Two Worlds: One basis of Medical Corruption in India
© Dr. Rajas Deshpande
I am fond of cars and was surprised to see my dream car, a beautiful blue Aston Martin Vanquish parked in the hospital. As I parked my own beloved, the parking assistant read my face and told me: “It’s the owner of a toll booth”. As luck would have it, this gentleman came to see me with some bigwigs. The consult lasted an hour. The “bigwig” whispered to me: “Don’t charge, he’s my close friend”. They left.
As new Medical advances reach India, our doctors make efforts to acquire these skills, techniques and modalities. Although already highly educated, this adds to their work and responsibility. Newer therapies / techniques either demand more time with patient or more sophisticated equipment. Nothing comes free. In other words: as in any other field, newer and higher comes costlier.
There exist two worlds in India, with four attributes: the affording and the poor, the literate and the illiterate. All four avail of political pressure tactics. Whenever a hospital / doctor makes a new advanced technology / skill available, our society and govt. expect that irrespective of which world the patient belongs to, the doctor must offer that service without questioning their ability to pay for it. This is understandable for the “Life-Saving” or “Emergency” therapies, but for all else that the hospital or doctor invests in, there are more “Free and Concessional” patients at any center than paying. Include the “blackmail” by local political influences, and one has no choice but to surrender to the demands of free.
Most patients look at the doctor’s charges or investigation charges as “Direct Profit”. Only few literates understand the investment in this service, the price of buying and maintaining a place, equipment, and trained staff and especially two decades of education in most cases. The price of the same test may vary based upon the hospital one goes to: and if it is a “High Class” medical set up in a metro, the prices of everything there will be high class. The quality of qualified doctors is mostly good, whether they practice in big or small hospitals. It’s the technology and ancillary services that make the difference, and it requires huge investments. People pay extra for air conditioning in railways and buses, but blame the doctor for corruption if the hospital charges are extra for A/c. The tendency to go to the “Best” class hospital and fight for the lowest rates known in the country is ubiquitous.
One does not question the Lawyer’s fees in thousands for an “appearance”, and millions for a “case”. Here “Skill” / talent is most important, and still there is no guarantee of winning. No equipment / investigations/ and sleepless nights of critical calls. Still no one talks of “Capping” the fee. I agree there should be no cap for any profession: it will destroy superior abilities and encourage mediocrity. All classes pay as the lawyer wishes. Two lawyers with same qualification may charge totally different: hundred versus million, but no one questions, not even their self-respecting bar council. But a doctor charging in lacs just for the “skill” of making right decisions (not surgical / procedures) is unheard of, even in the richest cases.
Life is cheaper in India than money.
An example. If a patient is admitted, the doctor is responsible 24/7 for that patient’s supervision, and there are round-the-clock calls with the ward / ICU about various tests, reports, consultations and discussion with the ward / ICU doctor about management. When the doctor writes a visiting fee, patient ends up thinking: He /She saw me only for 5-10 minutes, but charged so high. This is most common among the illiterates, but the literates compete fiercely here.
These factors, especially the “Adjusting” of all non-affording / poor, political-concessions-class, dumped-by-the-govt. class patients have tremendously affected the workloads of thousands of specialists, whose time is wasted in dealing with “primary” healthcare and “squeezing in” a few paying patients among the many non paying.
The rich expect the charges to be what were meant for the poor, and the poor expect all the facilities that were meant for the paying class. I am all for the poor, but this approach will just stall any development.
Compassion and charity, although commendable, never generate future investment.
This is one reason some doctors may have preferred the “backdoor income”. It is NOT justified at all, but so is not justified the “dumping” of all non affording patients upon private practitioners instead of treating them at govt hospitals, and then expecting that every non affording patient must receive the same “facilities” meant for the paying patients, including the doctor’s time. One sympathises with poverty and all doctors are ever willing to help and treat an emergency without thinking of money, but it is the “advantage taking” that is killing specialist time and resources. So some doctors started charging “low” primary fees and encouraging backdoor income. That became a trend. Few newer gen docs are now overcoming this. The concept that “everything medical” must be charity and profitmaking is a crime must go, unless all the doctors are paid well enough for a decent life.
Patients who have money to drink daily, smoke, travel for fun, wear a lot of gold, don costly phones, drive luxury cars stay in bungalows all apply for and get “free” treatments, there is no mechanism in place to check these cheats.
Compare the inflation in the price of any commodity over last two decades. Compare the difference in the prices of “skilled and advanced” as against basic in any field. You will find that the doctor’s charges (not the equipment / technology) have remained very low, and there are no wide variations in the different specialist’s fees.
If the “free and concessional” concept is wiped off, and everyone pays according to the doctor’s qualifications, skill, talent and time, also the complications of a case, it will definitely help reduce the corruption and “malpractices” in this field.
It will not completely go though: until every other field is also corruption free. Especially administration, Govt., Judiciary etc.
The society is a big family where everyone eats the same and follows the same rules.
Don’t isolate the medical professionals.
© Dr. Rajas Deshpande
PS: some details in the first paragraph changed to protect identity.