Money Minting Medical Care

PRLog (Press Release) – Jun 12, 2007 – Is there a great deal of malaise in the health care system in India as company after company sets up a string of hospitals to make a fast buck in the booming market economy? The rich may not bat an eyelid to shell out a few lakhs of rupees or even a million or more to get well? One more logical argument of the medical care sector is that there is a wait of years for a surgical procedure in Britain, Europe and America and the cost is very high there. So the patients and National Health Service of Britain as well insurance companies in the west find it worth their while to send their clients to India for speedy treatment in India at what is called a fraction of the cost back home. They know that Indian doctors trained in the best hospitals of the world are competent. Medical tourism, with a holiday in Goa, Kerala or the hill resorts thrown in makes India a very attractive proposition.

In this scenario, if the poor Indians, who cannot afford treatment at plush, five star hospitals and must take their turn at public hospitals, deserve to be ignored and left to their fate—to live or die as gods' will ordains. Yet day after day one hears of doctors' callousness in prescribing needless surgeries when medication or other treatments will suffice. It is alleged that cartels of hospital companies and private doctors running small clinics are in accord and concord to refer hordes of their patients to super specialists to seek advice, further treatment, a host of tests, invasive procedures like scans, angiographies, angioplasties, insertion of stent devices and heart bypass operations regardless of advanced age of patients, who may be incapable of even taking large doses of anesthesia.

Some of these great specialists offer free services at numerous charitable clinics with the hidden and basic intent and instinct of luring patients to their main hospital for a surgery like knee or hip replacement or heart treatment in an operation theatre. If they succeed in getting one out of ten patients so advised, they have succeeded in using their 'charitable time' profitably and successfully.

It is also known that some private doctors examining a patient for frozen shoulder, especially left arm pain, advise their patients in middle age or advanced age, to have their heart checked out. While this may appear to be a reasonable precaution on the part of the family doctor, the heart specialist may have other designs. He would like first of all to take an angiography, especially if some blood tests do not reveal much, but there is known to be a litmus test, very simple, which doctors use on themselves, but perhaps not always on their patients.

Yet it must be acknowledged that medical science and technology has taken great strides and a number of non-invasive or minimal invasive procedures have been devised and are being practiced and patients with severe and grave ailments are being treated quickly and sent back home in a few days after an operation. Several eye treatments do not require hospitalization at all and patients are sent back home after a couple of hours of arrival at a clinic and passage through an operation theatre. Even life saving heart transplants, liver and kidney transplants are available and these were unheard of a few decades ago.

Yet the battle royal over the Escorts Heart Institute between its new proprietors and the Executive Director, who has earned a temporary reprieve after a settlement of sorts out of court, might be seen in a new light. Before going into recess, the High Court had ordered a status quo ante until the next hearing in August. The parties to the dispute might have appreciated that dirty linen might be washed in public if the hearings resumed in a couple of months.

The original question of land having been given by the governmental at a nominal price to set up the Heart Institute on the understanding that 25 per cent of the beds would be for poor patients to be treated free of charge or at a nominal charge might come to the fore. The expectation would also be that even 25 per cent of the outdoor patients would be treated almost free with all the attendant tests.

If that happened, not only this particular institute or hospital, but a number of other hospitals having similarly received land on lease or freehold at a fraction of today's market price might similarly come up for undesired public debate and arise in the public domain for legal attention. Public interest litigation would draw the courts' attention and seek a pronouncement to curb the money making machines that many hospitals have sadly become.

Friends of the contenders of opposite sides in the Institute appear to have advised them to bury the hatchet as they would find themselves in hot water and their plans for huge profits could receive a considerable setback. That is not good business, whether it is good public service or not is totally a different matter.

Another aspect of the story is that pharmaceutical companies, which are also in the game of hospital factories, are bringing new expensive drugs to the market. Their sales teams are chasing doctors at their clinics and bringing to their notice new advances with the addition of a salt or two to offer better treatment. Sometimes the new formulations are four times the price of the original drugs, which are good for the rich as well as poor. But smart doctors must prescribe the new medications to help their friends in the industry. Old fashioned doctors, equally well qualified, if not better, advise their patients that they could do with the well tried standard, if not basic, formulations. They are not popular with the companies or the sales teams.

The Finance Ministry has tried to stop the drug companies from giving lavish gifts and offering holiday packages within India or outside the shores to influence the medical profession in its fair judgment. The implication is that they would also not be offered lavish hospitality in great hotels. But there are ways of bypassing all these rules even if tax rebates cannot be claimed for samples of medicines, leave alone gifts, hospitality and holidays.

The companies may or may not claim tax rebates for business expenses, but there is nothing to stop the use of first-rate guest houses around the world to take care of hospitality. Since several Indian pharmaceutical firms are themselves multinational companies or parts of them, the hospitality bills can be picked up by the parent company overseas or an overseas branch of an Indian establishment. The taxman's long arm cannot go that far.