How a healthcare system partial to privatisation fails the poor

29 July 2020
In a 4 June order, the Directorate General of Health Services issued a list of private hospitals in Delhi that are mandated to provide 10 percent of their total inpatient beds and 25 percent of their outpatient services free of charge to patients from the economically weaker section.
PRAKASH SINGH / AFP / Getty Images
In a 4 June order, the Directorate General of Health Services issued a list of private hospitals in Delhi that are mandated to provide 10 percent of their total inpatient beds and 25 percent of their outpatient services free of charge to patients from the economically weaker section.
PRAKASH SINGH / AFP / Getty Images

On 12 June, an image of the pricing list for COVID-19 treatment at a Max Healthcare hospital went viral on social media. Titled “Per Day Charges for COVID Management,” the banner displayed package rates for patients in a general ward as high as Rs 25,090. The package plans did not include the cost of COVID tests, “high value medicines” and management of co-morbidities, all of which the hospital slotted under exclusions to be charged separately.

Max Healthcare subsequently clarified that the chart was from their Patparganj facility in Delhi. The hospital tweeted that the chart “did not carry all the facts such as inclusions of routine tests, routine medicines, doctor and nurse charges etc.” It included another image showing the hospital’s COVID-19 package charges per day. A single room was priced at Rs 30,400, an intensive-care unit room at Rs 53,000 and an ICU with a ventilator at Rs 72,500.  Such treatment costs, prohibitively expensive for the vast majority of the country, have reignited a conversation among public health activists regarding the need to make private healthcare facilities available for and accessible to economically disadvantaged patients.

In an order dated 4 June, the Directorate General of Health Services, a department under the Delhi health ministry, issued a list of 56 private hospitals that are mandated to provide 10 percent of their total inpatient beds and 25 percent of their outpatient services free of charge to patients from the economically weaker section, or EWS. In Delhi, patients whose family income does not exceed Rs 7,020 a month qualify as EWS patients. The order also identified hospitals that are mandated to reserve free beds for COVID-19 EWS patients.

Much before the public health emergency brought about by the COVID-19 pandemic, the Supreme Court had ruled in favour of making the private healthcare sector inclusive of EWS patients. In a July 2018 judgement, the court directed that private hospitals built on subsidised government land must offer free treatment to patients from economically weaker sections. The court said that if hospitals flout this order, their lease may be cancelled.

In 2000, a committee under the chairmanship of Justice AS Qureshi was constituted to lay out guidelines for free treatment for the poor in private hospitals. This committee came up with the criteria of reserving 10 percent free beds in the in-patient department and 25 percent free beds in the out-patient department in hospitals which received land on concessional rates. “Delhi’s private hospitals located on government land were identified,” Ashok Agarwal, a lawyer who runs a non-profit called Social Jurist, said. “As of today, we have nearly 550 EWS beds.” Agarwal has been routinely filing public interest litigations to secure health and education rights for the economically disadvantaged. In 2002, Social Jurist moved the Delhi High Court against 20 private hospitals which had failed to ensure free treatment to the poor, in violation of the land deeds signed by them. In a March 2007 judgement, the high court ruled that the criteria recommended by the Justice Qureshi committee was to be adhered to, not just by the 20 respondent hospitals in Agarwal’s petition, but also “all other hospitals identically situated.”

According to public health activists, the larger problem is the culture of non-compliance in the private healthcare sector despite attempts at regulation. This is evident from a DGHS order issued on 14 May that directed private hospitals to comply with their EWS patient obligations. The order stated, “It has been brought to the notice of this Directorate that despite identified private hospitals being under obligation to provide free treatment to the extent prescribed by Hon’ble Supreme Court of India … to eligible patients, some identified private hospitals are compelling EWS patients to pay for either COVID-19 test or PPE Kit,”—personal protective equipment—“or both which is in contravention to the directions of the Apex Court.” Directing all identified private hospitals to provide free treatment to EWS patients, the order added, “If an eligible patient of EWS category is denied indoor treatment by the hospital authorities, despite the treating/ referring doctor advising for admission and the hospital having the vacant bed in the requisite category … action as deemed fit, would be initiated.”  

Aathira Konikkara is a reporting fellow at The Caravan.

Keywords: Ministry of Health and Family Welfare privatisation COVID-19
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