india

Updated: Aug 18, 2017 07:22 IST

Visiting hospitals in India is a nightmare for patients and their families, not just for the trauma associated with illness and injury, but also because of overcharging and apathy.

Reports abound of people being fleeced through unnecessary diagnostic tests and procedures, prescription of expensive medicines, inflated hospital bills, kickbacks for referring patients, nexus between pharmaceutical companies and doctors, and hospital and insurance company frauds.

As a result, patient-doctor trust is at an all-time low, prompting the government to intervene.

India’s drug-price regulator National Pharmaceutical Pricing Authority (NPPA) fixed the selling price of knee implants from Rs 54,000 to Rs 1.14 lakh, almost 70% lower than what is currently charged. Goods and Services Tax will be extra. The price for the most commonly used chromium cobalt knee implants, which account for about 80% of the market share, is fixed at Rs 54,720, down from the current market price that ranges between Rs 1 lakh and Rs 1.5 lakh.

In February, the NPPA had capped the price of stents at Rs 30,000 for high-end products and Rs 7,500 for bare-metal ones after companies sold it without printing the maximum retail price (MRP) to allow hospitals to mark up prices by as much as 650% in certain cases.

The NPPA is considering a price ceiling for orthopaedic implants for knee, shoulder, hip and other joints because an alleged industry-doctor nexus had pushed profit margins up to 400%.

“To prevent overcharging, it will be mandatory for medical device manufacturers to print the MRP on packages,” said minister of state for chemicals and fertilisers Mansukh L Mandaviya in the Lok Sabha.

He said the move follows amendments to the Legal Metrology (Packaged Commodities) Rules, 2011.

Doctor whistleblowers

Worried by the increasing mistrust, doctors have exposed rampant medical malpractices.

Pharmaceutical companies, for example, offer inducements such as diamond necklaces and overseas holidays to doctors for meeting prescription targets of expensive drugs. This prompts many doctors to prescribe such medicines even when they are not needed, found Pune-based gynaecologist Dr Arun Gadre after interviewing 78 doctors across India. He put his findings in a book, Dissenting Diagnosis, he co-authored with Dr Abhay Shukla.

“We were stunned at the transformation of an intensely service-oriented profession into a market-driven commodity and then into a corporate-led profiteering industry,” said Gadre, citing the case of a cancer drug that costs Rs 100 at retailers but is sold at an MRP of Rs 800.

“What do you think happens to the margin of Rs 700? The chemist has to hand Rs 700 to the doctor because it is he who prescribed the medicine in the first place,” he said.

Preventing malpractice

Professional misconduct by medical practitioners is governed by the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002, which states that “a physician should expose, without fear or favour, incompetent or corrupt, dishonest or unethical conduct on the part of members of the profession”.

It also says “a physician shall not give, solicit, or receive nor shall he offer to give solicit or receive, any gift, gratuity, commission or bonus in consideration of or return for the referring, recommending or procuring of any patient for medical, surgical or other treatment”.

Disciplinary action can be taken against erring doctors.

The Indian Medical Association (IMA) has a grievance-redressal cell that deals with complaints against doctors committing unethical practices. But complaints are rarely made and even if a doctor is found guilty, the only action taken is termination of his IMA membership.

“Over the past year, we have not received any complaint. For cases prior to that, I will have to check records, but I don’t remember having heard of any such complaint in recent years,” said Dr KK Aggarwal, the president of IMA.

In a first, the Poona Citizen Doctor Forum created a public database of ethical doctors. Patients share details of rational and ethical doctors on medimitra.org.

“Chennai and Jaipur have taken up similar initiatives,” said Gadre, who is part of The Alliance of Doctors for Ethical Healthcare that is creating public awareness about medical malpractices.

He doesn’t approve doctors taking to social media to highlight wrongdoings.

“That kind of whistle-blowing is equally unethical; one should act within the framework of IMA or Medical Council of India guidelines and let the matter be investigated before passing a judgment,” said Aggarwal.

Hospitals take stock

Several hospitals have established mechanisms to track outcome. “We collect data from all departments in all our hospitals and share it anonymously so that doctors, who are not named, know that their outcomes are not on a par. This prevents overbilling as there is no incentive for doctors to make patients overstay,” said Dr Anupam Sibal, the group medical director of Apollo Hospitals.

Non-government organizations too are helping regulators expose malpractice.

The Satara-based social activist and founder of Lek Ladaki Abhiyan, Varsha Despande, carried out 49 sting operations to expose doctors and hospitals engaged in illegal sex determination tests.

Her work led to 18 convictions under the pre-natal diagnostic techniques act that bans sex-determination and selective abortions.

At 1.4% of the GDP, India’s public health expenditure is among the lowest in the world. Almost 70% of the health spending is by people bearing their own expenses.

“Regulation is a must to streamline processes and it must be done by regulators as well as doctors to ensure patients always come first,” Sibal said.