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Govt health schemes failing the patient, claims top surgeon

This story by me was first published in the IIJNM publication The Observer, on Nov 27, 2015. The Observer is the work of print journalism students who report exclusive news stories from Bangalore and the state of Karnataka.

Many private hospitals use substandard equipment or turn patients away as they are expected to treat them under limited government budgets, a leading Bijapur neurosurgeon has claimed.

Dr Prashant B Katakol

Dr Prashant B Katakol

Dr Prashant B Katakol, co-ordinator of Karnataka Private Hospitals Association, has warned that government subsidised health schemes are choking the private sector.

Referring to “network hospitals” where citizens can use government health schemes for cashless treatment, Dr Katakol said: “For example, even to treat a rich IAS officer for spine surgery, private hospitals have to operate within Rs.40,000. We are not supposed to charge anything more.

“This way, how will the private sector survive?”

The Jyothi Sanjeevani scheme, which makes treatment for government employees cashless, restricts the budget for spine surgeries to around Rs.40,000.

For an open bypass surgery, network hospitals must not charge more than Rs.1.1 lakh for patients covered under the Jyothi Sanjeevani Scheme. However, the same surgery costs Rs.3.3 lakh or above in private hospitals.

Dr Katakol also said that the expenditure in surgeries in multispecialty hospitals includes medicines, surgery, stay, and cost of maintenance of equipment. But the government schemes do not give enough.

Similarly brain tumour surgeries may cost around Rs.2.5 lakh but the government schemes put the cost at around Rs.55,000.

Sudha Chandrasekhar, project manager of the Jyothi Sanjeevani Scheme (JSS), said: “The private hospitals said the costs would be more than what the scheme would give them, but we did not change the price. Rather, we made it clear to them how we arrived at those prices. They would work their costs out according to the volume of cases they get. They would take care of the costs themselves.”

Dr Katakol added: “The government is aiming more at controlling the package for hospitals rather than extending help to patients. Private hospitals that offer the schemes have been forced to be part of it. By now, almost 100 per cent of the population is covered under some scheme or the other. No one wants to invest further in healthcare in the state because of this.

“In the name of providing universal healthcare, the government is choking the private healthcare industry by telling us this is the amount within which you have to treat patients. The private sector has to meet its needs and has to have profitability or else it won’t survive.

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“Also, the Vajpayee Arogyashree scheme for below poverty line (BPL) families is based on having BPL cards. Recent reports say a huge number of BPL cards are bogus. You cannot base a health scheme on a completely faulty system of distribution of cards.

“The government lists its network hospitals for schemes, and then forces them to agree to subsidized healthcare. This is cartelization. Citizens should have the free will to go to any hospitals in the state.

“These hospitals then start ordering substandard equipment. Complicated cases are being turned away. Why would someone admit a patient who they know will occupy a bed for a long time under a limited budget?

“Or, they take extra payments from patients. No one talks about them.”

“Also, there is no government agency to control whether there is any appropriate treatment being given or not; no expert on this subject in the offices where these schemes are being governed,” he concluded.

Dr. Smitha T., head of medical services at BGS Global Hospital, Bangalore, which makes only the Vajpayee Arogyashree Scheme available, agreed to the budget issues.

She said: “We do not cover other schemes because it is an expenditure issue. The schemes don’t cover our costs. We are dependent on companies that provide the material and equipment; we do not make them in-house. If the payment doesn’t meet the costs, it’s very difficult for us to get material to do the same. We are able to sustain the VAS because our BPL patient numbers are less.”

Dr Anil Agadi of Agadi Hospital, who is also secretary of Private Hospitals and Nursing Home Association (PHANA), stopped having government health schemes in his hospital few years back. “We did not get our payments on time, sometimes 6-7 months after surgery. Private hospitals have to have good infrastructure, staff and instrumentation. And now even taxation is high. Government hospitals should improve their own standards first. Why should people need to even go to private hospitals?”

He added: “For surgeries, government is paying all-inclusive rates, including medicines. It is very difficult to control what medicines are needed. What do you do if medicines from cheapest companies do not work? It becomes really difficult to manage.”

“Charity comes at a price. If you subsidize up to nearly 90 per cent, you can’t sustain,” he concluded.

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