Health

Moment of reckoning

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Around six months ago, the deaths of two seven year olds at spiffy private hospitals in the National Capital Region (NCR) set in motion a chain of events that led to their bereaved fathers appearing before television cameras.

In many instances, families who allege medical negligence to be a key factor in the loss of a loved one grieve and fight their battle privately. But not so for Jayant Singh, the father of Adya, who succumbed to dengue. Mr. Singh demanded an inquiry into why Fortis Memorial Research Institute (FMRI), Gurugram, had charged him a bill of ₹18 lakh for his daughter’s 14-day treatment. This included the cost of 2,700 surgical gloves and 660 syringes. Around the same time, in a different part of the NCR, Shaurya, Gopendra Singh Tomar’s son, didn’t survive dengue while admitted in Medanta Medicity, another private hospital. The cost of his treatment came to ₹16 lakh, with profit margins ranging between 200% and 1,700% on drugs and consumables.

Taxing the patient

The two fathers joined forces to take on private hospitals, which are among the country’s least transparent and poorly-regulated sectors. They found an unlikely champion in Bhupendra Singh, an Indian Administrative Service officer, who took the unprecedented step of releasing evidence of profiteering by private hospitals — up to 2,000% in some cases. Mr. Singh, the officer, was transferred late night on February 28, with sources in the National Pharmaceutical Pricing Authority (NPPA) telling The Hindu that he was expecting it following mounting pressure from the private hospital lobby.

The NPPA investigation into profiteering was one of a kind as it made data related to profit margins, a closely-guarded secret by private hospitals, public. It gave proof for something that has been well known — that price gouging is the single most defining feature of patient experience in the country and an issue for the government to step in.

In the early 1980s, Indira Gandhi’s government was the first to allow banks to fund private hospitals in the country due to a growing demand for health-care services that government hospitals could not meet. The Apollo group was the first to pioneer the concept of corporate health-care in India by starting a private hospital in Chennai. It commenced its operations in 1984.

In all these years, the sector has avoided third party regulation by promising ‘self-regulation’. In fact, a month after Adya Singh’s death, Fortis’ Chief Executive Officer Bhavdeep Singh came out advocating self-regulation to end malpractice and medical negligence within private hospitals.

The only law that can (nominally) regulate the private sector is the Clinical Establishments (Registration and Regulation) Act, 2010, which aims to provide for a minimum standard of registration and regulation of clinical establishments across India. Only 10 States (Sikkim, Mizoram, Arunachal Pradesh, Himachal Pradesh, Bihar, Uttar Pradesh, Uttarakhand, Assam, Jharkhand and Rajasthan) and all Union Territories except Delhi have ratified it. However, even where the Act itself is ratified, the rules are not, thus making implementation of the Act impossible.

Multi-crore industry

Meanwhile, outside of government oversight, the private health sector has grown to become a $110 billion (approximately ₹71,500 crore) industry in four decades. According to a report by the High level Expert Group (HLEG), in 2012, India’s private sector accounts for 82% of all outpatient visits and 52% of hospitalisations. As of now, neither the States nor the Centre has any real power over these clinical establishments. With each year throwing up more cases of medical negligence and price gouging by private hospitals, patients and families are beginning to band together.

The fathers of the two children have one simple demand: that private hospitals, like every other sector, need to start justifying the cost of drugs, devices and procedures. What was the medical, ethical or economic justification for using 660 syringes — nearly 60 injections a day — on the girl?

Three decades ago, patient-led activism was what was instrumental in making medicines affordable for HIV treatment. With families banding together to demand their right to health, governments now can no longer ignore the growing demand for transparency in drug pricing, and the cost of health care and insurance in India.

vidya.krishnan@thehindu.co.in

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Printable version | Jan 23, 2020 1:58:43 PM | https://www.thehindu.com/sci-tech/health/moment-of-reckoning/article22920779.ece

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