Public or private: Why medical care in Mumbai is a nightmare

Take three major cities, adjoining each other and you will find different examples of healthcare arrangements and the Alice in Wonderland - shockingly so - emerges. First Navi Mumbai. The Navi Mumbai Municipal Corporation ordered the closure forthwith of a private hospital since it was admitting more patients than its allotted bed-strength. The operators, Hiranandani-Fortis appealed to the High Court which asked the Navi Mumbai Municipal Corporation a simple question: At the time of closure, what happens to the patients who may be on life-support? Then, Thane. The Civic Hospital, run by the state government, has lesser beds than its sanctioned strength, fewer by about 50. Patients spill over on to the floor, not just the 50 who may otherwise have had a bed, but many others. The place literally stinks, bed sheets don’t go to the laundry often enough, the plates on which daily diet is served often remains with the patient for over half a day, putrefied and smelling. Now, on to Mumbai where one knows of many charitable hospitals which are run as corporate businesses, built on lands provided by the state government or the civic body with the stipulation that 10 percent of the patients treated are poor and for free or at concessional rates. The government has never been able to enforce this contractual obligation of the hospital. [caption id=“attachment_363102” align=“alignleft” width=“380” caption=" You may or may not get cured but you lose a lot of money. Reuters"]  [/caption] Now, back to Thane. The civic body has said that unless the Fire Officer provided a no-objection certificate, stating that the nursing homes hospital is fire-safe, their licences to continue operating, risks non-renewal. Running them later would run afoul of the law. One, however, has not heard of the civic body carrying out any safety audit of its own Rajiv Gandhi Hospital or the Civic Hospital. In the first place, how did as many as 300 nursing homes get clearances? That is a question that would never find an answer, though one can guess. Of course, some new stipulations can emerge, like from the Municipal Corporation of Greater Mumbai that if a nursing home was located in a residential building, it ought to have a separate entry. How many have complied with this? The medical fraternity has conveyed to the civic body that the stipulations for securing a renewal, at least up to 80 percent of them, are just not possible. They would like them to be watered down, though the stipulations were fixed by the Centre after the Kolkata fire when close to 100 died in a private hospital in December last. This effort at bargain, hoping that the civic body would dilute the requirement stems from the belief that the authorities can always be managed, and instead of complying with them, the authorities can be forced to change their approach. In Thane, as many as 300 nursing homes of varying capacities are involved. The extent of private sector’s involvement, either as pure business enterprises or in the guise of charities, where all that is needed is to tag ‘Research Centre’ to its name to avail of benefits, is due to the inability or unwillingness of the public sector to provide a decent - forget the best - healthcare to the public, especially the poor who often find even the out of pocket expenses towards their treatment a huge burden. Revert to Navi Mumbai. It was a hospital built for the city’s citizens by the civic body which later handed it over to a private operator. Where did the commitment of the city towards it public disappear at that time because civic hospitals are decidedly cheaper than a private hospital. Why did it encourage the entry of a corporate players through a PPP? While any civic government enforcing rules and standards is, without doubt, a crying need across the country, especially because it forgets that it has pro bono responsibilities, the double standards and the ability to wink at shortcomings have always been the bane of governance. A combination of cashless hospitalisation encouraged by the private sector healthcare providers, the over-billing and excessive dependence on defensive medicine has made seeking medical help a gamble in itself. You may or may not get cured but you lose a lot of money. You do not need an Aamir Khan to tell you that; you would have experienced it yourself.