Whenever I come across a patient's ill-treatment in a government hospital, I am reminded again of why government-run healthcare is so insidious. Is it not a hospital's job to provide dignified treatment to patients? Its failure to do so should not be dismissed as "deficiency of service". Rather, it should be termed as "culpable abdication of duty" and summarily punished.
Is the private health care system any better? Having served in a top government institute for a quarter of a century, I am now a cardiologist doing solo private practice. But I am dismayed to find that the common factor which makes the health system run in India is money power.
Much has been written about how doctors are feted and rewarded by drug companies for the support shown to their products. It is true for a tiny minority of the medical fraternity of bigger teaching institutes. When it comes to consumable or stock instruments, the story is different. Medical instruments of higher value, say Rs 80 lakh or above, are about 25% cheaper when we buy these in the private sector from the same companies.
Obviously, the government health machinery follows the lowest price quoted under the "successful vendor approach". Therefore, one can surmise that there is cartelisation. Meaning: there is an unwritten agreement between the vendors to have the minimum base price when quoting for a government institute.
In the medical profession, especially in cardiology, senior doctors have a large say in disposable instruments such as pacemaker, stents and balloons. To my horror, I realised that the vendor would be able to give you the item at a cost lower than what is quoted for a government hospital. He can even give you a bill on the company letterhead of whatever amount you want your patient to pay; to make it a legal invoice, it will have VAT (value-added tax) included. This is the amount ultimately paid by the insurance company, the government or the armed forces for its clients or employees, as the case may be. The benefit of the lower price is seldom passed on to the patient.When I got a doctor's degree, I was told that I had got the freedom to prescribe or follow a treatment which I consider is the best for the patient. This belief was shattered too. I learnt about a local private hospital of great repute, where senior doctors are paid hefty salaries. The catch is that they have to work in a corporate style, in terms of targets and number of procedures.
Why does a hospital want to attract so many patients? The answer is simple: more footfall, more procedures, more profit. Ethics is damned. Incentives can achieve what your reputation as a competent professional cannot. Monetary incentives to the referring doctors range from 15-30% of the cost of the procedure. Even a childhood friend won't send patients to me as I do not give incentives. I am sincerely hoping that this ethical bar I have set for myself will not drive me to bankruptcy.
One should not have the impression that corruption starts and ends at the operating doctor. Companies which manufacture products have a fairly high advertising budget. For doctors who hold an administrative rank, the sky is the limit for incentives, even in the government sector - be it foreign study tours for yourself or your students or hospitality anywhere in the world. Perhaps, a dual purpose is served by a visit to Geneva (Switzerland), where you can monitor your Swiss bank account as well as attend a meeting of the World Health Organisation, whose head office is - incidentally and ironically - located there.
- The writer is a Mohali-based cardiologist