CORPORATE HOSPITALS

Since before independence, India has had some of the best hospitals in the state sector and most of them are attached to state medical colleges.  Some of the philanthropists set up hospitals under the charitable trusts which were providing the much needed healthcare to the growing population.  Till about late 1970s, the healthcare sector had been largely under state control or under the charitable trusts set up by the philanthropists.  Hardly there were any hospital in the corporate sector and corporate hospital culture was not at all known in the broad Indian scenario.  

The corporate healthcare started in India with the advent of Apollo hospitals which started its operations in Chennai in early 1980s. This spawned the mushrooming of hospitals in private sector which were funded by many investors and were listed in the bourses. The basic idea of any corporate listed in the bourses is to make money for the investors and keep the share prize high to enable the investor a market to trade. Unless the corporate hospital makes money and a healthy profit, the share prizes may not be ruling high and the investor may not have a market to trade his holdings. Therefore, the bottom-line has become a mantra for almost all the hospitals that are in private and listed in the bourses. For maintaining competitive edge, these hospitals started attracting best talents from both within the country and abroad offering compensation that were unheard of till a few years back.  In a few corporate hospitals that were started, some of the best brains were offered a share holding and a place in the board of directors, in addition to the hefty compensation.

The health insurance scheme by the public insurers that came into existence in the mid 1980s, boomed with the coming of age of insurance business and opening up of insurance sector to private participants in the early 1990s.  Today, most of the corporate hospitals have a separate desk handling health insurance and many patients who go to these hospitals have health insurance coverage from more than one insurance company.  The third party administrators who facilitate the easy claim settlement of the bills of the hospitals/ insured handle all the paper work and make the work of insurance company less burdensome. The hospitals have different packages for each type of ailment requiring procedures.  These packages include everything from the room rent, nursing, medical attendance, procedure expenses, etc.  These different packages are offered based on the patients' ability to pay or the amount of coverage of health insurance. 

Be that as it may, this writing is not chronicling the history of development of corporate hospitals and health insurance sector in the country.  On the contrary, it is to bring some of the practices that are prevalent in some of these hospitals which are borderline unethical.   The doctors who are working in some of these corporate hospitals are reportedly given a target of getting a particular number of patients every month/week for various procedures so that the hospital will be earning more money than just consultation charges on out-patient basis.  Therefore, the doctors are always on the lookout for a vulnerable patient or relatives to ensure that the out-patient are converted to in-patient and the recommended tests and procedures are done. Some of the doctors even go to the extent of frightening the patients or the hapless relatives with consequences of not admitting and going ahead with the recommended procedure.  

A leading corporate hospital chairman in a televised interview in a language channel was bold enough to admit that his hospital is not a place for common man.  When the anchor asked him whether the ICU charges are 5K per day, the doctor proudly said that the charges for ICU in his hospital are 10K per day and common man cannot afford his hospital.  With the corporate hospitals now working with profit as the motive, the  cost of health care has increased astronomically and took the healthcare in these hospitals beyond the reach of common man.   Not only that the charges in these hospitals are exorbitantly high, various tests and procedures recommended to be done at times become unnecessary. These tests and procedures inflate the cost of health care.  

Some time back  while discussing the cost of healthcare in the private hospitals, a gentleman recounted his personal experience with a hospital relating to his deceased father. The father suffered a massive cardiac arrest and he was rushed to the nearest corporate hospital. Despite the best efforts of the doctors,  he could not be revived and collapsed the same night. The hospital insisted that the son clear the bill before the deceased person's body was permitted to be removed.  The bill was to the tune of about  100K for just one night hospitalisation.  There was another instance when a woman who suffered a stroke had to undergo a particular diagnostic test in a reputed hospital which was available only in that hospital in the city.  After the test was performed, the reputed doctor insisted on admitting the patient and getting a procedure performed despite resistance from the family. He went to the extent of frightening the relatives with fatal consequences if the recommended procedure not got done immediately.  It is the will power of the relative and the faith the family has in the Almighty that saw them through the crisis and today thankfully nothing of the sort projected by the doctor happened.    In another recent instance, a young woman who went with a complaint of lower abdominal pain spreading to the lower back, was wrongly diagnosed with appendicitis and advised removal of the appendix in a corporate hospital in a tier 2 city.  Fortunately, in the last minute the husband was hesitant and on the advice of close relatives got the woman checked up in another hospital and it was revealed that no such procedure was warranted.  It was only a case of possible urinary tract infection and calcification.  Further tests are underway and it is confirmed that it is not appendicitis.  Had the husband of this young woman not been hesitant it would have entailed unnecessary removal of a healthy appendix at a huge cost to the couple.

Organ donation has not caught on in the country as it should be in a big way and many people are dying daily for want of a healthy matching organ from a donor or a cadaver.  In most of the cases of cadaver donations, the person is a victim in an accident and brought to the hospital in a critical condition and the doctors try to revive him.  After the attempts fail, the victim is declared brain dead and the relatives are impressed upon to donate the organs. It is a noble act on the part of the relatives who agree to donate the healthy organs of the accident victim who cannot be revived and declared brain dead, which is worthy of emulation by one and all. The actions of the law enforcing authorities in providing a green channel to take the harvested organs from one hospital to another to the waiting patient or from one city to another city is quite laudable.  What the Chennai city police had done in the last many occasions is commendable.  

However, there is another scenario that is now rearing its ugly head in the medical field.  It is of the declaration of an accident victim as brain dead immediately on admission to the hospital and arranging for harvesting of healthy organs for transplant to other patients.   It is reported, that in a corporate hospital there is a team of people who have specialised in convincing (?) the relatives of such accident victims declared brain dead, to agree to the hospital to harvest the organs for transplant.  The number of brain dead accident victims admitted to the hospitals is increasing year after year.  The spike in number of such cases in a few hospitals raise a doubt about the practices followed there.

The procedure for organ transplant is laid down by the government and there is a huge waiting list.  A relative of mine had undergone liver transplant almost after three years after registration in a major corporate hospital.  In another case of  a relative the kidney donor was the wife and the paper work was extraordinary and the approval was given only after the state committee was convinced of the need and complete scrutiny of the extensive paper work submitted. The procedure for getting a cadaver donation is also very strict as per the norms laid down per the rules framed under the act.  It appears that when it comes to VIP patients such rules are more observed in breach.