Thoughts And Ideas
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Thoughts And Ideas

How to defang India’s predatory doctors

To separate the sheep from wolves, India needs an Amazon-like, listing and review of all healthcare services

There’s something terribly wrong in the India of today where a man gets jailed for stealing your wallet, but a doctor can steal everything you own, and walk away scot free. Today we have a breed of doctors who instead of helping patients, are more like predatory vultures. They swoop down on the helpless sick, and ruthlessly pick them clean until nothing is left but bones.

One reason they are so successful is because everything they do is hidden from public view and buried in medical jargon. Instead if we make them put everything out in the open where even a layman can understand what is going on, it will be harder for them to cheat us.

One simple way to do this is to do an Amazon on healthcare services. Like when we want to buy something, we can go to an Amazon or Flipkart, read up on products being sold, compare prices, and read verified user reviews. Why not the same approach for medical care?

But first, let us try and understand how and why the healthcare industry is able to prey on us, as this is something that can affect any Indian.

Exploiting the dead

Some time ago, my wife’s grandfather had a heart attack at home. Her grandmother who was by his side, says he passed away on the spot. But he was put on a heart-lung machine by the hospital. Fortunately, my wife’s sister is a doctor. She called up, asked a few pertinent questions and realized he was brain dead. So she politely requested the hospital to disconnect the machine. The hospital did so, and then handed over a bill of around ₹100000 ($1500) for the use of their expensive equipment and hospital facilities for a 24-hour period. If my sister in law hadn’t interfered, her grandad would have been kept in the hospital for longer, and the bill would have buried the old lady in massive debt for no reason. But not every family is lucky enough to have a doctor who can spot a cheating hospital.

Hitting you when you are down

The thing is when faced with death of a dear one, we find it hard to give up hope, and feel guilty if we don’t do all we can to save them. The hospitals choose this moment to exploit us, as emotions are running high, impairing our ability to take rational decisions. A doctor can tell with a glance at a patient’s vital stats if he is beyond hope, as my sister in law did. But the hospital can quietly choose to pretend there is hope. A patient may be brain dead but equipment like the heart lung machine can keep the heart pumping blood, and the lungs and chest moving. To a layman, movement is life, and it’s too easy for an unscrupulous doctor to convince us there is hope.

Money talks

Of course, it’s all about the money. Government hospitals do offer free treatment but they are understaffed, poorly equipped, badly maintained, and only visited by the very poor who can’t afford to go elsewhere. By comparison, private hospitals are run as businesses. And like any good business would, they try to attract their customer(patients) by offering high quality products services, which in this case is consultation with reputed doctors and treatment with state-of-the-art medical facilities.

Conflict of Interest

We grew up trusting doctors to do what is good for us. But when a hospital is set up primarily as a business, there will be a conflict of interest. Will the patient’s needs get priority over the hospital’s needs? What if the right treatment for a patient is not be as profitable for the hospital as the wrong treatment? Obviously, since the hospital takes the final decision, it’s always going to be in their favour. And the doctors who we once trusted blindly will now have no qualms in recommending unnecessary treatment and surgical procedures whose exorbitant prices ensure the hospitals make solid profits.

A doctor friend of mine told me about his experience at one such hospital. He is a compassionate man, and would never recommend unnecessary surgical procedures to his patients. But one day, he was unofficially requested by the hospital manager to recommend surgery to more patients to help generate more income. Rather than compromise his principles, my friend quit and moved on to another job. Many doctors would not be in a position to refuse such a request due to financial or other constraints. But there are quite a few doctors who see their profession as a business first, and would see no harm in giving in to the hospital’s request.

Deadly Mark-ups

The current controversy in the Indian media about medical stents highlights this issue. A stent costs around ₹8000 to make but hospitals are known to add a profit margin of up to 650% on top of the distributor’s margin. At ₹50,000 or more, that stent would be out of reach of the poor, and even many living on a fixed income. This violates all ethics of fair play as the stent is a life-saving device. Probably because it’s now in the media spotlight, the prices on stents will be regulated. But what about all the other medical treatment and surgical procedures that hospitals scare patients into accepting, and massively overcharge them for?

Emotional Blackmail

I saw an online petition yesterday in which a lady explained how she was persuaded to have a caesarian delivery by a hospital who presented it as more ‘scientific, modern and risk-free.’ When emotionally blackmailed like this, how many mothers would opt for a natural delivery and put their child at risk? The petition mentions that studies have shown C-sections come with all the risks of a major surgery, including infections and other dangerous complications as well as the long recovery period. It also leads to a higher risk of post-partum depression and lower breastfeeding rate in women, and diseases like obesity and diabetes in children. World Health Organisation (WHO) norms state that C-section deliveries should be 10–15 per cent of the total number of deliveries. In India, the average rate is closer to 50%, with the state of Telengana having 75%, Tamil Nadu 58%, and Kerala 41%.

Courting the Doctors

The drug industry is another big driver of the commercialisation of healthcare. Medical representatives of drug makers regularly visit doctors with gifts, free medicine samples, and invitations to junkets and seminars at plush 5-star hotels and holiday resorts. In return, the medical reps ask the doctors to prescribe their drugs, and point the patient towards a pharmacy which stocks the drug. The doctor who feels under obligation to the medical rep for the perks he received, starts prescribing the drugs to his patients whether they need it or not.

Creating Superbugs

The resulting overprescription of drugs by doctors, especially antibiotics is pushing India towards a dangerous crisis. The media recently highlighted the case of an American lady who picked up an infection in India. This superbug was resistant to all 26 antibiotics that are currently in use, and the doctors couldn’t save her. With the rampant use of antibiotics in India, the superbug menace is a ticking timebomb that could result in a massive catastrophe in the country.

Charge as you Please

The other effect of drug commercialisation is the arbitary pricing of drugs. A friend’s mother recently found she had cancer and underwent chemotherapy to treat it. The hospital bill showed the cost of one bottle of the chemotherapy drug as ₹84,000. After the treatment, she found the same drug being sold for ₹64,000 at a pharmacy in a different town. She then checked the drug’s cost with a friend who owned a pharmacy. He offered it to her at ₹40,000, and he was still making a tidy profit.

A bigger slice of the pie

The nexus between doctors and the drug industry has now taken an even more worrying turn. Doctors want a bigger share of money that the patient pays to the medical industry. So the doctors have set up their own pharmacy within their hospital. But some patients still prefer to go to pharmacies outside the hospital. To stop this, the doctors became even more innovative. They applied for licenses to become drug marketers. They then buy unbranded generic drugs from a licensed drug manufacturer, rebrand it, price it exorbitantly, and make it available only at the hospital’s pharmacy. Not surprisingly, when the patients goes to his usual pharmacies, they admit they have never heard of this new brand. So the patients have no choice but to go back to the hospital and pay through their nose for a drug that is actually available for much cheaper in the market under other brand names.

Escaping the greedy doctors

Healthcare is a fundamental need of humans. If hospitals are run on a profit basis, it will inevitably lead to the exploitation of people in their hour of need. This is why in many developed countries, the primary healthcare services are run by the government.

Like in UK, the salary of the a GP working in the NHS is paid by the government, and is proportionate to the number of patients that the GP’s practice handles. Although these systems take care of all medical needs of UK citizens, it’s not perfect with long waiting periods for treatment and other issues. But at least, all citizens are guaranteed the best medical care. Some of these countries still do have private medical consultants but these can only be afforded by the very rich.

It might be worth observing that like India, the US has a profit-based healthcare system which exploits people. Obamacare was partly an attempt to fix it. Trump is trying to repeal Obamacare, and replace it by something else. But my point is the US is at least trying to fix the healthcare system.

Healthcare has to de-privatised

In India, the government has stepped aside and let the private medical establishment legally rob any person who has the misfortune to fall ill and go to a doctor. But setting up a national healthcare system requires a massive infrastructure that involves huge expenses, which the government may not have. Countries that take care of their citizens healthcare generally have high taxation rates, whereas in India barely 1% of the population pays taxes.

Obviously, such a national healthcare system won’t happen overnight. The government’s current initiative to digitise and track all financial transactions will help in setting up an efficient taxation system, which is the first step to creating a healthcare system. That doesn’t mean we have to accept being ripped off during the period the infrastructure is being put in place.

Putting checks into place

There are many checks that the government can put into place. These can be enforced without much cost or time, which will make it harder for hospitals to fleece patients.

In UK for instance, the government’s NHS (National Health Services) has a system of checks on doctors. Like if a GP is found to be prescribing antibiotics too often, he will have to give an explanation to the NHS on why he over-prescribed antibiotics. And that brings me to my point.

Online Shopping for Hospitals

We are living in an era in which there is a digital record of everything. If we want to buy something, we can go to an Amazon or Flipkart, read up on products being sold, compare prices, and read verified user reviews.

Till such time as the government can take over Healthcare, it should use the same Amazon model to create a similar website for anyone to compare the products and services being offered by the many hospitals in India’s medical and healthcare business.

To do this, the government will list every medical treatment on this site giving clear guidelines and indicative prices. The government will then make it mandatory for any hospital in India that offers the treatment to list it on this site along with a comprehensive price breakup for doctor consultation, surgical procedures, drugs, nursing, room charges, etc. All drugs will have links to a drug section which list the components in the drug, the price of the drug, and the price of all the other brands of the same drug in the market.

Everyone who is treated at any hospital will be given a username and password for the site. He will be requested to fill in a review that will be posted on the site. The review will cover the quality of service offered by the hospital, the knowledge and skill of the doctor and staff, drugs prescribed, treatment which he or she was administered, whether it was actually necessary, and the cost of all this.

Fixing the Loopholes

Of course, there are a lot of loopholes, but these are bridges that will have to be crossed when they are reached.

For instance, fake positive reviews could be posted by the hospital. To prevent this, the government should have random checks done by government medical officials to verify reviewers are genuine patients. Fake reviews should result in the hospital either losing its license or not being allowed to offer that treatment. Also all reviewers will also be given an option to mention what they were treated for and at what price so a viewer can verify that the reviewer was actually treated at the hospital.

Indians being Indians, it’s possible that a competing hospital could post a fake review in order to sabotage its competitor. One solution for this could be to place the onus on the hospital to monitor all reviews and inform the government if they suspect a reviewer is fake. Any hospital indulging in such sabotage will also lose its license if proven guilty. Like I said, there will be bridges to cross as we are going where no one has gone before.

How this will help

For instance, a pregnant lady can check the website for guidelines on normal deliveries vs Caesareans and see that a hospital should be doing only 10% Caesarean deliveries. She can then compare the rate at different hospitals, and avoid those showing a higher percentage of Caesarean deliveries.

Likewise a person planning on chemotherapy can check the price of the chemotherapy drug on the site, and verify that the hospital rates are reasonable before undergoing the treatment and so avoid nasty surprises.

Or if a person is prescribed a very expensive branded drug, he can look up its component, and find substitute brands of same medicine that come at much more reasonable prices.

Is this possible?

I’m not in software or the healthcare business. But if a layman like me, could come up with the basic idea for putting some controls on the predatory healthcare industry, think what a professional could do.

The Indian government needs to put one of India’s highly motivated software billionaires in charge of such an initiative, and provide them with a decent budget. I’m sure they can come up with a program that will rein in and tame the vultures who, in in the guise of healthcare, are freely preying on us.

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An attempt to bring heart-touching and thought-provoking writing under one roof to make an impact.

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