Covid-19 exposes the high cost of India’s reliance on private healthcare

Rate caps

Prices for privatised healthcare should be easy enough to regulate for a federal government, says Murali Neelakantan, a lawyer specialising in healthcare. “It’s not difficult to fix a price for all hospitals,” he says, noting that the government has already done this for civil servants under the Central Government Health Scheme, enabling them to claim free treatment in government hospitals and discounts for specific treatments in 1200 privately run hospitals around the country.

“There’s no reason why [procedures] are cheaper for government employees than they are for the common man,” says Neelakantan. “The formula and the solution for price regulation exists, and it can be easily applied across India.”

So far, the central government hasn’t tried anything so wide ranging. But state governments are experimenting with rate capping in the pandemic. In a series of tweets in June, the spokesperson for the Ministry of Home Affairs in Delhi said that a committee had recommended caps in 350 private Delhi hospitals: 10 000 rupees a day for covid-19 patients who require beds and personal protective equipment (PPE); 15 000 rupees for those needing to be admitted to intensive care; and 18 000 rupees for those requiring ventilator support.5 More than 10 other states in India, including Punjab, Tamil Nadu, Andhra Pradesh, and Jharkhand, have brought in policies to subsidise covid-19 treatment in private hospitals.

Despite this, however, activists say that caps throughout the country are not being enforced. Many private hospitals simply choose not to comply, with no penalty, and different states follow different rules. Kakar says, “The price cap in Delhi included the cost of PPE, interventional procedures, high end medicines, and treatment of comorbidities during covid-19 treatment, but states like Maharashtra did not include this.”

The caps have also allowed some insurance companies to avoid paying for treatments. One patient from the south Indian city of Tiruchirappalli told The BMJ under anonymity that she and her elderly mother had been charged 320 000 rupees for a room and treatment for 11 days, after testing positive for covid-19 in July. Their insurance company said that only 100 000 rupees could be covered despite them paying for annual medical insurance cover of 5 million rupees. The company said that the remaining amount should not have been charged by the hospital in the first place, as per the government stipulations.

“They told me that I could fight with the hospital if I wanted to and refused to pay the balance amount,” she says. She chose not to because she didn’t want to be blacklisted by the only major private hospital chain in her town.

Where there’s a will . . .

Parang Mehta, a paediatrician running his own practice in Surat, Gujarat, says that it’s not right for the private sector to provide most of the country’s healthcare needs. “Even businesses should have a moral compass and refrain from exploiting human desperation,” he says. But private healthcare has long been a lucrative business in India, so question marks remain over the will of the sector to implement change.

“It is a kind of existential threat for corporate healthcare,” says Malini Aisola, co-convenor of the All India Drug Action Network, a coalition campaigning for affordable healthcare. “We need regulatory reforms that carry forward into the long term—beyond the emergency that the pandemic has created. We need a more systematic approach to regulating the private sector.”

Kakar adds, “[Private hospitals] are trying to subvert any kind of fallout of regulation, especially to make sure that it doesn’t extend beyond the pandemic. They don’t want the commercial healthcare business model to be affected.”

Still, activists say that, if there can be anything good about the pandemic, it’s that the exploitative billing practices of the private sector are finally coming under scrutiny.