Why is Mumbai abandoning its civic hospitals? #Healthcare


 

 – Rediff.com India News

By deserting public hospitals we are dismantling our public health-care system, says Dr Sanjay Nagral. | Why is Mumbai abandoning its civic hospitals?

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Why is Mumbai abandoning its civic hospitals?

May 09, 2013 10:56 IST

By deserting public hospitals we are dismantling our public health-care system, says Dr Sanjay Nagral.

The recent story of babies with heart defects dying in Mumbai’s [ Images ] civic hospitals while the procurement of a heart-lung machine was delayed is tragic and shocking.

The heart defects in these toddlers were eminently correctable by timely surgery, which not only would have saved lives but also lead to a normal quality of life.

Unlike bypass surgery, which may add a few years to life, surgery for repairing congenital heart defects can translate into a normal healthy life span. Many readers are likely to have dismissed it as yet another chapter in the now familiar media exposes on the crumbling systems in Mumbai’s public hospitals. And we will all soon if we already haven’t forgotten about these babies and their cruel fate.

Mumbai’s civic hospitals boast of some of the oldest and finest cardiac surgery departments in the country. A lot of the early pioneering works in cardiac surgery in India [ Images ] –including the earliest successful heart operations — were performed at KEM Hospital‘s cardiac surgery department. Many of us who have trained in KEM’s surgery department have been beneficiaries of this great legacy.

Even today Mumbai’s civic medical colleges and hospitals are considered amongst the best in the country, both for undergraduate and postgraduate studies. Mumbai’s civic budget for health is one of the highest in the country and the teaching hospitals get a lion’s share of this.

So why is it that the purchase of a lifesaving heart-lung machine gets delayed for so long and it takes a newspaper expose for the authorities to respond?

Is it all about bureaucracy, red tape and indifference of some officials?

It is indeed tempting to think so for this is an easy, simplistic explanation. We can then momentarily feel sad, perhaps a little outraged, rationalise it and go back to the comfort zones of our daily lives. But there is more to it.

And that bit is not about some inefficient civic official, it is about you and me.

Public hospitals in Mumbai were once the heart of health-care in the city. Except for the few super rich who would seek services in a fringe private sector a large majority of the population including the middle class were treated in these hospitals.

Check with your parents and grandparents, and they will tell you this. Over the years a burgeoning private sector started attracting larger and larger sections of the population.

Today most people including the poor seek health care in the private sector which is perceived as ‘efficient’ and of ‘better’ quality. The middle classes have largely abandoned these hospitals and even the poor seek their services only for major illnesses often after being bankrupted in the private sector. Thus, these hospitals have essentially moved out of the imagination of those who shape public opinion.

A majority of the doctors trained in these institutions seek careers abroad or in the private sector. They have largely become training grounds for nourishing the private health- care industry. And finally no bureaucrat or politician now seeks treatment in these institutions, preferring to get their treatment funded at private institutions.

At the Bhabha hospital in Bandra — one of the largest civic peripheral hospitals where I work part time as a surgeon — there is a predictable pattern to patients brought to our casualty with accidents. Those who are well to do will often be whisked away by their family and friends to nearby private hospitals, whereas the poor will continue to be treated with us.

Thus in the bomb blasts of 2006 most of the victims including those with serious injuries were transferred to private hospitals since they were from the first class compartment. In the previous year’s riots and floods we managed the victims.

Many years ago when I was at KEM I would treat a large number of friends and their family; people like you and me. Now I treat a large number of maids and drivers of friends at Bhabha, whilst I treat their employers in the private hospitals I work with.

A few years ago when a senior journalist friend chose to get himself operated at Bhabha a large number of common friends expressed surprise and even admiration for his act of ‘courage’.

In a subconscious collective act we have abandoned these institutions to those ‘others’ who inhabit a different space, who have no voice, clout or energy to fight the battle for decent health-care.

The parents of the kids fortunate to have their hearts fixed may thank the newspaper and the journalist who broke, and followed up the story. The act of getting a few private hospitals to do the pending cases is but only a temporary solution.

Even worse, it strengthens the belief that such care can only be provided in the private sector. Some of the private hospitals will seize the moment to actually market themselves.

The specific reason for the delay in sanctioning the heart-lung machines could have been a slowly moving file, an indifferent official or even a lack of follow-up from the departments concerned. But each time a life-saving ventilator doesn’t work, a CT scan is not available for a young man who has fallen off a train and a young pregnant woman dies, as she is transported from hospital to hospital in ramshackle ambulances, a media story cannot correct the problem.

Unless we realise that by abandoning these hospitals we are complicit in the process of dismantling our public health-care system. Whether we like it or not, at some stage in our lives we need the services of public hospitals; what if you are knocked down on the road and carried by passersby to the nearest public facility?

The heart-lung machines have probably been temporarily procured and unlike the unfortunate ones who died, some of the kids will now live to tell the tale of the holes in their hearts. Many years later when they grow up will there still be a long queue for poor kids born with heart defects?

Their fate is inextricably linked with the value we give to the development of an efficient public health system. And that in turn will be determined by whether we relate to our civic hospitals as our own and are outraged by its inadequacies and indifference.

The holes in the babies’s hearts is currently a gap in our collective minds.

Dr Sanjay Nagral is a consultant surgeon, department of surgical gastroenterology, Jaslok Hospital and Research Centre, Mumbai. Photograph: Sahil Salvi

Dr Sanjay Nagral in Mumbai

 

Andhra Pradesh – Private hospitals may pull out of Aarogyasri #healthcare


As was anticipated and warned, the private healthcare industry is showing its true colours and indulging in supplier ‘hold-up’ and increasing the costs.

TNN | Apr 4, 2013,

HYDERABAD: Private hospitals in the city will pull the plug on the state’s flagship Aarogyasri scheme from May 3 after the government refused to accept a minimum 30% hike on the existing tariffs and said henceforth they would only admit patients who can be discharged before the deadline.

If private hospitals go ahead with their plans, thousands of poor people will be denied quality care in top private hospitals in Hyderabad and elsewhere in the state, and is likely to force the government to take action.

About 250 private hospitals in the state treat about 2 lakh patients annually under the Aarogyasri scheme for the 938 listed ailments and diseases.

“It is a sad decision but we are not in a position to carry the burden of the scheme anymore,” said Dr B Bhaskar Rao, president, ASHA.

“Since the scheme’s inception in 2007, costs have gone up steeply but the government is still reluctant to revise the tariffs. Initially, we were told that 28% of the population falls under BPL and will be covered under the scheme, but the fact is 82% of the population is eligible to avail this scheme,” he said.

“We have been requesting the government for a revision since last two years, but nothing has been done.”

In another development, the AP Private Hospitals and Nursing Homes Association (APNA) and AP Specialty Hospitals Association (ASHA), served a notice to the CEO of Aarogyasri trust, demanding a minimum 65% hike in the tariffs, over and above the revised tariffs for healthinsurance scheme for state government employees and their dependants for twin sharing of rooms.They also demanded a 100% hike over and above the revised tariffs for single private rooms. The notice comes at a time when the state government is planning to launch the scheme for government employees on the lines of Aarogyasri from Ugadi.

 

Setback to Chhattisgarh health care services


SUVOJIT BAGCHI, The Hindu, March 30, 2013

Private hospitals refuse treatment under government insurance schemes

The Chhattisgarh government has had to accept yet another setback while trying desperately to rope in private players to strengthen public health care services.

At least 20 major private hospitals have refused to provide treatment under the Chief Minister’s health insurance scheme — Mukhyamantri Swasthya Bima Yojana (MSBY). Reportedly, they are also not following guidelines to provide treatment under the national health insurance scheme, Rashtriya Swasthya Bima Yojana (RSBY), and are charging money from the patients.

Hospital owners claimed that the insured amount paid for treatment of the patients below poverty line (BPL) under RSBY is “very low.” In addition, introduction of a scheme for the people above poverty line (APL) under MSBY will “seriously damage business and thus will affect services.”

State health officials, hospital management and representatives of insurance companies and Third Party Administrators (TPA) held a meeting on Thursday. According to local news reports, Director, Health Services, Dr. Kamalpreet Singh, said rates had already been “upwardly revised” under RSBY and MSBY after consultation with private hospitals.

Under the new list, 272 categories of treatment, commonly called ‘packages,’ were increased by four to 200 per cent. Another 22 packages had been added and the new list will be applicable from April 1. However, major private players are not happy with the revised rate list and refused to implement the insurance schemes in their hospitals. The move angered the government and the health department has decided to de-panel the hospitals, the sources said.

Earlier this month, the government faced a setback while trying to introduce the policy of Public Private Partnership (PPP) in public health facilities. No private diagnostic centre had come forward to set up radiology and laboratory facilities in the two most underdeveloped divisions with high percentage of rural population — Bastar in south and Surguja in north Chhattisgarh following governments directives.

The Chhattisgarh Government’s Directorate of Health Services had to seek fresh bids for newly aligned divisions. According to the sources, while a good number of applications were filed for affluent divisions such as Raipur and Bilaspur, not receiving a single application for the poorer divisions illustrate the private players’ reluctance to acknowledge health care as a social service. However, the proponents of Chhattisgarh’s public-private venture in health care were optimistic about its future, even after these recent rounds of setbacks.

 


  • Major private players are not happy with the revised rate list
  • Government to “de-panel” hospitals that refuse to cooperate

 

Bihar: Private hospitals removing uterus and making money of the insurance scheme


 

RSBY logo

RSBY logo (Photo credit: Wikipedia)

 

 

30 JULY 2012

 

 

Bihar: It is reported that some of the private hospitals at Bihar is using Government’s insurance scheme provided for the people below the poverty line (BPL) and against the moral principles they earn money with or without the knowledge of the people.

The centre has launched the insurance scheme for the BPL during 2008 in the name of Rashtriya Swasthya Bima Yorjna (RSBY) with the aid of the state government to serve the BPL in healing the diseases. Under the scheme, the beneficiary has to pay a registration fee of Rs.30/-, and the state government will pay the premium. Under the scheme, the beneficiary will be covered for Rs.30,000/- and could take medical treatment in the approved hospitals under the scheme.

But, now a fraudulent medical business scheme has come to light where some of the private hospitals are performing unnecessary organ removal, mostly removing uterus for profit of the hospital and to pocket the insurance money.

It is reported that private hospitals in Bihar state has performed more than 15,000 hysterectomy (removal of uterus by surgery) in the last one year to earn the insurance amount of Rs.30,000/- allotted by the scheme.

The preliminary enquiries has shown that Samastipur district alone in the state, has performed around 15,000 hysterectomy surgeries on women in the last one year including uterus removal on unmarried girls below the age of 22.

Following the allegations, the Samatipur district magistrate Kundan Kumar has ordered a probe about the unnecessary hysterectomy including around 5,500 urgent surgeries carried out.

Six teams are being organized including doctors and the team will submit their report within 31 July.

“The probe will bring out the glaring anomalies in the execution of the scheme by private hospitals,” said, the District Magistrate.

”It is learnt that the private hospitals have claimed upto 12 crores under the scheme by the last one year and the in-depth probe will do the needful take necessary stern action against them on the basis of the inquiry.” he added.

It is also reported that many of the private hospitals has claimed insurance money without performing any operations at all.

“Door-to-Door” search and ultrasound tests will definitely reveal whether really the beneficiary had under gone the surgery – said Kumar.

The district administration of Samastipur has organized for camps during first week of August to enable the BPL families under the scheme to lodge complaints against erring hospitals.

A district official who visited the nursing homes under the scheme said that many of the nursing homes approved under the scheme do not have necessary facilities to perform surgeries.

“Nurising homes found guilty would be deleted from the approved list soon,” said Amrit Lal Meena, principle secretary of the state labour resources.

The RSBY scheme is suspected to have such wrong doings not only in Samastipur district, but also in the other states.

Bihar Chief Minister Nitish Kumar has ordered the district magistrates and civil surgeons to inspect all eligible private nursing homes to investigate the scam and ensure whether they are equipped to provide proper healthcare to the poor.

 

 

 

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