Thursday, March 1, 2007

Health sector privatization, a boon or bane?

Health sector privatization, a boon or bane?

Privatization! Do we need it or not? Few other questions can kick start a heated debate as this. What is seen now is that India is slowly engulfed by an enthusiasm to privatize anything and everything. Even while the left parties in India staunchly oppose the “privatize all” move, the proponents present it as a panacea to problems of the poor, incompetent services and loss making performances of public sector units. So is the case in health sector. As per a recent study ("Health transition in Kerala" by P.G.K Panikar), the share of private hospitals in Kerala is about 93%. The irony here is that Kerala supported a leftist Govt for nearly 50% of its life time!

Hospitals or medical care systems run by individuals is not a new phenomenon to us. Before the British rule, all the medical centers (e.g.: vaidyasala) were run by individuals or families who had a legacy knowledge about those system of medicine. Public health care system run by the state was predominantly a western idea (I don’t think that any of the earlier kingdoms that ruled India – or parts of it--- had a public health care system run by the Kingdoms) and naturally it came to India with the British rule.

Present Situation

By any stretch of the imagination it’s hard to believe that the Govt would have been able to provide the same service, quantitatively or qualitatively, with out private sector participation. Moreover private sector has provided unwavering support to the Govt for all of its endeavors towards attaining a national health security. An example is the national immunization programs. Private hospitals have helped the Govt in setting up the infrastructure for such a huge exercise which has parallels only to the General election in India in terms of its scale. Definitely the private healthcare sector is unequivocally a stakeholder in the better healthcare system we are enjoying at present.

But even while considering all contributions of the private sector in health care system in India, it needs to be pointed out that most of the times people are subjected to a disconcerting ruthlessness of profit making. As with any other private industry, the motto of business is making profit. Agreed; a business is not run for charity and it’s the right of the owner to make a return on his investment. But surely there should be a clear difference between robbery and making a justifiable profit.

I have seen that most of the time the proponents of privatization, repudiate the allegations of private hospital exploitations by terming it as problem of paranoid vision. Let me tell you one incident where I witnessed a classic example of looting by a private hospital.

On the morning of 7th October 2006, my friend Mithun took his wife Pavithra (names have been changed as per their request), who was in the initial stages of her pregnancy, to a five star hospital in Bangalore (This hospital is having branches in most of the metros). Pavithra had a severe abdominal pain and giddiness. This was followed by a brief loss of consciousness and convulsion. She had become noticeably pale by the time they reached hospital. When I reached hospital she was inside the Emergency room and Mithun was waiting outside the room. After some time a doctor came outside the room (we later came to know that he was Neurologist) and asked about her pregnancy and told Mithun that they suspect an epileptic fits and need to do more investigations as the symptoms manifested, like convulsions, point to the possibility of seizure disorder. Mithun who was in bewilderment had no other way but to buy the claim of the doctor who (at least in theory) knows a human body more than him. To rule out (or reinforce?) the possibility of an epileptic fits; she was taken for an MRI scanning. But the results ruled out the possibility a seizure disorder.

While standing outside the emergency room I saw one of the most interesting ad, I might have ever seen. Interesting part was not its presentation but its content. The colorful notice on the wall of the Emergency room was to inform the visitors of the hospital about the great discount they can avail if they do an MRI on weekdays than on weekends. There was almost a 30% discount on the MRI done on weekdays. I started wondering whether a hospital is something like an amusement park, where you go to enjoy your vacation and is MRI some kind of high adrenaline thrill ride that makes your visit worth remembering.

As far as I know, MRI (Magnetic resonance imaging) is a noninvasive medical imaging procedure that uses powerful magnets and radio waves to construct clear, detailed pictures of the part of the body under investigation, to assist the diagnosis.

Meanwhile I talked to my father who is a Surgeon in Kannur (A town in Kerala). He immediately told me that he suspects an Ectopic pregnancy rupture as in this case she is in the initial stages of pregnancy and complaining a severe abdominal pain. (Ectopic Pregnancy is an abnormal pregnancy that occurs outside the uterus. The most common site for an Ectopic pregnancy is within a fallopian tube).

As the MRI conducted could not pinpoint the cause of her symptoms and as there were no improvements made with the initial fluid supplements given, she was taken to ICU, where an abdominal ultra sound scanning reveled that it was an Ectopic pregnancy complication with ruptured fallopian tube and massive internal bleeding (Leading to a condition called shock—Due to loss of blood volume and low blood pressure). They performed an emergency surgery to fix the problem. She was pulled back to life from the brim.

Two days she was in hospital, as it was a laparoscopic procedure the stay needed at hospital was minimal. But then it was a shock (Literary this time and not medical) at the time for us, when we saw the bill. According to hospital its “just 80,000 rupees ONLY”. In the bill the cost of MRI was given as 20,000. When inquired we came to know that MRI for inpatients was higher than outpatient MRI and the "lucrative offer" of MRI discount in the advertisement was not applicable to inpatients!.

In the above case, was the incorrect assumption made by the neurologist, that it’s a case of epileptic fits; a non culpable error in judgment happened by overlooking the primary symptoms of the patient (like acute abdominal pain and anemia in early weeks of pregnancy) or was it a clever blissful wrong diagnosis to squeeze the patient?

How could a doctor miss the possibility of an Ectopic pregnancy rupture when the patient was manifesting copy book symptoms of the same? Was it a problem of the doctor’s super specialization? Is super specialization something where you learn more and more about less and less and ultimately know everything about nothing?

When I inquired in some private hospitals in Kerala I came to know that the same treatment would have incurred only a sum of 12000-- 15000 Rupees. Then why was the treatment exorbitantly costly in this five star hospital?

Was it not a daylight robbery? I strongly feel it was. Considering the fact that the hospital was promoting their radiology department with discounts and other offers, this incident of taking a cerebral MRI for pregnancy related complication smells fishy. If the cost of treatment, for a not so uncommon condition like Ectopic pregnancy rupture, was too high even for two upper middle class IT engineers, then its unthinkable what the situation would be for the majority our compatriots.

Complete privatization is not a panacea for our problems of poor service, at least not in service sectors like health care industry. Yes we do need private sector participation to a certain extent and I am not belittling their contributions. But this does not mean that you can get rid of the Govt healthcare system and rely only on private sector for all your needs.

Having the system of public domain may not stop this exploitation, but we will have at least an alternative to depend on. The achievements that we made in public healthcare are results of the accessibility that the common man had to the hospitals. But 5 star hospitals that charge exorbitantly high rates, like the one above may hinder this progress by introducing an economic inaccessibility and will pull down our progress.

As it is very evident that we have already crossed the rubicon of privatizing the health care system, it’s time for us now to think about having a regulatory authority which has the powers to audit the actions of private hospitals. This regulatory body must be composed of medical and legal experts, along with representatives from the Govt. This will definitely bring down private hospital exploitations where the patients are subjected to unnecessary/ unwanted medical investigations in the name of diagnosis.

Ending note: - How about this for an offer you may find in the near future at a pvt hospital; “Combo Offer: - Along with mother’s Hysterectomy, you get daughter’s caesarian Free!”


Anonymous said...

Gokul... kudos to your blog(pat on the back)... i think that without a public secotr, the days of freedom will be gone... a public sector has its own problems... like red tapism and bureaucracy... but your point in the blog is well taken... what in a country like india is a poor man going to do if privatization is the answer to development.

Anonymous said...

its a good attemptto give awareness regarding privatisation, but even those who are poor will prefer to go to private hospitals. b'case even they value their life as the facilities in govt hospitals are such .sarada