charged “exorbitant” rates for COVID-19 treatment by private hospitals in the city.
Vineet Wadhwa’s harrowing experience in finding treatment for his 58-year-old uncle led him to file a PIL in the Delhi High Court calling for the capping of rates at private hospitals, among other interventions.
Mr. Wadhwa said after his uncle was found positive on June 8, they tried admitting him at Akash Healthcare in Dwarka but were deterred by the charges. Patients were being charged around ₹40,000 per day or encouraged to take up a “10-day package”.
These ranged from “economy” costing ₹3 lakh, “sharing” costing ₹3.5 lakh to a “deluxe” package of ₹4 lakh, he said.
“In case of the package, even if a patient is discharged within three to four days, the full amount is charged,” claimed Mr. Wadhwa, adding that these details were communicated orally and the hospital refused to share any rate sheet.
The hospital authorities did not respond to calls regarding the same.
Ashutosh Kumar, 46, a yoga teacher from South Extension, said he fell ill during the last week of May and was later tested positive for COVID-19.
“My brother first called up Max Saket and they asked for a ₹5 lakh deposit. Then he called Ganga Ram and was asked for ₹6.5 lakh as advance. We could not afford it. Then we found a hospital which took only ₹1.5 lakh as advance,” he said over phone from the hospital.
Issuing a clarification to the media on Saturday, Max Healthcare senior director and CFO Yogesh Sareen denied accusations of profiteering: “Our COVID-only facility in Saket, which was fully occupied for the month of May 2020, incurred huge losses. This, when we had cut salaries of our senior clinicians and management by 20%-50%.”
The family of a COVID-19 patient who went to a private hospital for treatment said they were asked to deposit ₹2 lakh on the day of admission.
Government inaction
Highlighting the issue, Chief Minister Arvind Kejriwal said in a press conference on June 6, “A few days back, a person came to me and said that he was denied a bed by a private hospital, and after many requests they asked him ₹2 lakh for admission. I didn’t believe it... then on a live TV programme aired a few days ago, an anchor called up a hospital saying that he needs a bed for a corona-positive patient in his family. First he was denied the bed, and then on live TV told to pay ₹8 lakh for admission.”
Mr. Kejriwal said that the government would not allow ‘black marketing’ of beds in private hospitals. But a week later, there are no details in the public domain of action taken against any hospital for such incidents by the government.
According to experts, the non-regulation of charges for different procedures at private hospitals and people opting for these hospitals even when beds are available in government hospitals is adding to the problem.
The Delhi government is yet to announce any capping of rates in private hospitals. At two separate media briefings in the past week, Health Minister Satyendar Jain said that the government had asked for rates from private hospitals and is “looking into it”.
According to the Clinical Establishments (Central Government) Rules, 2012, charges at private hospitals should be within a “range of rates” fixed by the government.
“The clinical establishments shall charge the rates for each type of procedures and services within the range of rates determined and issued by the Central Government from time to time, in consultation with the State Governments,” reads one of the conditions for registration and continuation of such establishments.
But the rules are not applicable to Delhi, as the 2010 Act based on which the rules were formed has not been adopted by the Delhi government.
Fixing not practical?
“According to rules in Delhi, the rates are not fixed but hospitals have to display them so that people can choose according to their ability. The clinical establishments Act and the rules are not practical. Has the Central government or the States which have adopted it been able to fix rates?” said a Delhi government official.
States including Bihar, Assam, Uttar Pradesh and all Union Territories except Delhi have adopted the Act, according to the Central government.
In May 2018, the Delhi government came out with a draft policy to regulate private hospitals and to cap profits. Health Minister Satyendar Jain had said that it was to control “exploitative profit” made by private hospitals and nursing homes through “overcharging patients for medicines, investigations and other medical procedures”.
The draft policy recommended a number of measures, including a 50% profit cap over procurement of medicines and other consumables. But the policy is yet to become a law.
When contacted, the Delhi government spokesperson did not offer a comment.
“They are not supposed to take such huge amounts as advance. And private sector hospitals charging high rates is happening not just in Delhi but also in Chennai and Mumbai,” said Sakthivel Selvaraj, who works as a director at Public Health Foundation of India, Delhi.
“None of the States, including Delhi, apart from one or two have implemented the clinical establishments Act,” he said. “Without regulation or display of charges, it becomes a fish market.” Dr. Selvaraj said the Delhi government should follow Mumbai’s example and take over private hospital beds and also cap rates for different services such as ICU, ventilator and rooms.
But Narendra Saini, former secretary general of the Indian Medical Association, said capping of prices is not as easy as it sounds. “You cannot have the same charge for the same service in a hospital such as AIIMS, a big private hospital and a 50-bed private hospital. The cost inputs, including the payment to specialists, cost of land, machinery are different. The government should set up an independent committee or agency to study the cost in primary, secondary and tertiary government healthcare institutions; then factor in land, machinery, and capital costs; and then come out with three sets of rates for three types of private hospitals for the same services or procedures,” he said.
Improving public hospitals
“But the question is, why do people do not want to go to government hospitals? Beds are free in government hospitals and people are still rushing to private hospitals. The government should make its hospitals better,” said Mr. Saini.
Delhi Medical Association president Girish Tyagi also highlighted the issue. “Government hospitals should improve infrastructure, housekeeping, manpower, and staff should be empathetic towards patients. It is because of these deficiencies that people are going to the private sector,” he said.
“In most of the OECD countries — apart from the U.S. and a few others — rates of different procedures and services offered by private hospitals are fixed by the government. Health care is not like any other commodity,” said Dr. Selvaraj.
Dr. Tyagi said the Delhi government should audit charges in both government and private hospitals and cap the prices for COVID-19 treatment.
“People should not be harassed. But private hospitals should also be taken into consideration as their expenses have also increased due to the virus outbreak,” he said.
Meeting on prices
Lieutenant-Governor Anil Baijal and Chief Minister Arvind Kejriwal will hold a meeting of the Delhi Disaster Management Authority tomorrow to discuss fixing a price ceiling for treatment of COVID-19 at private hospitals. The meeting will also discuss charges levied by private ambulance services; and reducing the price charged for COVID-19 testing by private, drive-thru labs. For Delhiites, it has come not a day too soon.
