Introspect, self regulate or face the music … again

new-viveka-100x100Aadya’s death and family’s decision to go public, even though it meant reliving their tragedy two months after her death, will not be in vain if the introspection leads to true change in protocols and practice

As Ahmedabad’s Shalby Hospitals prepares for its IPO on December 5, the trend of healthcare entrepreneurs tapping capital markets continues. The rationale seems obvious. The cost of services in the private healthcare segment is pretty high, particularly since most of it is out-of-pocket. But there are no quick gains on healthcare stocks. For instance, an Equirus Capital report of October shows that the BSE Healthcare Index recorded a one-year return of 13 per cent, way below the S&P BSE Sensex (19 per cent) and the Nifty (marginally higher at 20 per cent). The stock prices of major hospital groups registered sizable negative percentage returns over the past year: Fortis group (19 per cent), Narayana Health (11 per cent) and Apollo Hospitals (22 per cent). In the diagnostics sector, Dr Lal Path Labs registered a negative stock return of 34 per cent over the same period. But with an eye on the future, investments continue. For example, the Apollo Hospitals group plans to add 765 beds at a total estimated project cost of Rs 11,900 million over FY18-22. Thus across the sector, growth will be slow and balance sheets stressed. But given the lack of choice and the demand-supply gap, healthcare enterprises will be a steady long-term bet, provided they work on the trust deficit with their primary customers: their patients.

The tragic death of seven-year-old Aadya Singh in Gurugram’s Fortis Memorial Research Institute (FMRI) has revived public outrage against private healthcare institutions. The case, where the father was presented with a bill of almost Rs 16 lakhs for the treatment of his daughter over a fortnight, seemed to cement the perception that private hospitals are profiteering from patients. Social media exploded with unverified calculations of the FMRI bill to show that doctors’ fees were a fraction, while the government got the lion’s share, thanks to GST and other taxes.

Faced with mounting criticism on social media, the public health administration swung into action. Under instruction from the Union Health Ministry, the Haryana government ordered a probe into the matter. FMRI responded by going public with a detailed statement defending all its decisions through Aadya’s treatment.

Preeti Sudan, who was appointed Union Health Secretary just a month before, urged chief health secretaries of all states and union territories to get the Clinical Establishment Act 2010 adopted/ implemented. But the Act is no magic bullet. For example, the Karnataka government recently attempted to pass an amendment to the Karnataka Private Medical Establishments (Amendment) Bill, 2017 to rein in the cost of medical treatments and procedures. Doctors went on strike in protest, while private hospitals shut their OPDs for a day, to protest against certain clauses in the proposed amendment. The state legislature finally passed a watered down version, which had patient groups crying foul.

Aadya’s death and family’s decision to go public, even though it meant reliving their tragedy two months after her death, will not be in vain if the introspection leads to true change in protocols and practice The good news is that there is some movement in this direction. For instance, in late November, IMA listed 20 suggestions ranging from asking the government to implement the ‘one price-one drug one company’ policy (so that cost of 80 per cent of medicine can be reduced) to elimination of standing orders for laboratory studies, electrocardiograms, and chest X-ray films. The release states that physicians must learn to order specific tests and not simply a battery of tests which includes the actual test desired. It is a sincere hope that health ministry officials ensure that such suggestions become part of standard protocol.

The bad news is that public memory is short. Without self regulation, there will be more Aadya Singhs to further erode the trust. Patients in India may not have a choice but as the crackdown on medical device prices has proved, doesn’t it make better business sense to self regulate rather than face a backlash from policy makers under public pressure?

Viveka Roychowdhury