Friday, June 22, 2012

Hospitals as corporate entities

There was a program in Satyamev Jayate regarding medical malpractices. It reminded me about various such stories that I had heard.
  1. When I was admitted to the hospital following the stroke, we had to purchase medicines and consumables like cotton from the hospital medical shop. When I was discharged, Jaya found a wholesale shop nearby which sold the items at upto 1/3 of the hospital prices. We could make out no difference in quality. I don't know the costing and obviously retail prices will be higher than wholesale prices but  will it be 3 times as high?
  2. It seems that in some hospitals, the doctors are given revenue targets so they have to prescribe various irrelevant tests in order to meet those targets. Doctors who meet their revenue targets are close to the management. Doctors who are uncomfortable with such practises and don't meet the targets run the risk of being transferred to a department that they don't fancy, akin to the punishment postings that bureaucrats get when they don't toe the line of their political masters.
  3. When I had been in hospital for about 6 months, a doctor friend told us that I could have been discharged 2 months earlier and that whatever was being done in the hospital could also be done at home. When Jaya asked the hospital management about discharge, she was told that it would be better to continue in the hospital since any emergencies can be dealt with easily. We were offered a room at concessional rates to continue to stay in the hospital. We finally bit the bullet and got discharged and there has never been an occasion where we felt that we would have been better off in a hospital.
  4. When in the hospital, I used to hear nurses talk about how low their pay was, from 1000 to 1300 rupees per month which was low even by the standards of the day especially considering that they had 12 hour shifts. And I was hardly admitted to a hospital renowned for charity work.
  5. Rs. 50-60 lakhs have to be paid as donation for a seat in many private medical colleges. (I heard that in PSG Medical College this year, it is 70 lakhs.) If that kind of money has to be paid for getting a seat, doctors will obviously charge more when they set up practise in order to recoup their costs. They will set up practise in the richer sections of cities thus leaving many areas under-served. Also, in their quest for turnover, doctors don't spend much time with the patients. 
  6. Apparently, there is something called a 'basin test' - a perfectly normal person is asked to do a blood test and is charged for it. He is given a normal report and the blood is thrown into a basin.
  7. Since ICU charges are higher, I heard that a dead patient was kept in the ICU and the attenders were only informed the next day.
  8. I heard that the  head of some hospital conducts pujas to get more patients if there were unoccupied beds in his hospital. Can you beat that for hypocrisy? 
The problem is that the increasing healthcare costs will not affect a person like me who can afford to pay the bills, who has access to different sources of information and who is probably looked at through a different lens by many medical personnel compared to other people who have not had the same privileges. As it is explained in this post, there are 3 major reasons why patients are not consumers:
  1. Health care is generally not a refusable or elective service.
  2. There is an asymmetry of information
  3. Purchasing power is concentrated in the hands of a very small number of "consumers".(I don't know the figures for India.)
The widespread distrust of doctors means that self-medication is widespread. People consume antibiotics as a preventive thus exacerbated the problem of antibiotic resistance. I saw in the news that doctors were demanding Aamir Khan's apology for some inaccuracy in the program. They are missing the wood for the trees. The perception of medical malpractice is widespread and if I  had got the idea of writing this post a couple of years ago and kept notes about everything that I had heard, I would have had a much longer list of malpractices. Why blame the mirror when the face is ugly?

PS: A TED talk by Atul Gawande: How do we heal medicine?

1 comment:

  1. With as much criticism that it is there for the American system and the insurance companies, one thing I can say is that hospital dont keep anyone longer than needed in the hospitals because the insurance simply won't pay.

    So insurance companies controlling everything is not necessarily a bad thing. They are better equipped than the patient's family who is under stress. Yes, there is the flip side that the insurance, but there are benefits too.