note demonetisation

'No one thinks of the poor': Low-income patients are hobbled by the currency-note ban

Patients who traveled long distances to hospitals in Delhi and Mumbai were stranded on Wednesday, unable to pay for medicines or food.

On Tuesday 17-year-old Jyoti Mane and her mother Shaila boarded a train from Ahemdnagar to Mumbai where Jyoti is undergoing treatment for ovarian cancer. Shaila had sold her mangalsutra to pay her daughter's medical bills, which was now 20 notes of Rs 1,000 that she carefully placed in her small purse tucked inside her blouse. “We travel in the general compartment, there is always a fear of being robbed,” said Shaila.

When they reached Mumbai's Tata Memorial Hospital on Wednesday morning, mother and daughter were shocked that a taxi driver refused to accept their Rs 1,000 note. “We were told that the government has banned these notes,” said Shaila. She has now given the Rs 20,000 cash to her sister in the hope that she can deposit it in the bank and get notes which she can use.

Tata Memorial Hospital in Parel where Jyoti will undergo chemotherapy is run with government support and, like other public hospitals, was accepting the demonetised Rs 1,000 and Rs 500 notes on the first day of the currency ban. But the Manes were hungry because they could not use the notes to buy food. “My daughter has not eaten anything since morning,” said Shaila Mane, her eyes filling with tears as she hopes she has not lost all her money. “They banned the notes overnight. What if the government says that my money is fake?”

Jyoti Mane with her mother Shaila outside Tata Memorial Hospital. Photo: Priyanka Vora.
Jyoti Mane with her mother Shaila outside Tata Memorial Hospital. Photo: Priyanka Vora.

“When we come to Mumbai, we bring big denomination notes," said Chanardeo Mahato, who is from Bihar but has been at Tata Memorial to be treated for cancer since mid-October. "If we bring small denomination notes, how will we keep it safe? This prime minister should have thought of us before taking such a decision. Where do I get money to buy medicines?”

Tayyaz Idrishi, a resident of the Antop Hill area in central Mumbai, had brought his two-month-old daughter Rukaya Khatoon to Tata Memorial Hospital to check if she had cancer. “It is a bad day,” said Idrishi, who is a tailor. “I had an Rs 1,000 note and six Rs 100 notes. The Rs 1,000 note is useless.” Idrishi was left with only Rs 300 after paying the taxi to the hospital in Rs 100 notes. We might have to walk home with my sick child because we will not have any money left.”

Idrishi keeps some Rs 500 notes at home for emergencies but they are worthless. “Garib aadmi ka koi nahin sochta. Humare pas dhan nahin hai, kala dhan kahan se hoga,” he lamented. No one thinks about the poor. We have no wealth, so how could we have black money?

Antop Hill resident, Tayyaz Idrishi with his sick daughter. Photo: Priyanka Vora.
Antop Hill resident, Tayyaz Idrishi with his sick daughter. Photo: Priyanka Vora.

Private hospitals in Mumbai were looking for other forms of payment as 35-year-old Rohit Gada who is suffering from a lung ailment found out at Parel Hospital. Gada's family had just gathered Rs 50,000 to make the mandatory deposit before his treatment but the hospital did not accept cash. “We are asking patients to write us cheques,” said a doctor.

“We are insisting that patients pay by credit or debit cards,” said Dr Rajeev Boudhankar, CEO, Bhatia Hospital. “If they don’t have cards, we are taking cheques but patients have to give an undertaking along with it."

Doctors from major private hospitals, including Boudhankar, had written to the prime minister’s office for permission to honour the demonetised notes. Meanwhile, Maharashtra health minister Dr Deepak Sawant has gone ahead and instructed hospitals, government and private, to accept Rs 500 and Rs 1000 notes.

The scene of patients suddenly strapped for cash played out across cities on Wednesday. At Bengaluru's privately-run St John Hospital, three altercations broke out in quick succession at the billing counter on Wednesday evening. Patients and there relatives demanded explanations as to why the hospital would not take Rs 500 and Rs 1,000 notes. Many pleaded with the cashiers to take the notes and exchange them when banks opened. Others cursed.

Arguments break out at the billing section of St John's Hospital in Bengaluru. Photo: Nayantara Narayanan.
Arguments break out at the billing section of St John's Hospital in Bengaluru. Photo: Nayantara Narayanan.

At New Delhi's All India Institute of Medical Sciences, Sarah Banu was running around to get an injection for her sister-in-law who was in labour. “They say they cannot take Rs 500," she said. "I have no idea where to get the medicines from. I have no idea how I will return home. Even the pharmacy is not accepting the cash. When I complained to my doctor, he said 'Do you think I am a minister?'”

Crunch at pharmacies

Khule nahi hai. We do not have change,” said Ritu Raj, pharmacist at AMRIT Pharmacy, at Safdarjung Hospital in Delhi told Moradabad resident Ishtakar Ali. The Affordable Medicines and Reliable Implants for Treatment, or AMRIT as it is called, sells drugs at highly discounted rates. The store that caters to approximately 250-300 patients every day.

The pharmacy had many more customers on Wednesday, possibly because of the announcement that government pharmacies would accept Rs 500 and Rs 1,000 notes. But by 1.30 pm, the pharmacy had already turned away about 40 patients, said Raj.

Union health minister JP Nadda tweeted that the ministry had issued instructions to all Central government Hospitals and AMRIT pharmacies to accept Rs 500 and Rs 1,000 notes but pharmacists did not seem to know of any such instruction, and had barely any cash when they started the store in the morning.

“We ran out of change between 10 am to 11 am,” said Raj,

Lovely Devi had travelled all the way from Gopalganj in Bihar to Safdarjung Hospital in Delhi to have her one-year old son, Aryan, examined by a doctor. “He has had a stomach problem for months now," she said. "But I cannot buy medicines the doctor has written.”

The pharmacies at Yusuf Sarai, near All India Institute of Medical Sciences and Safdarjung Hospital, were also refusing Rs 500-1000 notes. Anil Kushwaha, a salesman at Ambey Medicine Corner said, “We have sent many people back. Can we give medicines for free?”

Chemist store inside KEM Hospital, Mumbai's largest public hospital, was shut from the outside to keep customers away. Photo: Priyanka Vora.
Chemist store inside KEM Hospital, Mumbai's largest public hospital, was shut from the outside to keep customers away. Photo: Priyanka Vora.

Navin Shah who runs a chemist store in Mumbai's Parel also ran out of change. “We were selling medicines in the morning but now we don’t have any change to give them,” said Shah who was, instead, handing credit notes to regular customers.

Modi ji should have given some change to chemists, if he wanted us to continue selling drugs,” said pharmacist Ritesh Kumar Oja who had to turn about 40 customers away.

A mobile police van was on stand-by near chemist shops in Parel as customers and shop owners are fighting over currency notes. “The chemist is saying that I should buy something worth Rs 500 as they don’t have any change to give me,” said Suresh Kadam who was waiting outside National Chemist in Parel to buy medicines for his kidney stones.

Pharmacists note that most high-end medicines cost more than Rs 500 and so pharmacies do not stock up on too many Rs 100 notes. at the same time, the most common denomination they receive from medicine buyers is Rs 500.

"Over the next couple of days we expect business to go down a little," said Gajendra, a pharmacist opposite Chinmaya Mission Hospital in Bengaluru. "But it should pick up again once the new notes come in."

We welcome your comments at
Sponsored Content BY 

What hospitals can do to drive entrepreneurship and enhance patient experience

Hospitals can perform better by partnering with entrepreneurs and encouraging a culture of intrapreneurship focused on customer centricity.

At the Emory University Hospital in Atlanta, visitors don’t have to worry about navigating their way across the complex hospital premises. All they need to do is download wayfinding tools from the installed digital signage onto their smartphone and get step by step directions. Other hospitals have digital signage in surgical waiting rooms that share surgery updates with the anxious families waiting outside, or offer general information to visitors in waiting rooms. Many others use digital registration tools to reduce check-in time or have Smart TVs in patient rooms that serve educational and anxiety alleviating content.

Most of these tech enabled solutions have emerged as hospitals look for better ways to enhance patient experience – one of the top criteria in evaluating hospital performance. Patient experience accounts for 25% of a hospital’s Value-Based Purchasing (VBP) score as per the US government’s Centres for Medicare and Mediaid Services (CMS) programme. As a Mckinsey report says, hospitals need to break down a patient’s journey into various aspects, clinical and non-clinical, and seek ways of improving every touch point in the journey. As hospitals also need to focus on delivering quality healthcare, they are increasingly collaborating with entrepreneurs who offer such patient centric solutions or encouraging innovative intrapreneurship within the organization.

At the Hospital Leadership Summit hosted by Abbott, some of the speakers from diverse industry backgrounds brought up the role of entrepreneurship in order to deliver on patient experience.

Getting the best from collaborations

Speakers such as Dr Naresh Trehan, Chairman and Managing Director - Medanta Hospitals, and Meena Ganesh, CEO and MD - Portea Medical, who spoke at the panel discussion on “Are we fit for the world of new consumers?”, highlighted the importance of collaborating with entrepreneurs to fill the gaps in the patient experience eco system. As Dr Trehan says, “As healthcare service providers we are too steeped in our own work. So even though we may realize there are gaps in customer experience delivery, we don’t want to get distracted from our core job, which is healthcare delivery. We would rather leave the job of filling those gaps to an outsider who can do it well.”

Meena Ganesh shares a similar view when she says that entrepreneurs offer an outsider’s fresh perspective on the existing gaps in healthcare. They are therefore better equipped to offer disruptive technology solutions that put the customer right at the center. Her own venture, Portea Medical, was born out of a need in the hitherto unaddressed area of patient experience – quality home care.

There are enough examples of hospitals that have gained significantly by partnering with or investing in such ventures. For example, the Children’s Medical Centre in Dallas actively invests in tech startups to offer better care to its patients. One such startup produces sensors smaller than a grain of sand, that can be embedded in pills to alert caregivers if a medication has been taken or not. Another app delivers care givers at customers’ door step for check-ups. Providence St Joseph’s Health, that has medical centres across the U.S., has invested in a range of startups that address different patient needs – from patient feedback and wearable monitoring devices to remote video interpretation and surgical blood loss monitoring. UNC Hospital in North Carolina uses a change management platform developed by a startup in order to improve patient experience at its Emergency and Dermatology departments. The platform essentially comes with a friendly and non-intrusive way to gather patient feedback.

When intrapreneurship can lead to patient centric innovation

Hospitals can also encourage a culture of intrapreneurship within the organization. According to Meena Ganesh, this would mean building a ‘listening organization’ because as she says, listening and being open to new ideas leads to innovation. Santosh Desai, MD& CEO - Future Brands Ltd, who was also part of the panel discussion, feels that most innovations are a result of looking at “large cultural shifts, outside the frame of narrow business”. So hospitals will need to encourage enterprising professionals in the organization to observe behavior trends as part of the ideation process. Also, as Dr Ram Narain, Executive Director, Kokilaben Dhirubhai Ambani Hospital, points out, they will need to tell the employees who have the potential to drive innovative initiatives, “Do not fail, but if you fail, we still back you.” Innovative companies such as Google actively follow this practice, allowing employees to pick projects they are passionate about and work on them to deliver fresh solutions.

Realizing the need to encourage new ideas among employees to enhance patient experience, many healthcare enterprises are instituting innovative strategies. Henry Ford System, for example, began a system of rewarding great employee ideas. One internal contest was around clinical applications for wearable technology. The incentive was particularly attractive – a cash prize of $ 10,000 to the winners. Not surprisingly, the employees came up with some very innovative ideas that included: a system to record mobility of acute care patients through wearable trackers, health reminder system for elderly patients and mobile game interface with activity trackers to encourage children towards exercising. The employees admitted later that the exercise was so interesting that they would have participated in it even without a cash prize incentive.

Another example is Penn Medicine in Philadelphia which launched an ‘innovation tournament’ across the organization as part of its efforts to improve patient care. Participants worked with professors from Wharton Business School to prepare for the ideas challenge. More than 1,750 ideas were submitted by 1,400 participants, out of which 10 were selected. The focus was on getting ideas around the front end and some of the submitted ideas included:

  • Check-out management: Exclusive waiting rooms with TV, Internet and other facilities for patients waiting to be discharged so as to reduce space congestion and make their waiting time more comfortable.
  • Space for emotional privacy: An exclusive and friendly space for individuals and families to mourn the loss of dear ones in private.
  • Online patient organizer: A web based app that helps first time patients prepare better for their appointment by providing check lists for documents, medicines, etc to be carried and giving information regarding the hospital navigation, the consulting doctor etc.
  • Help for non-English speakers: Iconography cards to help non-English speaking patients express themselves and seek help in case of emergencies or other situations.

As Arlen Meyers, MD, President and CEO of the Society of Physician Entrepreneurs, says in a report, although many good ideas come from the front line, physicians must also be encouraged to think innovatively about patient experience. An academic study also builds a strong case to encourage intrapreneurship among nurses. Given they comprise a large part of the front-line staff for healthcare delivery, nurses should also be given the freedom to create and design innovative systems for improving patient experience.

According to a Harvard Business Review article quoted in a university study, employees who have the potential to be intrapreneurs, show some marked characteristics. These include a sense of ownership, perseverance, emotional intelligence and the ability to look at the big picture along with the desire, and ideas, to improve it. But trust and support of the management is essential to bringing out and taking the ideas forward.

Creating an environment conducive to innovation is the first step to bringing about innovation-driven outcomes. These were just some of the insights on healthcare management gleaned from the Hospital Leadership Summit hosted by Abbott. In over 150 countries, Abbott, which is among the top 100 global innovator companies, is working with hospitals and healthcare professionals to improve the quality of health services.

To read more content on best practices for hospital leaders, visit Abbott’s Bringing Health to Life portal here.

This article was produced on behalf of Abbott by the marketing team and not by the editorial staff.