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Parking-centred hospitals: How vehicles affect health care access

It is possible you have heard relatives and friends, as I have on several occasions, rail against the parking fees that they have to shell out every time they drive into state-of-the-art private hospitals. They charge Rs 30-40 every four-six hours; or they impose a flat fee of Rs 100 on those wishing to access the parking for 24 hours a day.

It may seem a quibble that a patient or his or her family willing to foot the medical bill of a private hospital should complain against its parking fees. But turn this argument on its head: shouldn’t a person paying thousands or lakhs of rupees to a hospital at least enjoy free parking?

 Parking-centred hospitals: How vehicles affect health care access

Representational Image. Reuters

For you, Rs 40 may not seem a squeeze. But for the superannuated, visiting the hospital, say, for dialysis three times a week, it would seem a needless expenditure.

For large private hospitals, Rs 40 multiplied by thousands of vehicles a month is tantamount to making a killing without much ado.

Parking fees would seem justified if hospitals were to deploy the revenue it generates to subsidize treatment of the poor. Have you ever seen a signboard in the parking area of a hospital announce that? Not even the cash-rich private hospitals would want to forego extra income, regardless of its inherent illegitimacy.

It is illegitimate because you have to take the parking ticket at the entrance to the hospital, even if you have driven in to merely buy a strip of painkillers from the 24x7 pharmacy. It’s not parking but an entry fee in reality. An entry fee that is similar to what people pay on driving into a shopping mall or, say, a national wildlife park.

But a mall and a park are significantly different from hospitals in their importance to human beings. Nobody other than the morbid will visit hospitals to kill time or for leisure or to gorge on food in its cafes. Worse, you have increasingly fewer options other than visiting hospitals for even minor ailments. This is because neighbourhood doctors are fast disappearing, as they find it more lucrative to operate from the premises of branded healthcare providers. It, therefore, seems downright callous to charge user-fee for accessing hospitals. You don’t visit them just for kicks.

Again, unlike malls, parking fees in hospitals can’t be justified as a method to prevent over-crowding. Space in hospital, ordinarily, should be linked to the beds they have and the number of people they can attend to in the OPD (outdoor patient departments). Their parking area should represent the anticipated demand on them.

The chances of hospitals experiencing a sudden patient surge are extremely remote, unlike in a mall, which experiences heavy footfalls over the weekend, as people have the time, or during the end-of-season discount sales. You may decide to shop another day, but medical supervision often doesn’t provide you the luxury of postponement.

Apart from visitors to the OPD, there are two classes of people who are not patients but visit hospitals. There are those who are members of the patient’s immediate family, required to assist him or her, either because they are old or are children. In this sense, they are supplementing the hospital’s efforts at providing healthcare. For them to pay the parking fee is akin to penalizing them for the service rendered.

The second class comprises visitors who constitute the patient’s extended family or are friends. It is possible to argue that high parking fees would help dissuade this class of people from calling on patients admitted to a hospital, justified on the grounds that their visits are more social in nature than palliative. This argument many would debunk, arguing that an ailing person’s therapeutic requirements involve having people around whom he or she cherishes.

Nevertheless, overcrowding at private hospitals is checked not through parking fees but having fixed visiting hours and regulated entry – for instance, visitors are allowed in subject to the patient’s attendant producing the visitor pass – usually one, at best two. This is why friends of the patient coordinate with his or her family to choose the day of their visit. In other words, they don’t restrict their visits because of the parking fees that hospitals charge, underscoring the hollowness of the deterrence argument.

Thus, confinement to hospital for even a week could have a patient’s family and friends pay a cumulative parking fee of well over Rs 1000. This is what you can call a spin-off from having an in-house patient. We don’t question the principle involved because of the power differential between the hospital and its patient.

True, parking rates in India are abysmally low in comparison to those in the western cities, where the rate is high and charged every hour. This scheme has been adopted to persuade people to take the public transport system, cut down on pollution and fuel consumption. India is soon likely to emulate this system of calculating parking fees, evident from many cities shifting to parking fees calculated every four-six hours.

In such a scenario, don’t be surprised if the hospitals in India too follow suit, as healthcare providers have in the West. Yet, there is a rising popular pressure on hospitals to lower their parking fees or waive them. For instance, the respected Canadian Medical Association Journal in 2011 wanted hospitals to abolish parking fees, condemning them as nothing more than user fees and an impediment to healthcare.

The journal’s then interim editor-in-chief, Dr. Rajendra Kale, wrote, “Some patients (who have often waited several weeks to see a doctor) try to end a consultation abruptly when they realize that they will have to pay for an additional hour for parking, This is parking-centred health care, which is not compatible with patient-centred health care.”

The CBC News programme, Marketplace, surveyed over 1,000 Canadians and found 52 percent saying parking costs affected the frequency of their visits to a hospital; 38 percent couldn’t visit a patient as frequently as they wanted; and 3 percent skipped medical appointments altogether.

CBC News quoted cancer specialist Dr. Bob Winston as saying, “Patients benefit hugely by having family and friends come in, both from a psychological point of view but also from a practical point of view. Any inhibition for support for the patients is the wrong thing."

High parking fees at hospitals have stoked fury in England and the US, inspiring concerted campaigns to have these reduced. India could do well to ensure private healthcare providers do not diddle their customers through parking fees, the imposition of which is inherently illegitimate.

To begin with, hospital should provide one free-parking ticket every patient, for he or she needs a 24-hour attendant. Or, better still, use the income generated from the parking area for community healthcare.

The author is a Delhi-based journalist and can be reached at ashrafajaz3@gmail.com

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Updated Date: Jun 04, 2014 19:04:56 IST

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