The exemption for Rs 5,000 spent on preventive healthcare announced by Pranab Mukherjee brought a glow to Preetha Reddy, Managing Director of Apollo Hospital when she was on Times Now. At least, she said, he wants “India to be healthier”.
Chances are it would make the private health sector, said to account for a large share of Indian economy, healthier. That is, the curers would be healthier, for such preventive visits to hospitals would ensure that. There would be bills to pay at the till.
Since it is going to be tax exempt, the spender would not feel the pinch, though, he may well end up spending more and more on needless tests. That needlessness has been one single reason why patients end up paying fat bills in private, or as the bigger ones are known, corporate hospitals. The poor guy who doesn’t have enough to take out as a tax-exempt medical bill, of course, end up being unhealthy, or be trapped to suffer the carelessness and apathy of government and municipal health systems.
Let us stay with the private, trust and corporate hospitals as a class for a while.
The first question asked when a patient is being admitted is, “Are you insured?”
A ‘Yes’ means the billing rates change. It also means immediate use of defensive medicine which implies a series of pathological tests, anything and everything, as if the doctor attending on you has forgotten clinical diagnosis; that the doctor is entirely dependent on the machine to tell the man what to do with the human being on the hospital bed.
I recall going to get a prescription filled at the drugstore of a Pune hospital run by a trust. The pharmacist was asking each patient’s attendant – wonder why a hospital ought to be so dependent on an attendant when a patient under its care ought to be cared for; a tailor does not ask me to sew buttons on my shirt he is stitching for me, he does it – whether ‘it is insurance or cash patient’. Insured meant a 30 percent mark-up on the pharmacy bill.
These hospitals, as Mumbai’s experience shows, are built on government land given free with a promise of a slice of beds and healthcare facilities being reserved for the poor. They deny what is promised and overcharge those who pay. And if the patient is insured, then the bills are high.
If this happens with insurance with a regulator in place, imagine what would be the case with the Rs 5,000 per tax-payer available for easy picking. You can bet your shirt, if anything is left, that is, that patients would return with hardly a balance left for him to use within the same fiscal year. The hospitals can then expect an annual flow of Rs 5,000 per tax-payer. The accountants would be happy; the balance sheets would be healthy. The insurance companies, the argument is, inordinately delay settling the bills of the cashless patients so they cover their risks by inflating the bills.
It is no secret that the poor patients are short-changed in the government hospitals. They go there in the hope, hope, mark it, not expectation, of proper care to mitigate his misery due to illness. He does not find the doctors who ought to be on duty to minster to him. Then the hospitals, dispensaries and health-posts do not stock enough of the right drugs in their pharmacy.
How many of us have noticed that there are more medical stores outside a government or civic hospitals than there are outside the private, corporate and trust-run hospitals? They abound because prescriptions have to be filled while the private, corporate and trust-run hospitals have their own hospitals. They corner the margins too.
And how does that work? My neighbour went to a trust-run hospital and within the first hour, a dozen saline bottles landed up and in 24 hours, none was used on him. When left the hospital, he was billed for it. If he had no use for them, he could donate it for use on the poor. And who is going to superintend if it indeed was later used on that category of patients?
So, on the same show, Kiran Majumdar-Shaw of Biocon lamented that the finance minister could have helped India get really healthier by announcing an insurance scheme for the poor. But the government-run or subsidised insurance has some limits that do not take the sick toward better healthcare. So far, there never has been an effort to measure the outcomes of the insurance for the poor. It is a dark corner in the welfare arrangement. We don’t even know if it is working or workable at all. The satisfaction comes from the outlays, not outcomes. So what was Majumdar-Shaw talking about?
The short question is: who benefits?
It is evident, is it not?