Home / Opinion / Online-views /  Minority Report | The discounted scalpel

The Times of India of 15 March carried an advertisement on Page 9 with an inaugural offer by Jaypee Hospital in Noida, on the outskirts of Delhi. Besides advertising “world-class services at affordable prices", it beamed a chart of prices listed against surgeries with the actual price and the offered price. Almost like a Pizza Hut menu. So a heart bypass surgery that would otherwise cost a patient 2.58 lakh was offered at 1.5 lakh; total knee replacement priced at 2.4 lakh was going for 1.5 lakh; a 53,000 gall bladder surgery had been slashed to 20,000 and a cataract operation that would normally set you behind by 24,000 was priced at 12,500 only.

A 50% discount was also offered on PET, MRI and CT scans, mammography, ultrasound, X-Ray and lab investigations, and this large ad told us that the “offer was valid till 31st May 2015".

Every service industry has the right to seduce customers. It’s understood that an entrepreneurial investment of any kind must be boosted by sales and good business to keep its head above water. I am also sure that if this were a cosmetic enhancement clinic, an offer on an expensive gym membership or a sari shop sale announcing discounts, most of us wouldn’t notice it at all. So why does a similar ad from a hospital evince doubtful interest? My quick answer is that a hospital is in the business of saving lives through ethical practice.

More than that, medical ethics currently pose a big question mark in India. Inequalities of income, wealth and the now growing defensive relationship between doctors and patients has begun to erode the old undying trust and worship-like reverence that patients had for doctors. Doctors no longer treat their professions or their patients with a good mix of head, heart, scientific knowledge and instinct. It’s a very sterile relationship.

As a result, the medical trysts most of us have are with the gigantic diagnostic industry. Whether it is a lump in the breast or a mild allergy, you must wade through numerous investigations. Doctors ostensibly don’t want to take chances; patients are too trapped in ignorance and fear to argue with specialized advice. Hospitals invariably stand to gain from the eggshells that patients must walk on.

There is a lot of diagnostic advancement and, thus, a lot of prevention, no doubt—though this luxury is available only to those who can afford it. At the same time, more surgeries take place in India than are necessary, going by what’s reported; more people die on ventilator support in intensive care units connected to machines and tubes instead of passing peacefully at home; more depend on everyday medicines, more Indian pharmacies are constantly crowded, and the very obvious: few babies are born through normal delivery. My yoga teacher, who currently co-consults with a gynaecologist at a reputed Delhi hospital (she did not give me permission to use her name or that of the hospital) on fertility issues among young urban women and teaches yoga to new mothers, keeps telling me that she rarely comes across a woman who has had a natural childbirth. “Every birth or at least eight out of 10 are done by Caesarean section—even when the mother is a 27-year-old with a normal pregnancy," she says.

So let’s return to the original question. In this climate of better diagnosis, more prevention but failing goodwill for the business of medicine, is it ethical for a hospital to offer discounted rates? Might it prompt people with middle-class mentalities and limited budgets to opt for procedures they may not immediately need or may not need at all? It may even urge some to easily agree for a larger battery of tests if a 50% discount is going on an MRI. I am very sure this Jaypee Hospital in Noida is not the only one hawking discounts through expensive ads. Even reputed diagnostic chains such as Dr Lal PathLabs routinely offer health packages and slashed rates on pathological tests as do top hospitals by creating smart (and more affordable) annual health-check offers. Yet, surely a line could be drawn somewhere. Surgery rates slashed by a lakh of rupees brings the doubt whether the original rates are justified to begin with. There is a difference, I believe, between raising awareness by calling people on “World Heart Day" to test affordably for heart disease and a discounted bypass surgery.

I checked the legalities with a lawyer, who assured me that such ads are perfectly legal. But I will still say that total knee replacement is hardly like a pair of Nike shoes going at half the price because the season has changed, the colour is off the fashion forecast and new designs have hit the market.

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