Partial waiver of bills if patient dies in a day of being admitted to Delhi private hospital
The Delhi government on Monday issued a draft policy with sweeping changes in charges levied by private hospitals in the city, including a controversial provision for a partial bill waiver if a patient dies within a day of being taken to a hospital emergency.
Under the draft policy, which will be open for suggestions from the public for a month, if a patient dies within six hours of being taken to a hospital emergency, 50% of the cost of treatment will be waived. If the death occurs within 24 hours, 20% of the total bill amount will be waived.
“There have been a lot of complaints of overcharging and malpractices in private hospitals. This policy will help increase transparency,” Delhi health minister Satyender Jain told reporters on Monday.
“The maximum number of feuds happens when the patients die within the first few hours and the relatives are handed a huge bill. We have suggested that the hospitals waive off 50% of the cost on humanitarian grounds as 50% covers the cost of consumables and medicines,” added Dr KK Aggarwal, former president of the Indian Medical Association and a member of the panel that proposed the policy aimed at capping profits of private hospitals.
The new draft policy urges doctors to prescribe drugs from the 376 medicines on the National List of Essential Medicines (NLEM), the prices for which are fixed by the Union government. For drugs not on the essential list, hospitals can charge either the Maximum Retail Price (MRP) or a mark-up of 50% on the purchase price, whichever is less, it says.
The same applies to all disposables and consumables such as gloves, syringes and cotton swabs. For surgical implants, the hospitals can charge MRP or a 35% mark-up on purchase price, whichever is less. The policy also says that hospitals must list the cost of various treatment packages and counsel the patients on the expected complications and the added cost, if they happen. An additional surgery or procedure performed on the patient should cost only 50% of original cost. In case of complicated cases, the hospitals may prepare high-risk packages, which can cost 20% more than normal packages.
The advisory also said that any private hospital or nursing home shall not refuse treatment to any patient brought in emergency condition. It said they no dead body can be detained in the hospital for want of non-payment of dues. In order to bring about these changes, the Nursing Homes Registration Rules that govern all private hospitals and nursing homes will have to be amended to include the provisions. This will require the Delhi government to clear the proposal in its Cabinet and send it to the Lieutenant-Governor for clearance.
“The draft has been released for public consultation, after which it will have to be approved by the Delhi Cabinet and the L-G for it to become enforceable,” said Dr Kirti Bhushan, Delhi director general of health services.
A Haryana government panel probing the death of a seven-year-old girl from dengue related complications at Fortis Memorial Research Institute in September had in January recommended reducing profit margins at corporate hospitals. The panel said profit margins on drugs and consumables ranged from 5% to as high as 1737%. The bill could have come down to one-third of the amount charged if a comprehensive package had been offered by the hospital, the panel had said.
Several hospitals and health care experts described the measures as “harsh” and said they may adversely impact patient care.
“The advisory is quite harsh from the perspective of private health care services providers based in NCT Delhi. We are in the process of studying the document in detail and will be engaging with the government in a constructive manner. We completely understand the need for transparency and fair and reasonable profits. The reality, however, is quite different. Most private players are making losses or single digit returns which don’t even cover the cost of capital. Some of the recommendations may also adversely impact patient care and quality,” said Max Healthcare authorities in a statement.
“Regulating prices in this way may push health care providers against the wall and lead to deteriorating quality of services. For example, in the case of a hernia, the chances for complications are little, 96% would not need any care, but what of the 4% who might need ICU care for prolonged periods?” said Dr MC Misra, former director of the All India Institute of Medical Sciences (AIIMS).
“You cannot expect five-star services and not want to pay for it; who will pay for the huge infrastructure that the hospitals have to maintain? Rather, the treatment cost can be controlled through insurance, which should be mandatory for all. Right now, there are so few people with health insurance that the ones with it are milked by the private hospitals,” Misra added.
“How can you formulate these packages when the government has not set any standard treatment guidelines? When it comes to procedures, it is not that simple. Would capping prices lead to patients being turned away or restrict their choices? And is the public sector prepared to deal with the increased patient load? The issue is very complex,” said Samit Chowdhury associate professor of Health Policy Research Unit, Institute of Economic Growth (IEG), but pointed out that consumers will benefit from the cap on drug prices.
Insurance companies, however, welcomed the move. “As the cost of health care goes up, so do insurance premiums, making them unaffordable. There are no regulation of costs for health care providers now. The draft regulations will ensure that the patients are charged reasonable rates and this will benefit all stakeholders,” said G Srinivasan, chairman and managing director of New India Assurance.