One area where successive governments have failed is the continued neglect in instituting and enforcing laws in the area of healthcare that affect all, rich and poor alike. Arbitrary overbilling is one of the major problems that thousands of patients in India routinely face.

A recent article published in Scroll in news website stated the problem of overbilling by hospitals in Hyderabad’s upmarket Banjara Hills. The article also stated that the patient was diagnosed with sleep apnea and suspected pulmonary hypertension and was admitted into the intensive care unit for two days and then kept in a private room for observation for another two days before being discharged.

To the author’s surprise the bill charged by the hospital higher than that from the state implemented Aarogyashri by 30% to 40% for most items. Leading to question the policy behind charging such exorbitant cost of medical procedures performed by the hospital.

Somewhat similar incidents were in light last year when in a knee jerk reaction the Haryana government issued notices to Fortis Hospital in Gurgaon after it billed a dengue patient around Rs 17 lakh for 15 days of treatment in its intensive care unit. At around the same time, the Delhi government cancelled the licence of Max Hospital in Shalimar Bagh for declaring a baby dead when he was in fact alive. Also last year, West Bengal and Karnataka instituted laws to deal with medical negligence and overpricing.

Policy Paralysis

The Clinical Establishment Act 2000, is already in place to curb such incidences from happening, but the ground reality is far from what is portrayed. The act has not been implemented in letter and spirit by most of the states, because of the view that implementation of the law will lead to inspector raj. While there is no relief for over charging, people are left with the only one option to file a complaint in the consumer court or civil court.

Procedural Problem

Another argument that points towards the procedural problem in the system is the absence of price range for medical procedures. The counter argument stated by various agencies opposing the setting up of price range is that fixing of charges for medical treatment is not possible as government is not providing subsidies to private institutions and as charges are fixed depending upon the inventory e.g. equipment, land cost, cost of human resources and patient inflow, charges cannot be equal for different establishment.

Another major issue is the lack of transparency in charges by the hospitals – it has been found that some hospitals charge different price from different patients depending upon the mode of payment for example patients opting payment via insurance is usually charged higher that those making payments in cash. Pricing is, thus, non-transparent and often arbitrary and irrational. The situation is more grave in rural areas where there is lack of secondary and tertiary hospitals and the ones that operate in such areas have a monopoly over the cost of procedures.

Without addressing the price problem the budget announcement of National Health Protection Scheme to provide Rs 5 lakh a year to each of 10 crore targeted families for secondary and tertiary care hospitalisation rather difficult to achieve.

Having stated that the government urgently needs to address the critical components of policy, one way out can be that instead of fixing charges per procedure, a range of charges should be fixed or an upper limit of charges should be introduced. In a bid to achieve universal health coverage it is evident to increasing the budget for healthcare to 2.5% of GDP by 2022 instead of 2025. While the Prime Minister vision of setting up a medical college in every three districts is commendable, it would only be a reality with greater resource allocation to the healthcare sector. Now is the right time to address the problem of variance in price in healthcare before the 2019 elections.

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