Hospital Treatment Rates
By Dhurjati Mukherjee
That health is a neglected sector in India has been echoed by experts over the years, but the government has not taken adequate measures to ensure that benefits reach all sections of society. It is, in this connection, that the very recent Supreme Court order merits special attention. The order directed “all hospitals and clinical establishments must display rates charged for each type of service provided and facilities available for the benefit of patients at a conspicuous place in the vernacular as well as in the English language and charge rates for each type of procedure and service within the range of rates determined and issued by the Centre from time to time, in consultation with the state government”.
The bench of Justices BR Gavai and Sandeep Mehta, hearing a PIL by the NGO ‘Veterans Forum for Transparency in Public Life,’ boldly stated, “If the Union government fails to find a solution, then we will consider the petitioner’s plea for implementing CGHS-prescribed standardised rates.” The PIL sought clarity on medical expenses and urged the Centre to determine the fee chargeable to patients based on Rule 9 of the Clinical Establishment Rules 2012 on which the judgment would stand out to be a landmark order.
It is indeed distressing to note that health has become big business in the country and the private nursing homes charge rates that even the middle class finds difficult to pay. There is no regulation by the state governments and the Centre is totally indifferent to the continued fleecing of the population. The political class has never said anything regarding the matter and there are virtually no protests as the nursing homes owners are rich and powerful.
Though some of the state governments have given land at subsidised rates to these nursing homes – some also call them hospitals – they are supposed to reserve some beds for the poor and the economically weaker sections, but this is not done, and the state governments do not check whether these health centres actually treat the poor. It has to be accepted that the ruling dispensation at the Centre favours the rich, but this is also true of most state governments.
The question that comes up is how will the poor get proper treatment? There is no survey undertaken in the country to determine how many poor people are not properly diagnosed and, as such, treatment is not received by them. Moreover, costs of treatment in the private sector are quite high, specially of life-threatening diseases. But though these are considered life-threatening in the country, this is not so in the Western world as also in the emerging economies.
It is a well-known fact that the conditions of rural health centres and hospitals run by the government are in a pitiable state of affairs with very few specialists and even general doctors not being able to give proper attention to the huge number of patients. Moreover,equipmentis lacking and specialised treatment, in most cases, is not possible.
Some experts question that there is no proper survey to find out how much people from the lower segments of society have to spend to get proper treatment, how many of them can really afford this treatment, how much they have to travel to avail of this treatment? It has been found that poor people have been found to sell their fixed assets like land, even part of building, apart from jewellery etc. and taking huge loans at high rates of interest, mostly from moneylenders.
Though such order for standardisation of rates should have been taken decades back to prevent health being treated as a source business, the present order, if acted on seriously, would greatly benefit the common man. One cannot deny that health facilities must improve in all parts of the country, specially in the backward districts, and this can only happen when facilities are available at affordable rates.
It is worth referring to a World Health Organization (WHO) report which rightly highlighted the fact that with countries reducing investments in health after the Covid outbreak does not augur well as health security is complementary to economic security. To address gaps and prepare for the next pandemic, the regional director of Southeast Asian region of WHO stressed on investments and strengthening six pillars of health systems –service delivery, health workforce, access to medical products, vaccines and technologies, health information systems, and financing backed by political commitment.
The government proposal of setting up hospitals in PPP mode in select underserved districts has not been implemented as business houses are not interested to set up such centres in remote rural areas. It was envisaged that medical colleges would be attached to district hospitals in PPP mode to address shortage of qualified medical doctors. However, the Indian Medical Association (IMA) expressed concerns by public health experts that inviting the private sector to manage public hospitals was tantamount to backdoor corporatisation of civil hospitals and this would not help the poor as the mass would not get benefits at affordable rates.
A recent development that should be welcomed is the initiative by the insurance regulator to allow subscribers to avail cashless treatment at any private hospital or nursing home, irrespective of whether it is part of an insurer’s network or not. Earlier to get treated in such a nursing home, which was not part of an insurer’s network of facilities, patients had to pay the full amount and go through the cumbersome process to claim reimbursement. This would undoubtedly help a major section of the middle class, specially the salaried who have such insurance facilities.
It goes without saying that health is critical to human well-being and, as such, there is need to look into the whole issue and evolve an effective solution in the matter. The judiciary has done the right intervention though this was needed much earlier. Now it is the prerogative of the Centre to direct the states to check the functioning of private nursing homes and hospitals and ensure not just standardisation of rates but see to it that at least 20 percent of beds are reserved for the poor from whom just the actual costs of surgery and minimum doctor’s fees are recovered.
Only talking of ‘health for all’ has no meaning unless effective steps are taken by the Centre and the states. Maybe some time, the judiciary will also intervene and direct the states to ensure that the poor citizens of the country are not deprived of basic health facilities. As socio-economic development is intrinsically linked to better health, the present landmark order, if adhered to, will bring about a drastic change in the functioning of private health centres. — INFA