In the days of manmade and natural epidemics of various types prevailing at the global/national levels, meeting the high costs of hospitalization is a major concern in India. Undoubtedly, schemes such as Ayushman Bharat and Arogyasri etc., provide a great deal of relief to sizeable sections of population in the country. Yet, there is a significant population outside the purview of these schemes. The most vulnerable sections are elderly people and those not fitting with in the umbrella of any of these healthcare schemes.
In a country of the size and complexity of India, healthcare must be provided by both public and private sectors. The past decade has seen substantial improvements in healthcare facilities both in public and private sectors. Despite significant efforts made in the public sector, healthcare facilities in various states are inequitable. People either by choice or compulsion depend on private sector. Confidence of citizen in public sector healthcare services is gradually increasing. As a case in point, the use of public health facilities has, as per the NSSO survey, increased from 28.3% to 32.5% in rural areas and 21.2% to 26.2% in urban areas between 2014-2017. Still a lot of ground needs to be covered by the public sector.
It is a stark reality that a significant percentage of population of India is still outside the ambit of these major health schemes. Such population has to device their own survival measures and depend on them by spending out-of-pocket expenditure on healthcare. The equation completely goes awry in an unfortunate caseof hospitalizationas in-patient. Those covered by schemes such as Ayushman Bharat may be able to sail through. However, even the middle class or upper middle-class families uncovered, find themselves helpless in case of any family memberrequired to be admitted in a hospital. As the coverage of medical insurance and other health security measures is limited, it remains a challenge at the end of the episode to settle the medical bills.
The high cost of medical treatment could be contained by following a simple strategy and taking certain steps forreducing the cost of treatment. The strategy is to take preventive measures and depend on alternative remedies. However, those needing intensive care, the cost reduction could be done in two ways. First, by taking steps to reduce the cost of treatment for example health facilities to use generic medicines. The prescription and use of generic drugs can itself significantly reduce the cost of treatment.To ensure affordability of essential drugs, and compliance with standard treatment guidelines, and to improve quality of care, regularly updating theNational List of Essential Medicines is important.
Second, by reducing the number of days to be spent as in-patient in a hospital. On the one hand, it will free hospital beds and on other hand, it will be lighter on the pocket of patients. Implementation of this component, however, will require development of a network of home health care providers and facilities.
What are the factors that lead to increased cost of providing health care? Some of these namely, are high cost of imported equipment for diagnosis and treatment, increased expenditure on salaries of health care professionals, ever-growing maintenance costs, expectation of a maximum rate of return on the investments particularly by the private healthcare providers, steep cost of creation of infrastructure, mushrooming standalone diagnostic facilities of indeterminate quality, and payment of various taxes etc.
The skewed physical distribution of hospitals, especially in the private sector. has some serious ramifications. This includes poaching of prominentdoctors of ahospital by other hospitals by paying a higher remuneration. Frequent change of management of private sector hospitals alsoleads to profit booking and thereby enhancing the cost of in-patient care.
Doctor G Guru Reddy, Chairman and Managing Director of the Continental hospitals, has given a beautiful quote stating: “Providing medical care is a business but patient care is not”. According to him, patient care is an art, and the medical science alone cannot cater for it. Ultimately, patient care boils down to the ethical questions and human values to be imbibed by doctors and paramedical staff. Thus, running of medical facility must be done on commercial lines but patient care is something sacrosanct that should not be compromised.
The moot point is to maintain a balance between keeping cost of treatment low with proper patient care; and still be able to run the medical facilities. Continuous efforts need to be made by the management to keep running cost of medical facilities within a reasonable limit. The cost could also be contained by the substituting import of diagnostic and equipment by indigenously developing such equipment within the country. Of course, this will require substantial research and development.
