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'Hospital Audits, Clinical Outcome Data': How to Regulate Private Sector Hospitals during Covid-19 Crisis

People wait in a queue to interact with their relatives through a video phone facility set up by a COVID- 19 help desk outside a hospital.  (AP Photo/Manish Swarup)

People wait in a queue to interact with their relatives through a video phone facility set up by a COVID- 19 help desk outside a hospital. (AP Photo/Manish Swarup)

Reports of patients with insurance being milked have been making headlines since the pandemic first broke out. State government instructed price capping on private hospitals has been imposed only in certain places, and even there, rules are being flouted.

The private healthcare sector -- a robust ecosystem of large hospitals owned by corporates, diagnostic clinics, as well as nursing homes -- was perhaps the most underutilized resource during the COVID-19 pandemic. While state hospitals and government-run diagnostic centers were at the forefront of tackling the pandemic when it first broke out, private players were absent during the initial battle, despite having resources, equipment, and a vast pool of medical professionals.

However, when these hospitals did come into the picture, their obscenely high charges for treating COVID-19 patients made headlines and went viral on social media. Reports of patients with insurance being milked have been making headlines since then. State government instructed price capping on private hospitals has been imposed only in certain places, and even there, rules are being flouted.

In some states, where few private hospitals have been designated to provide COVID care, beds are hardly available and people have to shell out an exorbitant amount to get tested at private diagnostic clinics. According to a report in The Print, the central government told the Supreme Court last week that, 'states could consider the rates fixed under the Ayushman Bharat scheme or the Central Government Health Scheme (CGHS) as a benchmark to determine the price cap on Covid-19 treatment in private hospitals.'

However, whether this price capping is an effective method or not, how can the private sector be made more accountable, how to regulate the pharma companies better are still questions that need nuanced discussions and meditations.

In a recent webinar organized by India Spend in collaboration with MCGill TB Centre, titled 'How is COVID-19 changing India's private healthcare sector?' these issues were discussed rigorously by a group of panelists -- Anoo Bhuyan, Data Journalist, Sonali Vaid, Healthcare Improvement Advisor, Rukmini S, Data Journalist, Inayat Kakar, Peoples Health Movement, Rema Nagarajan, Journalist, Vidya Krishnan, Journalist, and Malini Aisola, Drug Action Network -- who not only helped in shedding some light on the current situation but also offered solutions that should be considered by the government.

The webinar was moderated by Madhukar Pai, Professor & Canada Research Chair of Epidemiology & Global Health at McGill TB Centre. During the webinar, Pai said that We cannot just think from crisis to crisis and there has to be a dramatic investment in public health.

"It cannot be left at the lowball amount that the government has been spending for years. Indian public health not only needs more money, but they also need to deliver a better quality of care and win people's thrust back into the public system. And, the private sector needs to be better regulated. It is not a sector that can be left on self-regulation." he said.

Journalist Rukmini S pointed out that there has been very little data available in the public domain on the effectiveness of Ayushman Bharat Scheme in terms of reimbursing patients.

"From Ayushman Bharat, very little data has been made public. The early data was released to make the point that there wasn't an increase in respiratory diseases or any other related diseases to show that there weren't any undiagnosed COVID cases. Whether it has helped in treating patients, and reimbursing their costs, I have tried to look for that data but I didn't get any good data," she said.

Panelist Rema Nagarajan pointed out, "The first thing is for the government to acknowledge that 90 percent of the Indian population earns less than Rs 20,000 per month. So, the so-called 'regulated rates' are unaffordable for them. Therefore, either the government needs to be more realistic, and help people pay those bills and if the government has to pay the bills, then the bills must also be audited... We can definitely ask for audits of all private hospitals, random sampling of the billing, and forensic auditing of their billing. That's the least that the government can do."

Adding to Nagarajan's assertion panelist Sonali Vaid said that accountability should not just stop at the billing process.

"In addition to bills, I would like to see data on clinical outcomes, hospital infection rates. why is it so difficult (for private hospitals) to make these data available to the public? The same goes for government hospitals too... However, I am not sure about a rating or accreditation systems, because they can be gamed, they are expensive, especially an international accreditation system, and they don't necessarily ensure quality. " Vaid added that while she is wary in terms of external benchmarks, she believes that there has to be a move towards transparency, in outcomes, and costs both.

Right now, the lack of data means that that the private sector gets to make the assertion that they provide better care, and can get away with it. It might actually be true but neither a patient nor a journalist or a member of the civil society has any way to challenge that, said journalist Anoo Bhuyan. "The government has no way to challenge that and make a policy prescription because the private sector continues to always assert that it is better and we are supposed to just believe that when we go to the private sector, we must pay such high premiums because the quality of care and the outcome will be better there," she added.

Panelist Inayat Kakar pointed out that another way to ensure accountability is for the civil society groups and patients groups to be better organized as far as dealing with the private health care sector is concerned. "Right now, we have HIV patients fighting one fight, and Covid patients are fighting another fight, and there is another set of patients with other issues... we need to be better organized to reckon with these things, and develop more nuanced positions because while health care has become a central electoral issue... the right to health has still not come as a political agenda," added Kakar.

Another panelist and journalist, Vidya Krishnan said, "If you are insured you get overtreated, and if you are poor there is no dignity...I think 'One Nation, One scheme' is the most lucid idea I have heard. We have to stop this medical apartheid where the medical science changes, depending on how much money you have in your pocket. There are standard operating protocols whether it is the private sector or the public... We have to stop this medical apartheid which is deeply rooted in the very castist segregation."

Krishnan added, "even robust European nations are looking at nationalizing healthcare, and I think it is time to have that conversation in India, especially if you have benefited from taxpayers' largesse, which every big hospital has. They don't pay electricity bills, they don't pay water bills, and for next to nothing market values they set up these facilities and they milk patients. This cannot go on any longer." she added.

Malini Aisola, from Drug Action Network, pointed out how pharma companies have also capitalized on this pandemic, and why they should be regulated too.

"In the absence of any established treatment of COVID-19, the pharma industry has grabbed onto any opportunity to launch or produce experimental treatment. This in itself is not wrong. But, we have to understand the backdrop against which this is happening, where health products are being approved on the basis of waivers to producing evidence and accelerating the processes, be it in the case of drugs, diagnostics, or vaccines. " Aisola said.

"Enabled by the lack of transparency of the drug regulators, the pharma industry has been doing both -- cutting corners, and not producing adequate evidence, and also in the absence of the evidence, heavily promoting their experimental treatments. The price has been purposely kept very high in order to monetize from the pandemic and the anxiety of the public," she said. Aisola pointed that it has been a challenge to get information regarding the bases of the approvals of COVID diagnostics, and other therapies due to which people have already spent lots of money on treatments whose utility is questionable.

You can watch the discussion here.

first published:August 08, 2020, 16:27 IST