How To Deal With Higher Costs In Private COVID Care?

• Prof K Nageshwar

Telangana government has once again cracked down on few private hospitals for imposing exorbitant charges for COVID care. This knee-jerk reaction is more a political response than any mature public health decision. The COVID care, since the onset of the pandemic, has been characterized by the unprepared government sector and unregulated private sector. The government’s approach to the problem of profiteering in the private healthcare centre swung from the complete abdication of its responsibility to a total crackdown. Instead, the matured approach would be engagement with the private sector.

The confrontation between government and private health care facilities need not always further the interest of the people in the age of pandemics. As Supreme Court observed in the Suo Motu writ petition No. 70 of 2020, there shall be Government Public Partnership to avoid world war against COVID-19.

The Supreme Court has observed that the fundamental Right to health includes affordable treatment.

Either more and more provisions are to be made by the State Government and the local administration or there shall be a cap on the fees charged by the private hospitals which can be in the exercise of the powers under the Disaster Management Act, the bench comprising Justices Ashok Bhushan, R. Subhash Reddy, and MR Shah observed in SUO MOTU WRIT PETITION (CIVIL) NO.7 OF 2020 [RE: THE PROPER TREATMENT OF COVID 19 PATIENTS AND DIGNIFIED HANDLING OF DEAD BODIES IN THE HOSPITALS ETC.]

As Allahabad high court observed in Medwin hospital vs State of Uttar Pradesh, the State cannot restrain a private health care facility merely on the ground of higher charges. Instead, the private hospitals have to be made accountable. The cost of services rendered needs to be regulated to avoid profiteering. Mere restraining private hospitals from offering COVID care will further reduce access to health in the age of pandemic resulting in a demand-supply mismatch in pandemic care that pushes up the cost.

A series of measures are required to regulate private health care and prevent brazen commercialization of health care. As the applicant in Sachin Jain vs Union of India told the Supreme Court, a private hospital has to give it in writing if admission is denied to a patient. Artificial intelligence can be employed to peruse the medical bills of private hospitals to avert levying exorbitant charges. Several high courts in the last few months of the pandemic have impressed upon the governments to take a host of measures to curb commercialization of health care that too in the age of pandemic. For instance, Kerala High Court firmly defended State Government’s orders capping charges in private hospitals. The Courts have also upheld the government takeover of 50% of beds in private hospitals.

Kerala state government, Mumbai administration, etc, have set up local level war rooms to monitor the availability of beds, oxygen, ventilators, and medicines in private hospitals to avoid artificial scarcity being created leading to the higher charges.

A grievance redressal mechanism has to be set up at different levels to look into the complaints of overcharging for the services rendered in private hospitals. Different levels of health care facilities like isolation centres, first and second-level treatment centres connected with hospitals have to be set up to avoid an unnecessary rush at multi-specialty private hospitals. Private hospitals should be encouraged to offer telemedicine services to those in-home care and in smaller medical facilities. Such measures would ease demand and supply that can reduce the cost in a free market.

Private hospitals should be made to collect only the actual cost of procurement for the supply of drugs, PPE kits, etc. All private hospitals should display the cost they charge for the services offered. Transparency will act as a deterrent against profiteering. Overmedication often leads to a higher burden on patients. Standard protocols help to enforce that would regulate the cost too.

Over some time private sector gained primacy in health care delivery resulting in unethical practices and disproportionate out-of-pocket health expenditure in India. Expansion of health care facilities in government, NGO, philanthropic sectors would enhance competition thereby forcing the private health care providers to lower the costs.

By Prof K Nageshwar

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