The Rs15.79-lakh hospital bill, presented to the parents of a seven-year old who died of dengue after 15 days of treatment at Fortis Hospital Gurugram, has triggered a nationwide debate over hospital charges. We learn that Fortis Hospital reached out to the medical community and corporates associated with pharmaceuticals and healthcare to justify the bill and counter the public anger spilling out on social media. Reliable sources tell us that hospitals, leading doctors and influential persons were sent emails explaining the cost of treatment and its break-up.
But anecdotes about elite hospitals ripping off hapless patients are too rampant to be countered with aggressive challenges by super-privileged corporate honchos associated with healthcare and pharmaceutical companies. So, when TV Mohandas Pai (associated with the Manipal group) and Kiran Mazumdar-Shaw (chairperson of Biocon ltd) attempted to slap down all those who commented against the Hospital, it made for an ugly spectacle. Some gems from these encounters are worth narrating, mainly because, ultimately, it is these influencers who have the ear of policy-makers and politicians, while ordinary people only face the consequences.
Mr Pai launched a personal attack on Dr Ashok Khemka, the whistle-blower IAS officer from Haryana who had questioned the exorbitant Fortis bill in his tweets. Mr Pai retorted that he disliked “people like you (Khemka) passing judgement without data! shows prejudging and prejudice!” (unedited). Dr Khemka pointed out that the bill was ex-facie high. By way of comparison, he said, Rs18 lakh was his “annual salary after completing more than 26 years in the IAS. My professional qualifications, too, match the best in industry.”
Mr Pai ticked off a journalist specialising in healthcare saying, “Why do you patronise private hospitals if you think they exploit you? Boycott them, go to govt hospitals; enjoy the care of the socialist experience.”
Ms Mazumdar-Shaw told people that they didn’t understand how healthcare works and went on to rant against people failing to get themselves insurance. She said, “People don’t mind charging their phones every month but desist buying insurance which costs less!” She added that they then blame hospitals for this ‘crazy psychology’. (Unedited comment. She possibly meant, “changing their phones.”).
Confident that the little girl’s family had no insurance, she lectured –“A 1000 p.a. insurance cover can save you from such exorbitant costs.” This preposterous statement triggered hundreds of tweets demanding to know which insurer would offer them a Rs18-lakh cover for Rs1000 per annum. Anoo Bhuyan, the journalist, offered a fact correction: “The family, whose 7 yr old died from dengue with a bill of Rs 15.79 lakh, had an insurance amount paid of Rs 5.21 lakh (figures from Fortis press release).” But Ms Mazumdar-Shaw simply doesn’t know how insurance works; neither does she get it when explained. She seemed to think that all costs, no matter how high, were covered by insurance and fitting them into the coverage was “the hospital’s headache not patient’s.” Fortis and the insurance company “must explain this unacceptable situation” (presumably explain why insurance wouldn’t cover any amount of exorbitant charges). This triggered another barrage of tweets that hopefully served as a lesson to her on basics of insurance and how premium is linked to overall quantum of coverage as well as the risk of claim rejection and other issues.
After this Marie Antoinette-type exchange (the last Queen of France before the French Revolution who is credited with the infamous comment that if the masses don’t have bread, let them eat cake), Ms Mazumdar-Shaw mercifully dropped the discussion with a neat about-turn, saying:– “hospitals must be penalised for overbilling through fast-track consumer protection courts” (edited) and that “the Fortis case needs to be investigated for this inordinate billing.” Most hospitals, as Dr Khemka pointed out, get land at subsidised rates. Also, the government heavily subsidises the education of all ‘good’ doctors on merit lists, who often go on to work at these hospitals.
Unaffordable or unreliable healthcare is a serious and emotive issue and not one where influential billionaires should be sniping and sneering at those seeking good treatment at affordable rates. What we need urgently is serious academic research on healthcare costs which cover the actual cost of medical education (public and private) as well as the cost of running hospitals (including government hospitals with permanent staff on lifelong pensions). This will help us to do a rational cost comparison and understand of the extent of subsidisation by the exchequer—eventually paid by taxpayers who may not even use the services.
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Make it compulsory and implement without exception and within a couple of months, we will see a dramatic upturn in the quality of healthcare provided by Govt. Hospitals. The Apollo's, Fortis types can then cater to the Dr. Pai and Madam Shaws of the country who will pay even millions without cribbing.