Death by the good doctor
The problems faced by healthcare are similar, though a lot worse, to those faced in finance
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The horrific tragedy of a young couple committing suicide as they could not save their only son from dengue has brought the role of corporate hospitals once more in the spotlight. The story is like this: a little boy contracted dengue and as his parents took him from hospital to hospital in south Delhi, he was refused a bed. By the time a hospital agreed to take him in, it was too late. He died. The distraught parents killed themselves in a suicide pact. The boy’s father had lamented that you need a ‘contact’ to get a hospital bed in Delhi. It is true. You need a ‘contact’ to get a bed in most private hospitals if you have a ‘low-earning’ medical condition. A knee replacement will earn the hospital upwards of Rs.3 lakh for the 6-8 days it takes, while a dengue bed will earn a tenth for the same period. Doctors who work in such hospitals do confess privately that there are verbal instructions to refuse dengue patients or those who don’t ‘earn’ that well.
Other than doctors prescribing tests from particular labs that give them a cut and recommending particular non-generics that give the good doctor and family a visit to Bali, all expenses paid, there are even more serious traps in private healthcare. The first trap is to recommend a surgery that’s not needed. My mother went with foot pain to a private west Delhi hospital and the doctor wanted to admit her right away to get her foot operated. Deposit the money now, there is a special rate going—it made me think I was in a seedy property broker’s office rather than an upmarket private hospital. A friend took her father for knee replacement in Chennai, and the hospital kept a deposit saying the man was very sick and recommended all manner of tests. When her father asked to see the doctor about the need for the tests, they discharged him in 30 minutes. An hour back they had said he was very sick. But when questioned on cost, they threw him out. The second trap is to pad up the bill once you have been caught. Every doctor who visits the patient bills the patient, even if she has just paid a social call because she knew the family (seriously, it really happened to a friend in Delhi). The dietician will float by to check if the food is fine. You say no, it isn’t. She will titter. And say we’ll do something. Floats out. Nothing changes and she bills you. An endocrinologist will wash up. Ask what meds you’re on. You give the name of the tablet you’ve been on for years, you’re 77 years old and a diabetic for 40 years. He will diss it. Prescribe something else without asking any other question. And, of course, bills you for the advice. Another matter that the new meds cause system imbalance and you go right back to what you were on.
The problems faced by healthcare are similar, though a lot worse, to those faced in finance. There is asymmetry of information, opaque products, mis-aligned incentives and no punitive action. A bad product will only cost you money, conflicted healthcare costs your life, or worse, that of a loved one. An industry body as the self regulating agency route to better behaviour does not work. It does not work for us journalists, nor for lawyers or doctors or chartered accountants or company secretaries. The number of people who have lost their licences due to bad professional conduct in any of these professions will be statistically insignificant.
Putting an army of inspectors out finally backfires, both in terms of money and the eventual rent-seeking entities the inspectors turn out to be.
So is there a way out? Can we turn to technology and disclosure to make some headway in this market failure in healthcare? Consider the ease with which rival insurance companies are able to get your details and call you just before your car insurance is set to expire. How did they manage to get this private information and then call you on your DND (do-not-disturb) number? If the government can create a network of agencies that can track individual credit, payment and banking behaviour through credit rating agencies such as Cibil (Credit Information Bureau Ltd), then why should it hesitate to make data disclosures from the companies to the public mandatory?
What if each hospital was to put out its data every day, week or month on how many surgeries it performed, what each cost, success rate, and ratings of the hospital by patients. In times of a city epidemic, the hospital should put out the number of disease-linked patients seen and how many were hospitalised.
This needs more thought and debate, but clearly the old way of self-regulation and inspections has failed hugely. The excuse that this is confidential data and cannot be shared as it harms business interests is so pathetically weak that the fact that it survives in India makes you think that there is mala fide intent to keep the citizens ignorant.
Monika Halan works in the area of financial literacy and financial intermediation policy and is a certified financial planner. She is editor , Mint Money, Yale World Fellow 2011 and on the board of FPSB India. She can be reached at email@example.com