The Cost of “FREE” medical treatment     

Government Hospitals are supposedly free or at the very least cheap. In current times lot of flak has been heaped on private hospitals and these have been labelled as cheats and dacoits out to fleece patients of their money in their time of misery. Many of my own patients, administrators and politicians feel that private sector charges are disproportionately high and compare our charges to the charges of procedures in PGIMER.

https://timesofindia.indiatimes.com/…/articles…/62186924.cms

Today I read about a study conducted by an associate professor of health economics at PGIMER where they traced 2955 patients of trauma to assess the cost incurred by them. On an average each patient spent 17830 Rs from their pocket on procedures, drugs and disposables plus indirect costs including loss of productivity of about 33 lacs per patient. This does not include the cost borne by the taxpayer in form of Government infrastructure, subsidized or free services and human resource paid for by the exchequer.

This along with a study conducted by Dr Shakti Gupta at AIIMS in 2012 which calculated the real cost of a laproscopic procedure done at AIIMS are the only two studies to my knowledge in this regard. This is a very important area and before we are swept by tide of hatred against private doctors and hospitals we need to calculate the bang for buck while providing healthcare. When we calculate cost to treat a patient we need to factor in cost of multiple visits, transport, loss of workdays for relatives, actual amount spent on treatment whether by patient or taxpayer. Any comparison between private and Government healthcare needs to keep these factors in mind.

Since there is no such comprehensive study or work done it is unfair to label the private sector healthcare services as expensive. Infact the efficiency and the no frills approach which are adopted by Small and medium Healthcare establishments provide solutions to many healthcare needs at a much cheaper cost than even the Government sector. This however will change with the implementation of Clinical Establishment Act , its mandatory licences and permits, its inspector raj , and its bureaucratic interference.

India is a complex society with variety of healthcare needs. There is need for more institutions like PGIMER, but then so also is there need for increased numbers of PHCs, civil hospitals, the nursing homes and the Fortis like hospitals. Our aim should be to get the maximum output for the investment made in healthcare “COLLECTIVELY”. Government cannot do it alone but neither can Private sector. We love to blame the quacks but even they serve a purpose in some areas.

The rates of CGHS, ECHS and other organizations also need urgent upward revision in view of the real costs vis a vis the visible costs. This upward revision may actually result in money saved because it will then make it viable for the service providers to work ethically instead of resorting to overbilling for disposables and medicines to make up for unrealistic costs of procedures as permitted by the insurers.

Dr Neeraj Nagpal 
Convenor,Medicos Legal Action Group, Managing Director MLAG Indemnity,
Ex President IMA Chandigarh
Director Hope Gastrointestinal Diagnostic Clinic,
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