BAD MEDICINE

Is the corporate hospital killing small hospitals and exploiting patients?

You’ve heard the stories many times. Now two doctors confirm them in a new book.

During the past twenty years, following liberalisation policies, the growth of the IT industry and other factors, as well as disposable incomes among certain classes, have increased – though this is not the case across the social spectrum. As one doctor has said, Pune city, which should have fifty Sassoon Hospitals (public hospitals), has only one, although new corporate and multi-speciality hospitals are coming up daily.

They are bright and glittering. In some ways, they are like shopping malls. Sometimes they have even been registered as so-called charity hospitals, but their only objective is profit. Partly because of their state-of-the-art equipment, but also because of a growing lack of choice, as older hospitals run by trusts or individuals close down, people are going to these hospitals. Such hospitals deliberately foster the impression that they provide high-quality services, which justifies their high costs of care.

There is another important aspect of such “hospital-malls”. New technology costs lakhs and crores of rupees. If these machines are now indispensable for diagnosis, hospitals run by individual doctors are less able to compete. If the medical sector is left to the mercy of the market, and if the foundation of the whole business is profit, where will this take us?

Unwanted investigations, procedures and operations

A pathologist from a metropolitan city says, “In corporate hospitals, each patient may be seen by multiple specialists. An orthopaedic is called because the hands and feet are aching; a neurologist for numbness in the hands. They come and look at the patient and their charges are added to the bill. Is it useful for multiple specialists to examine a patient? This question is never even asked.

“In many private medical colleges, the students only see a few patients, and even fewer from the poorest sections. How will they develop social sensitivity?”

“In corporate hospitals, investigations are not based on what the patient’s illness is, and whether there is a need for specific investigations. Given any complaint, they produce a list of investigations that must be done,” notes Dr HV Sardesai, practising physician from Pune.

A surgeon from a metropolitan city observes, “Totally unnecessary surgeries are being performed in corporate hospitals. During investigations, they may see a small stone in the gall bladder. It is not causing the patient any problems. But they scare the patient into going in for a surgery.

“I know of a case where the patient was charged Rs 1.5 lakh for an inguinal hernia surgery done by laparoscope (surgery for inguinal hernia is one of the simplest operations).”

“Asking about the rising corporate hospital sector is a question that needs no answer. It is not just rising, but is now firmly established. Government health services have been weakened due to government indifference, and that is why there is scope for corporate hospitals to prosper. Due to the entry of corporates, the order of priorities has changed. Now the doctors’ priority is no longer the best interests of the patients, but the profit earned by the shareholders of the company,” says Dr Arjun Rajagopalan, a surgeon from Chennai.

Blatant commercial marketing by corporate hospitals

A gynaecologist from a big city is of the opinion, “People’s sensitivities have become numbed due to certain corporate hospitals. Once bills in these hospitals started mounting up to Rs 10-20 lakh, people began to consider our bills of Rs 40,000-50,000 as trivial. These hospitals are like malls. Our society does not need them. Instead, all tertiary health care should be provided by the government.”

A skin specialist from a big city comments, “Public relations officers of many corporate hospitals keep roaming around to visit doctors; they entice doctors to send patients (to their hospitals) by tempting them with cuts. Nearly everybody indulges in this practice. It must be legally banned.”

Another big-city doctor, a general surgeon, notes, “Labour leaders at factories in our city are now in the pay of corporate hospitals. They agree to arrangements for the health care of workers to be covered by the employer at a particular corporate hospital. Now none of those 5000 workers comes to me. If they do come, they take some minor treatment and then go to the contracted corporate hospital. They have to, otherwise their medical expenses are not reimbursed by the employer.

“I said to one such leader, ‘You protest against malls set up by Reliance. But now when you join up with the corporates, what are we smaller hospitals supposed to do? Besides, these corporate hospitals charge bills of Rs 1 lakh and more, while the surgeon gets only Rs 4000 to 5000.’”

A general practitioner from a small town offers more on the topic: “Corporate hospitals often engage in marketing in a variety of ways. ‘Buy one, get one free’, ‘Discount week’… full-page advertisements, mostly full of falsehoods. They throw parties for general practitioners, and they give them cuts. On top of this, they throw parties and supply liquor to keep politicians in their thrall. Some corporate and large hospitals admit bogus patients under the Rajiv Gandhi Health Scheme (a publicly funded health insurance scheme). They give the admitted person money, and plenty to eat and drink. They prepare records showing that an angioplasty or angiography has been done on that person, when actually nothing has been done. I wonder how the government comes out with such schemes, without first regulating private hospitals. Without regulation, the basic objectives of such schemes are lost, and they become mechanisms for corporate hospitals to loot public funds.”

“I feel that there is no humanism to be found in corporate hospitals. Small hospitals are being destroyed due to these corporates. This must stop. In small hospitals, there is at least the possibility that the doctor has not lost his basic sense of humanism. They wait for the patient to make the payment. They give concessions. None of this happens in corporate hospitals,” observes another general practitioner from a small town.

An ophthalmologist from a big city says, “Corporate hospitals maintain everything five-star style, but forget about the patient. When the patient comes, they give him lemonade or tea. They advertise that they have the latest hi-tech optics shop. The patient melts because of the free lemonade, and he buys a pair of spectacles that have an actual value of Rs 200 or so, for Rs 3000–5000! The in-house optician is the main income avenue of corporate hospitals. Sometimes they offer a free check-up. The scheme has a 20-per-cent-off offer, just like in a mall. The whole atmosphere is designed to tempt.

“Corporates can implement government schemes and insurance schemes. We run small hospitals, our reimbursements are delayed, and we don’t have the time to keep making trips back and forth to get our payment from the insurance company.

“Corporate hospitals vie for tie-ups with large public sector companies. And the officials are more than eager to oblige. These public enterprises give exorbitant reimbursement to their employees; Rs 5000 for just a pair of spectacles, of course made available from corporate hospitals. The big corporates in Mumbai draw in cases from all over Maharashtra. But junior trainee doctors operate on those cases! Further, often the quality of these corporate hospitals is not as good as they claim in their advertisements. When they do a cataract operation, they sometimes make money even on the lens. They charge a high amount of money for an expensive lens, but implant an average-quality lens.”

“If a patient goes with my referral note, he gets 30 to 40 per cent off on an MRI (because I do not take any commission). One patient forgot to take my note. He was charged the full amount, and a cut went to some third party,” says Dr Rajiv Dhamankar, practising paediatrician in Alibag, Maharashtra.

“Nowadays people want glamour and marketing. They have become used to the mall culture. The concept of ‘master check- up’ (packages of large number of tests, of which many may be unnecessary) has gotten into their heads. Now doctors who practise ethically and scientifically are looked upon with contempt, because they obviously can’t afford this glitter. But people often don’t know what they are getting into by going to corporate hospitals,” remarks an ophthalmologist from a metropolitan city.

Excerpted with permission from Dissenting Diagnosis, Dr Arun Gadre and Dr Abhay Shukla, Random House India.

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Changing the conversation around mental health in rural India

Insights that emerged from discussions around mental health at a village this World Mental Health Day.

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