The problem of expensive hospitals in India

Social media outrage over the hefty hospital bill charged to the family of a seven-year-old who died of dengue fever near Delhi has once again turned the spotlight on India's poor state of public healthcare infrastructure and private hospitals that slap their patients with excessively high rates.  

Following the death of the patient, identified as Adya Singh, in September, the private corporate hospital Fortis Memorial Research Institute in Gurgaon, a Delhi suburb, slapped her family with a bill amounting to around 1.8 million rupees (€23,600, $25,000)

The 20-page itemized bill stoked criticism that the hospital prescribed expensive medicines and overcharged for things like strips that check blood sugar levels.

The father of the deceased patient has demanded a probe into the treatment and billing done by the corporate hospital, while a family friend's tweet expressing anger about the billing sparked social media outrage.

India's Health Minister JP Nadda responded to the incident by tweeting: "We will take all the necessary action."

Malpractices rampant

While this case has been thrust into the public domain, the bigger question is how private healthcare institutions which are known for charging sky-high fees for medical services operate without any accountability in the South Asian nation.

"These five-star hospitals have no transparency and no regulation whatsoever. This is the new reality in India and we need legislation to prevent patients from being treated like a cash cow," Puneet Bedi, a gynecologist from the premier Apollo Hospital, told DW.

Many doctors who spoke to DW on condition of anonymity due to the sensitivity of the issue and its potential impact on their positions say that three types of malpractices are particularly common in private hospitals: kickbacks for referrals, irrational drug prescribing and unnecessary interventions.

"The decay is deepening with the increasing onslaught of big corporate hospitals, growing pressure from the pharmaceutical industry and the massively expanding clout of medical equipment agencies," said a senior oncologist.

Last year, investigative agencies busted a racket of top doctors, including the CEO of a private hospital, in north India in connection with kidney transplants at big private hospitals in Indian cities. Then, in 2015, the Supreme Court passed a landmark verdict awarding nearly 20 million rupees to a young victim who lost her eyesight owing to the incompetence of doctors in the southern state of Tamil Nadu.

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The unfortunate aspect, though, is that India lacks appropriate laws to regulate hospitals, diagnostic centers and other healthcare facilities in the private sector. The more reputed the hospital, the more it charges.

The practices of private hospitals was brought into the fore by two doctors Abhay Shukla and Arun Gadre in their book "Dissenting Diagnosis," which gives a chilling insider account of widespread malpractices afflicting the nation's healthcare sector.

The book explains that the nexus between corporate hospitals, pharma companies and doctors has increased the risks and costs of healthcare to such an extent that millions of middle-class Indians slide into poverty when they fall sick.

Low priority

Just last year, a year-long investigation by a web portal called Cobrapost detailed medical practices spanning three mega-cities of Delhi, Mumbai and Bangalore and covering 20 major private multi-specialty hospitals. It unearthed a racket of referrals in which these hospitals offer commission ranging between 10 and 30 percent to doctors and smaller hospitals or nursing homes.

In May this year, medical journal Lancet pointed out that India ranks below much poorer nations such as Bangladesh, Nepal, Ghana and even Liberia when it comes to providing healthcare for its masses.

On the basis of data from the Global Burden of Disease report, it said that India ranked 154 out of 195 countries in terms of access to healthcare.

The low priority accorded to health is highlighted by the fact that India spends less than 2 percent of its GDP on healthcare, which is far less than what is required considering the country's huge 1.2-billion-plus population.

In March this year, the long-awaited National Health Policy, unveiled by Prime Minister Narendra Modi-led government, promised to increase public health spending to 2.5 per cent of GDP in a time-bound manner and guarantee healthcare services to all Indians, particularly the underprivileged.

"But that is not the case. We have to do more. I agree there is commercialization of healthcare and there is overcharging, but there needs to be a serious rethink about how to go forward. The poor will suffer otherwise," Dr M C Mishra, former director of the All India Institute of Medical Sciences, told DW.

"The only way to tackle this situation is by boosting health insurance and educating people. Like financial inclusion we need healthcare inclusion," says Jitendra Kumar Singh of the Indian Medical Association.