The Akhil Bharatiya Pratinidhi Sabha calls upon all the countrymen, including swayamsevaks, voluntary organisations and the government to endeavour to make lives of all citizens disease free by awakening the society for healthy life style, child and mother”s healthcare, eradication of malnourishment and de-addiction against intoxication. For making all kinds of medical services accessible to common people, the central and state governments should bring requisite improvement in the infrastructure, policies and procedures, with the allocation of adequate resources. For this, coordinated expansion, regulation, teaching and research be promoted in all the systems of medicine, and the regulatory mechanism and statutory provisions be executed transparently”.
—Resolution No. 1, Need for effective health care and easy access to affordable medical services, Rashtriya Swayamsevak Sangh, Akhil Bharatiya Pratinidhi Sabha 2016, 11-13 March 2016, Nagaur, Rajasthan
The affordable and accessible healthcare has become a talking point with the launching of the Ayushman Bharat Programme in the Union Budget 2018. When this world’s largest healthcare programme has taken us forward in the direction of universal health coverage, the report presented by National Pharmaceutical Pricing Authority (NPPA) raises many questions about the state of healthcare system in Bharat.
Recently, in Delhi itself, many complaints of negligence and overbillings were registered against the prominent private hospitals. Especially, the spread of dengue and Chikanguniya, breakdown of public healthcare system and private hospitals taking patients for a ride were the regular news items. On February 2018, NPPA, while taking cognisance of the complaints registered by patients against such hospitals, released an office memorandum titled “Price analysis based on the complaints received in NPPA regarding overcharging in bills by four hospitals”. The numbers revealed without the names of the hospitals are shocking and alarming.
The memorandum analyses the bills from four reputed private hospitals in Delhi and NCR and reveals that these new industries in the name of healthcare are making profits of up to 1,737 per cent on medicines, medical devises, consumables and diagnostics. These four services constitute nearly 56.7 percent of the total amount paid by the patients. Generally, the perception is that surgical operations and room rents make the private hospitals highly expensive. But, according to the memorandum, the surgery and room charges are 0.39 per cent and 11 per cent respectively, of the total bills. It is the non-scheduled formulations such as disposable syringes, catheters etc are being charged mindlessly, that push the relatives of the patients in a distressing situation.
Though the National List of Essential Medicines, 2015 has capped the pricing of certain drugs and medical equipments, the consumables and diagnostic services are not covered under this. As per the memorandum, these scheduled drugs are only 4.10 per cent of the total expenditure. Taking benefit of the same, private hospitals that acquire the consumables at wholesale prices provide the same to the patients at exorbitant prices. The same is true about the diagnostic services. Interestingly, it is not the manufacturers or retailers who are the beneficiaries of this excessive pricing but the private hospitals who proudly showcase themselves as the ‘modern healthcare industry’. The organisations involved in conversion industry also take benefit of the hapless situation.
In this regard, expanding the scope of price control to cover more medicines, medical devices, diagnostic tests, consultation fees and even hospital treatment procedures etc, as the Government did in case of coronary stents, is the first policy intervention that is urgently needed As this will provide with the enabling environment to the domestic manufacturers vis-à-vis their foreign competitors, they would also support the price controlled mechanism. At the systemic level, some long-term treatment is required for the healthcare sector. The luxury hospitals can go for special service charges that can be availed by patients as per choice.
Since independence, despite persistent efforts, actual spending on public health has been dismal. Due to non-availability of quality services and infrastructure in the Government hospitals, around 80 percent people rely on private hospitals for healthcare needs. Many are pushed to the level of below poverty line just because of their spending on hospitalisation. Though universal insurance can provide some support to the common people, it would not address the malice ingrained in the system. Perhaps, private players would further use it to extract more money via insurance companies.
This vicious circle of profiteering starts with the medical education itself. As there are limited seats, with increasing share of private medical colleges, huge money and long time are spent on acquiring medical degrees. This is seen more as an investment that has to be recovered after starting a mall-like hospital that further demands huge financial inflow. Pharmaceutical companies are hand-in-glove in this process and manage their accounts accordingly. The helpless patients are the victims of this vicious circle of profiteering. Creating affordable medical education facilities with short-term training and empowering the family physicians can be important ways to address this issue.
The opening of new AIIMS like facilities, providing generic medicines at affordable costs, spreading awareness on cleanliness and enlarging insurance net etc are some of the important initiatives taken by the Government. Providing quality medical practitioners and services with the infrastructure created by the Government will be the future challenge. Involving the civil society, especially the service oriented trusts including temple institutions, can be useful option in our cultural context. There are many successful cooperative and service oriented models created by some voluntary organisations. Making healthcare affordable and accessible, where Government would provide the infrastructure and other players would be the service providers, is the only way we can ensure Ayushman Bharat in real sense.
