I had the opportunity to interact with Dr PC Reddy [PC] when he promoted the concept of the corporate hospital in the early 1980s with the Apollo Hospitals Enterprise. There was the promise of offering world class medicare at a fraction of the cost in the developed countries.
Apollo and dozens other corporate hospitals that followed his lead had substantially fulfilled this promise. The nation should be thankful to the pioneer and the others who emulated him.
In the following four decades, medicare has made handsome improvements. Today quality tertiary care is available in several large cities and even in tier-2 cities. Heart operations, total knee replacements and dozens of other intricate surgeries are performed daily by the dozen in hundreds of hospitals.
Unfortunately, however, costs have shot-up in tandem. With the huge spurt in exchange rates of the US dollar and other currencies, costs of such surgeries in India still continue to be a fraction of that in developed countries. Most of the sophisticated diagnostic machines and tools, stents and implants and hundreds of quality consumables are continued to be imported at high cost.
With technology becoming obsolete in quick time, there is a desire and need to get the equipment updated frequently.
Corporate hospitals enjoy custom from the richer sections of the population; the quick spread of corporate clientele and insurance has resulted in a much higher level of affordability. This comfort has led to frequent upgradation of facilities and introduction of more and more sophisticated diagnostic tools.
Such increases in capital costs demand increasing revenues. There is also the imperative to ensure fuller utilisation of the highly expensive equipment in quick time – to amortise the expenditure and to earn for the next advanced equipment.
This should explain the tendency to prescribe tests, not strictly required. Surgical Gastroenterology & Liver Transplantation specialist Dr Samiran Nundy, graphically describes this: “a ‘cut’ for the prescribing doctor is common in diagnostic laboratories. A Rs 3000 fee for Rs 10,000 scan involves an increase in cost by around 50 per cent.”
“Look at the change in a matter of just a few decades of the cost of a simple x-ray. It has shot up from Rs 10 in the 1970s to over Rs 400 today in corporate hospitals.” [IE November 2018.]
The justification for such unsavory practices from corporate hospitals and medical specialists arises from the comfort of sections of the population able to afford such high costs. This is particularly true of the emergence of a political class with limitless access to funds or having a facility to pass it on to the government.
I give a few instances:
# months’ long treatment at India and Houston meted out to Union Commerce Minister Murosoli Maran
# the long treatment at Apollo Hospitals for then chief minister J Jayalalithaa
# the prolonged hospitalisation and treatment of Kaduvetti Guru, a leader of PMK
# the chief executive of multi-national who had months treatment for cancer at Apollo
# the famous singer-composer SP Balasubrahmanyam treated by MGM Hospitals
The above cases are about wealthy individuals who could afford big ticket billing. In a fight for life even sections from middle and poor classes that could not afford are billed high and end up bankrupt.
Look at the experience in another large corporate hospital: I checked in at this hospital with a complaint of the feel of walking on a cotton mattress.
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Where are the road corner friendly physicians? Rich corporate hospitals also impact adversely the behavioral patterns of private medical practitioners. Look at this experience: This one has good credentials of having served the Services retiring with a rank. He serves as consultant to couple of corporate hospitals and conducts surgeries, runs a clinic at a 8 ft. x 8 ft. room. The articulate doctor is quite active in professional associations. Recently I consulted him for attending a common cold and cough. He listened to my problems for around 10 minutes, checked blood pressure and charged me Rs 800 for consultation. He also gave two sample medicines received as doctor’s samples and added the MRP of Rs 150 and demanded Rs 950. Quite graciously he retained the Rs 1000 I gave. I wonder, why the consultation fee should be as high as that charged by five-star corporate hospitals which have heavy overheads. Should he also charge for the sample medicines? I reckoned his family income around Rs 20 lakh/month. I also wonder the fees collected without bill could also mean sizeable tax savings. With the huge capitation fees plus the high fees charged, medical education is expensive. Suddenly I noticed a dearth of road corner physicians who would be friendly to the neighbours’ around. Corporatisation and commoditisation of medical education have contributed to unaffordable levels of costs of consultation. The mushrooming of medical colleges also sucks large numbers of medical practitioners for teaching. The tribe of neighbourhood family physicians has vanished! I remember with nostalgia the Rs 2 and the Rs 5 charged for consultation with free colour potions and tablets for cure! Or the ubiquitous corporation dispensaries that commanded good custom. The solution lies in upgrading the huge infrastructure created by the government and make them render quality medicare like the Mohalla Clinics of Delhi or the Government Corona Hospital, Guindy. – A nostalgic octogenarian |
The receptionist collected Rs 800. I was orally examined for a few minutes by a neurologist. The specialist, quickly diagnosed it as diabetic neuropathy and prescribed a couple of tests.
The next day Rs 10,750 was collected for the NCS test, that lasted 30 minutes; the report was handed minutes later.
The clinical lab for testing blood needed 3-4 days. Rs 3800 paid.
The neurologist would not see the NCS test report and advised my presenting the clinical test reports along with the Serum protein electrophoresis report and the NCS test report together.
After fixing the appointment the next week, I collected the clinical lab report and proceeded to meet the specialist at the appointed time. But the kindly doctor was not there and I was asked to check in the afternoon, three hours later.
When I protested pointing to the loss as a professional with tight schedules, the secretary lined up a meeting with a colleague of the neurologist. The kindly specialist found one of the blood reports not legible. I had to go to the lab to get a better print. The kindly doctor prescribed some medicines.
The secretaries’ team promptly presented a bill for Rs 800 towards consultancy. When I protested, they explained as per the protocol, the original fee was valid just for a week. I explained the blood reports took time and it was not my fault. I left, the hospital, leaving the reports with them.
The team of secretaries telephoned next day informing that they have graciously dropped the additional consultation fee demanded.
When I checked with another renowned specialist with rich credentials, he said that NCS test and prescription of so much medication were not necessary and a simple fortification of Vitamin B would do. I was poorer by Rs 15,350 plus costs of transportation, medicines… Still experience walking on a cloud (not 9 though).
