Why money is no alternative for healthcare at government hospitals

Last week when my driver’s child complained of stomach pain, I offered to pay for her treatment at a private clinic, which he refused outright. “You would pay for the first visit and maybe the next. What about the follow-ups and tests? What if she needs hospitalisation?” His panic seemed valid.

Instead, he decided to use his government health insurance card at a local hospital. It took him a full working day to get past the queues and see a doctor who prescribed some basic medicines. Two days later, the child complained of the same problem and had to be rushed to the Emergency. A couple of years ago, when my domestic help’s teenage daughter fell ill, she took her to a local doctor who gave her vitamins. The girl died the next day.

These are horror stories from Ghaziabad where much of the public facilities are not better than that of a muffasil town. But does Delhi fare any better?

A study by World Bank economist Jishnu Das and his colleagues found that the basic quality of primary healthcare were the same in rural Madhya Pradesh and urban Delhi. In Delhi, only 52% of health service providers working in private sector had medical degrees, while 16% had no medical qualifications. The average consultation time per patient, both at government and private set-ups, was 5.3 minutes. The rate of correct diagnosis was just 21.8 per cent.

Another study showed that in urban Delhi, the average household visited a doctor twice a month. A 2006 survey by the World Health Organization revealed that 40% of low-income families in India had to borrow money from outside the family to meet their healthcare needs and 16% of them had been pushed below the poverty line by this trend.

The Centre’s Rashtriya Swastha Bima Yojna, running in Delhi since 2008, rides on the private sector to provide medical care and surgical procedures. The Delhi government pays an annual premium of R 750 to provide a cover of R30,000 each to one million families mostly from below poverty line and other economically vulnerable sections.

 But the R30,000 insurance card is not enough to last for even two days of treatment at a private hospital notorious for inflating bills by pushing patients to expensive options.

For patients in need of critical surgeries and treatment, the city government provides assistance of up to R5 lakh through the Delhi Arogya Kosh. But approvals and disbursements of funds often get caught in the usual bureaucratic tangles.

The government funds, say experts, is not being spent to improve healthcare but to purchase it from the private sector that commands 80% of the market. With little regulation and no standardised pricing, even charitable hospitals have turned into five-star facilities. For a poor patient with an insurance card, the biggest challenge is to find a private hospital that will willingly treat him.

Apart from GB Pant, Delhi government doesn’t have a fully functional multi-specialty hospital in the state. Rajiv Gandhi Hospital in east Delhi’s Tahirpur and Janakpuri Hospital in west Delhi offer only truncated services. Outsourcing secondary and tertiary healthcare to the private sector would have made sense had the government delivered decent primary care. In its latest report, the CAG pointed out that many essential drugs were not available in key government hospitals. Out Patient Departments suffered due to shortage of equipment and staff. Even ambulances were not equipped with oxygen cylinders and first-aid boxes. Five hospitals did not have blood banks.

As a matter of policy, public funds end up at unregulated private hospitals through poor patients who receive no healthcare in the bargain. And you thought good health is the right of every citizen.


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