New Delhi: Expecting their baby in the first week of September, Bidintha Brahma and her husband Biju Mushahary had prepared themselves for the delivery procedures to be conducted at Phoenix Hospital – a birthing and neonatal hospital in Greater Kailash. “We had no idea that our plans would not work, and that we would have to face entirely different consequences,” said Biju.
On September 5, while the two of them were still in Phoenix, they found out that Bidintha had tested positive for COVID-19 and were asked to shift her to a COVID-19 hospital at the earliest. The next afternoon, she was admitted to Moolchand Hospital.
She delivered her child that very day, on September 6, after a C-section surgery. She was kept in the ICU for a night and later shifted to a private isolation ward, while the child was kept away from her.
The couple had been advised by another doctor to get a retest done because Bidintha had no COVID-19 symptoms. The second test reports reached them on September 6, and it was negative. These were both RT-PCR tests done at Noble Diagnostic Centre in Hari Nagar.
Under normal circumstances, she could have been discharged three days after the Caesarean surgery but the COVID doctors suggested she stay put in the hospital for at least two weeks. “While it was all too confusing, we knew that she could very well be taken home as she was asymptomatic. We did feel that it made no sense to keep the mother and child apart for that long,” said Biju.
He insisted that her negative test reports be taken into account and she be discharged after three days. The doctors finally agreed on the condition that Biju would have to sign a ‘discharge against medical advice’ (DAMA) document.
On September 8, Biju got his child released from the hospital and asked for the bill to be paid for Bidintha’s discharge scheduled on the next day. He was told that the bill until then was around Rs 1.23 lakh, and he would need up to an additional Rs 20,000 for a day’s cost (that means Rs 20,000 per day cost for three days after the child was delivered.)
When it was time for her discharge on September 9, the billing department suggested Biju opt for insurance payment. “I refused to pay via insurance for two reasons: first, my insurance did not have a maternity cover and I was not sure if she would be treated as a COVID-19 patient at all; second, insurance processing generally takes a couple of hours and we were not willing to wait any longer,” said Biju. The billing department, however, was persistent and said that the final amount will be lesser with insurance.
When Biju received the final bill, the amount charged for three days of Bidintha’s treatment had now reached Rs 2.17 lakh. He was shocked to note this sudden increase. “That bill was of Rs 1.8 lakh – again a marginal increase from what they had informed me the previous day,” said Biju.
Bidintha was supposed to be discharged at 12 pm, but this ordeal delayed it until 6 pm. “We were tired and had no energy to fight with the hospital anymore. I cleared all payments, but the hospital refused to come clean and give me the provisional bill until the previous day.”
Issues of abrupt and unexplained overcharging in private hospitals are not new. Despite the Delhi government’s June 20 order on capping prices for COVID-19 treatments, private hospitals continue to flout these rules unabashedly and keep the patients in the dark.
The latest in their series of embezzlement is this erroneous and convenient misinterpretation of the applicability of the price capping for insurance patients. Moolchand Hospital itself has far too many examples of this nature.
Inflated medical bills
When Sunny Guliyani found out that his 62-year-old mother Asha had been charged Rs 3.73 lakh for COVID-19 treatment at Moolchand hospital, he wrote a complaint letter to R.N. Das, the Delhi government’s nodal person for complaints against private hospitals. He wrote that he’s mentally disturbed because the insurance company was not ready to make the payment. Therefore, he had to pay through his credit card at a 24% interest rate charged by the bank.
On August 10, Madhu Handa, medical administrator at Moolchand Hospital, responded to this complaint forwarded by Das to the hospital. He noted that the patient was admitted on a cashless/credit basis based on approval by the insurance company and that they could have availed the capped rates if they opted for a self-pay basis instead. His response attributes the hospital pricing to “due to lack of clarity around applicability of capped rates for cashless patients.”
Inayat Singh Kakar, a health rights advocate associated with the People’s Health Movement, however, dismisses such explanations. “There is absolutely no basis for such a claim! The order makes no such exceptions for insurance patients at all. In fact, it is quite clear that the prescribed rates are applicable to all patients,” she said.
Along with many others, Inayat has been instrumental in helping patients navigate their way through the murkiness of healthcare systems during the pandemic. They have been highlighting loopholes, discrepancies and violations of the order on price capping in private hospitals.
“It’s one thing when private hospitals violate government directives and overcharge patients, but when the government also refuses to take action, it is very frustrating – more so because the Delhi government came back to power on the promise to provide right to healthcare for all,” Kakar said.
For her, these times have only reinforced the need for a stronger public healthcare system and regulation of private healthcare systems. “These are not new revelations, but demands raised by citizens for ages now. But, without structural repairs, how long can patients just keep running from pillar to post like this?” she asked.
In June, Nitin Gulati had also raised complaints about overcharging by Moolchand Hospital. His mother, Tarun Lata, was billed Rs 2.59 lakh for a 10-day period in the isolation ward for COVID-19 treatment.
The insurance company had initially agreed to pay as per the Delhi government’s price cap directive and not the full bill amount. His insurance covered Rs 1.02 lakh and an additional Rs 80,000 was added to the amount covered when Gulati’s employer intervened, but that still meant an out-of-pocket expenditure of Rs 80,000.
Poor grievance redressal mechanism
On August 6, Gulati wrote a complaint letter to R.N. Das which was forwarded to the central government health scheme (CGHS) branch, even though his case had nothing to do with the CGHS. On August 7, Madhu Handa denied the charges and responded to the complaint and the CSO letter on violations by private hospitals saying the billing was done as per the agreement between the hospital and the insurance company.
Inayat explained, “You see, that order is completely silent on grievance redressal mechanisms. In absence of such mechanisms, patients are left on their own.” So far, they have approached several people from the Delhi government for help, and it has been quite ineffectual. “They are all public servants, so why should they not be accessible to the public? Why is the onus on the public to just hunt down email IDs?” she asked.
Das has admitted that hospitals cannot continue to charge insurance patients any differently. “The rate is fixed and there is no ambiguity about this. It is as simple as that. There is no loophole.” he said.
In response to violations by private hospitals, Amresh Kumar of Aam Aadmi Party, had earlier told me that he had done his bit by following the protocol of connecting the aggrieved patient to a higher official in the hospital.
Inayat stated that they have often had to rely on the media to get the government officials to act somehow. “Otherwise, when you contact them [government officials], instead of sharing contact details of bureaucrats, they give contact details of party workers. We do not even know what their official position is or what powers they actually have. My suspicion is that these are fairly junior officials who have been entrusted with the task of “managing” patients and not really helping them,” she said.
More importantly, she observed that the state government has invested their energies in trying to convince the patient to just pay the bills in hospital and make the least amount of noise. “It is as if the AAP wants to only hush everything and not enforce its own order!” she added.
Malini Aisola of the All India Drugs Action Network, who has also been working with Inayat on such cases, said, “More than three months on, the sheer lack of accountability and indifference of the government is just mind blowing. We have been repeatedly asking for audits of bills since June 20. At this point, the tally for the number of patients treated, under the government rates and hospital rates, in each private hospital for COVID should be made public.”
Fragmented healthcare financing system
Jashodhara Dasgupta of SAHAYOG noted that these violations by private hospitals are all symptoms of a larger problem. She categorically stated that these problems have to be seen in the context of the need for a universal health coverage – a demand that she and other health rights advocates have repeatedly raised for decades. “We must continue with that demand and what that essentially means is healthcare for all and that it has to be tax-financed and cashless. The government has to raise this funding for all with the option for people who do want to go to the private sector exclusively to opt out,” she explained.
She explained that anyone under the CGHS coverage can access healthcare in a private tertiary hospital. “In the 1950s, that kind of health coverage was to be extended to the whole population but it never happened. It remained only with the fat cats who are a part of the government bureaucracy and the elevated representatives,” she said.
As per the National Sample Survey, 2018, 80.9% of people in urban India do not have any health expenditure coverage. For the masses who remain outside the ambit of these tax-financed health coverage mechanisms, private hospitals and insurance companies continue a free loot.
While the pandemic has only laid bare the inadequacies of our healthcare systems, we cannot lose sight of the principle problem: that the government is in a rush to privatise healthcare in all forms. With that intent, the government has found ways to compel people to pay premiums to private insurance providers. “That has basically two effects: first, because there is an insurance cover, hospitals decide to bleed out the insurance amount to the maximum; second, this private insurance model does nothing to address high out-of-pocket expenditure either,” said Jashodhara.
In absence of any stringent regulation and price standardisation method backed by a reliable grievance redressal mechanism, the collusion of private hospitals, private insurance, and government inaction has driven people to penury. It is, unfortunately, of no surprise that private hospitals and private insurance companies have managed to exhibit steady profit rates even during the pandemic. And, the patients are still hoping for the government officials to do something better than just sending them contact details of another official or forwarding emails.
Sweta Dash is associated with the Right to Food campaign.