A Complete Abdication of Responsibility
















The views expressed are personal



The Myth of Overcharging in Private Corporate Hospitals in India








‘So, where are you folk, from’?

‘We are from New Delhi, India’.



‘So do you guys do ‘bypass surgery’






‘Sir, we charge USD 10000 for the surgery’.


‘So what is your success rate?’

‘Well, it is close to 99%’.











A Time for Reflection

The last week of December is usually a time for reflection.

And the private healthcare industry in India has a lot to think about. The last two months have been those of turmoil for the industry. The crisis related to the implementation of a draconian Clinical Establishment’s Act in Karnataka led to angry protests by the medical community in Bangalore, while in Delhi two cases of alleged overcharging and medical negligence at the two leading hospital chains caused an unprecedented furor. Much has been said about these cases, I won’t add more, however, we must reflect upon what lies behind these flair-ups.

These cases must not be considered as an isolated outbreak of public anger with the media and the politicians blowing up the issues. While that did happen, we must look at them as a trigger for a far deeper malaise.

For a long time, private healthcare in India is increasingly being viewed by patients with a great deal of distrust. With the public healthcare in tatters, the consumers continue to flock to the private establishments, where the care and services are of high quality, however, they no longer trust their doctors and hospitals. This is an extremely worrying sign because the only thing that binds patients and clinicians is trust, an implicit faith in the system that the hospitals and the clinicians will always act in the interest of the patient.

We must ponder over what has led to this catastrophic erosion of trust.

Private healthcare systems are being increasingly looked upon as businesses with commercial interests, which far out-weigh patient’s interests. The media has been peddling this narrative for a while, highlighting cases of ‘wrong billing’ without diving into the arcane of what exactly is wrongly billed. Selective charges of profiteering on things like syringes and gloves are bandied about causing more damage. Somehow, the real narrative of hospital profitability measured in terms of financial parameters such as Return on Capital Employed (ROCE) do not find any mention in these stories. The fact that most private healthcare companies are barely profitable just doesn’t seem to register. Private Healthcare systems need to address this urgently. They must get together and build a counter-narrative, which highlights their often precarious finances and the enormous risks they have taken to build a healthcare system, which actually takes care of the needs of the majority of the people of our country.

While this needs to happen on the external front a lot of house cleaning must also happen internally. The hospitals must review their pricing structures and make them more transparent. The patients today are educated and if the components of a hospital bill are explained to them in detail, I am sure many will understand and appreciate.

The other big issue that destroys trust is the difference that the patients find in the estimates given at the time of admission and the final bill that they end up with. Medicine is at best an inexact science and in many cases, it is hard to predict a patient’s course during hospitalization. However, large private chains do have the data and technology to be able to predict estimates with a reasonable level of accuracy in a high number of cases. Thus a system can analyze bills of say, the last 500 patients who underwent a bypass grafting, exclude the outliers and predict the probability of the bill is a certain amount. This can be shared with the patients transparently. Even if hospitals do this for cases of planned and routine surgeries, I am sure the trust levels will increase.

The real trust builder is, of course, ensuring proper engagement and communication with the patients. Large hospitals, with hundreds of patients, often forget to pay enough attention to individuals leading to a sense of isolation and abandonment. The hospitals need to establish protocols for patient communication. The clinicians must sit down with the patients and their caregivers and explain how the patients are doing in the hospital, the challenges that they foresee and the prognosis. My view is that even if the prognosis is grave, it should be shared transparently with the caregivers. This should be done with great sensitivity and empathy and in a language which is shorn of all the jargon.

Finally, the biggest builder of trust is the time that a clinician spends with the patient and their caregivers. In busy hospitals, clinicians often just do not have enough time to spend with their patients. The out-patient consultations are frequently cursory and fleeting, often leaving the patient wondering whether their doctor has even understood their medical condition or not. While admitted to the hospital, sometimes patients don’t even see their surgeons even when they are being wheeled into the OT’s. Why can’t we have a system, where the operating clinician would himself visit the patient either in their rooms or in the pre-op area, reassure them once just before they face the knife. There can be many such processes that can be established, which gives greater comfort to the patients.

The media noise of profiteering resonates with patients and caregivers only because they find their hospital experiences sterile and scary. As the healthcare costs mount, the patients will need better experiences for them to trust their hospitals and care providers.

My belief is that the time has come for private healthcare providers in the country to walk the talk on patient-centric care. No amount of external regulation will help build the lost trust. It is only actions, which build trust in patients and their caregivers, which will help regain the lost ground.

And once we regain our patient’s trust, they will not find us profiteering nor will the media’s false charges stick.

Here is wishing all my readers a Merry Christmas and a very Happy New Year.

The views expressed are personal


The Aftermath

While the slug-fest between the government of Delhi and private healthcare providers, the Indian Medical Association/Delhi Medical Association and a completely partisan media continues, one is left wondering about the possible aftermath of this ugly episode. The media will soon move on to other stories and the government having scored some brownie points and having successfully demonstrated its ‘might’ will look at another vote-catching device, only the citizens of Delhi will be stuck with a much worse healthcare system.

Let us look at some of the reasons for this.

With the kind of sheer hostility that is being shown by the consumers towards private healthcare and individual doctors, many are already talking about not accepting seriously sick patients. Their fear is that if the patient dies in the hospital, they will be blamed for the death and they run the very real risk of being publicly abused by vicious and ignorant television anchors, beaten up by patient attendants and may be sacked from their jobs. In an environment where the media and the patients believe that it is the doctor’s job to get them well and that he is fair game if the outcome is not the desired one, we are clearly telling our doctors not to treat patients where there is a risk of failure. This will indeed be very sad because as patients we must give our doctors the confidence and the strength to fight the good fight to the best of their skills and ability. That trust is the very basis of the practice of medicine.

The advent of private healthcare had also seen some of the best and the brightest Indian doctors returning to India to work in these corporate hospitals. The world over, Indian doctors and nurses are recognized for their skills and diligence. There is much demand for them all over the world. The prevailing atmosphere of distrust and antipathy is already making many of them uneasy. Many have started regretting their decision to return and work in India. Many who were contemplating to return would now prefer to stay put. Many who had plans to go abroad for training, would now look at ways to bring their plans forward and try to stay abroad longer. One can hardly blame them.

Private hospitals are beginning to realize that it is far more important to have paperwork and video recordings of their patient interactions rather than a caring system, where people are encouraged to go the extra mile to help a patient. Since, the hospitals are not sure when they may be facing a media or a court trial, they will ensure that they are well protected at all times. This will further push up the cost of private healthcare. The undue activism visible today will end up defeating its own purpose.

Setting up and running hospitals is an expensive proposition. Only investors with very deep pockets can build the required infrastructure and sustain operations till they see profits, which happen years later and are meager in any case. If the local governments pandering to their vote-bases arbitrarily decide to shut down hospitals, why would investors put in money to build healthcare infrastructure in the country? The government spends on healthcare are in any case minuscule and compare poorly even with sub-Saharan Africa. The government hospitals are already over-crowded, mismanaged, filthy and without much accountability. If the private investors decide that investing in healthcare is not well worth the risk, where will the people like you and me go for our healthcare needs? If I was planning to set up a hospital in Delhi today, I would certainly think twice.

Working for some of the leading ”corporate” hospitals in India in the last 15 years, I have had the opportunity to travel the world. Everywhere that I have traveled, I have been uniformly asked one question, which is, how has Indian private healthcare system evolved so well. Considering the country’s other developmental parameters, private healthcare, which attracts patients from all over the world (Max Healthcare received patients from 80 countries across the world this year) stands out. Not only is the quality of health care compares well with the world’s best, the costs are the lowest. Ironically, instead of taking pride in our achievements, we are trying our best to run down our hospitals and the people who work in them.

Private healthcare players in Delhi are quite dumb-founded by the political grandstanding, the unwarranted hostility of an ignorant media and worse of all the support of ordinary citizens to this madness. Are we, the citizens of Delhi willing to pay this kind of steep price just because we believe the half-truths being peddled by self-serving politicians and a biased, unprincipled media?

PS: Might be a good idea to find out where these same politicians and media warriors and their families go to when they need serious healthcare. No prizes for guessing though.

The views expressed are personal.