Profit driven practices, sky high targets, and patients being put in harm’s way: these are just a few of the charges leveled at India’s private health care system following an exposé published Thursday.
The damning evidence, published in the British Medical Journal (BMJ) reveals how the country’s lucrative private medicine trade is actively harming the lives of its patients, as doctors are forced to put them through unnecessary tests—and even surgeries—in order to meet quotas.
“For seven years I had to bear the burden of doing unnecessary investigations and procedures, including angioplasty, under pressure from the management of the hospital,” reveals Gautam Mistry, a cardiologist in Kolkata. “Doctors who face pressure from hospital management to overprescribe surgeries or investigations fear for their livelihood. They also need to practice for a certain number of years, and by complaining they would be jeopardizing their career,” he said.
Consultants like Mistry are routinely hired by private hospitals as a means of boosting profits, but the near-impossible goals they are set only achievable with expensive, futile surgeries, the piece alleges.
One of the most concerning discoveries comes from Kunal Saha, president of the NGO People for Better Treatment, which advocates for a corruption-free medical system in India. “Significant numbers of patients must be advised to be admitted for surgery or medical procedures that bring in real financial profit for the hospital,” he says. “Needless surgery, even simple procedures like tonsillectomy or appendectomy, may cause unexpected hazards for the patient.”
If this is the case, just how many patients in the 50 percent of hospital beds India’s private health care users occupy have been encouraged to undergo costly procedures in order to line providers’ pockets? Aside from the physical harm these operations pose, they also come with major financial risk, too, as the country’s dearth of effective medical insurance programs mean hospital bills must be paid out of pocket.
A recent report into health care professionals’ practices demonstrated just how bad the problem has become. “Voices with Conscience from the Medical Profession” contains 78 interviews with doctors conducted by gynecologist Arun Gadre, who says that, “corporate hospitals are not content unless there is some procedure or operation done related to each bed in the hospital.” A private reference for an angioplasty can hit up to 40,000 rupees (approximately $604—monthly earnings in India average $295 per month), and that consultants with low conversion rates face questioning—and even dismissal—from their CEOs if the percentage is not deemed high enough. “He tells me…that unless I increase it, I will have to leave the hospital,” one reads.
While putting the industry’s corruption under the spotlight is a new endeavor, medical professionals say they have known about its rogue undercurrent for a long time. Gadre describes the MCI as “Machiavellian,” adding that “state medical councils that have always worked only to maintain the hitherto ‘untouchable’ status of the Indian medical community.”
Devi Shetty, chairman of the international for-profit hospitals organization Narayana Health Group, disagreed that impossible goals were commonplace. “We often hear about revenue targets for doctors in private hospitals; I know it is a very rare phenomenon,” he told the BMJ.
Companies offering a second opinion on medical diagnoses—or prices—are now springing up in India, promising to tackle the country’s over-prescription rate. According to one report, second opinions about surgeries offered contrary advice for 44 percent of the 12,500 patients surveyed—a potentially life changing discovery for the many thousands caught in the crossfire between profit hungry private medical organization owners and doctors unwilling to take a stand.
Scant data on the full extent of the problem is available, but if this is widespread in one country’s private medical industry, it could easily be the case elsewhere in the world, too. Two reports published this week exposed the realities of the American health care system, which sees doctors pushed to the limit and often making troubling mistakes.
Being a doctor may be a revered profession, but without ethics being strongly upheld for both them and their patients, cracks will only continue to show.