By John B Monteiro

Jul 31: For long there have been loud grumblings about spiraling costs of medical treatment in private hospitals. The fact got a national exposure when the father of a girl child, who died in a car accident involving the Mercedes in which Hema Malini was being driven in Rajasthan, complained that if his daughter was taken in the same ambulance to the same high-end hospital, she would have survived. Apparently the girl was not taken to the same hospital fearing the sky- high bill beyond the paying capabilities of ordinary mortals.

Against this background the central government is mulling legislation to compel hospitals to treat accident victims – a sort of Right To Education scenario in the medical service sector – and might end up in confusion and evasion as is happening under the RTE regime. The subject is not going to be swept under the carpet as it has entered the school text books. But, first the facts as front-paged in Deccan Herald (27-7-15) under the title "IMA bristles as NCERT book says pvt healthcare costly".

A team of text-book writers and academics have locked horns with the Indian Medical Association (IMA), which had objected to the content of a National Council of Education Research and Training (NCERT) Class VII’s book that shows how costly private healthcare is compared to government hospitals.

While the IMA has written to Prime Minister Narendra Modi seeking revision of the chapter on the ground that the contents show private healthcare in a bad light, the academics, too, have reached out to Modi requesting him not to entertain the IMA’s demand.

In the NCERT’s social science textbook "Social and Political Life" for Class VII students, a chapter titled "Role of the Government in Health" says the cost of private healthcare services is higher than that of public health services as the former are "run for profit"."Medicines are expensive. Many people cannot afford them or have to borrow money when there is an illness in the family. In order to earn more money, these private services encourage practices that are incorrect. At times, cheaper methods, though available, are not used. For example, it is common to find doctors prescribing unnecessary medicine, injections or saline bottles when tablets or simple medicine can suffice," says the chapter. It also has a comic strip that highlights the difference in cost of treatment in public and private healthcare centres, in which a school student pays Rs 150 for treatment at a government hospital while his classmate pays Rs 3,500 for the same treatment at a private healthcare centre.

Objecting to these, the IMA recently wrote to Modi, Human Resource Development Minister Smriti Irani, Health Minister J P Nadda and the NCERT demanding the chapter’s deletion from the textbook.

"The IMA’s allegations and demands are unfortunate and based on a selective reading of the chapter," said the team that wrote the book. It also argued that NCERT textbooks aim at developing the abilities of children to "critically engage and analyse these realities in keeping with the tenets of the Constitution of India".

This takes us to the Bible wherein when Evangelist Luke wrote in the New Testament, 2000 years ago, "Physician heal thyself", he would not have foreseen the state of medical practice today. Otherwise, he would have expanded his cryptic sentence to read: "Physician heal thyself of greed". And when we talk of corporate hospitals, lurking behind the façade are doctors who are collaborators in the treasure hunt. Coming back to the Bible, many writers since Luke have seen through the breach of Hippocratic Oath that doctors take and given us insights into the changing medical scene. Sample the following:

"Is there no hope?", the sick man said,
The silent doctor shook his head,
And took his leave with signs of sorrow,
Despairing of his fee tomorrow.
---- John Gay, English poet (1688 – 1732).

And again:

You tell your doctor, that you are ill
And what does he, but write a bill,
Of which you need not read one letter.
For if you knew but what you take,
Though you recover, he must break.
---- Mathew Prior, English poet (1825 – 1864).

They said money makes the mare go. Money makes the doctors sprint. Beyond cheating in exams and interviews, there are large-scale scams, including impersonation, in securing medical seats. Getting to be a doctor is the most coveted thing today. More than being very intelligent and scoring high marks, capitation money greases the way to doctordom. The investment has to be recouped and, thus, the physician’s profession often turns out to be money minting machine – never mind the poor patient. The enterprising among the doctors have gone where the money is – the West - where salaries and consulting fees are about ten times what they are in India.

Now a new dimension has been added to the medical scene in India. Medical service has been corporatised with large hospital groups offering high-end services at high-end fees. The newly emerging medial industry is replicating the hospitality industry marked by star hotels. So far, this sector was offering its services to Indian rich who could afford its high charges. Now a new term, medical tourism, has come on the scene. Medical tourism, according a Confederation of Indian Industry–McKinsey Report, was projected to grow to be $ 2.3 billion business for India in 2012. The number of medical tourists is said to be growing at 15% every year. In top hospitals 10% of all patients are foreigners. While earlier, patients came from SAARC Region, Middle East, African and CIS countries, now the trend is towards patients from USA, UK, Canada, Europe, Australia and New Zealand.

The reason is not far to seek, In the last set of countries, there is a long waiting period to be taken into the operation theatre for major operations. Secondly, many in the US are not insured to cover the very high costs. For instance, the average coronary bypass grafting costs $6,600 in India compared to $60,000 in US The great success of medical tourism in Thailand has raised the appetite of Indian corporate medical groups. All these factors have rung the alarm bells. With accent on earning foreign exchange and offering the best to foreigners, where do Indian patients - like the girl child involved in the accident in Rajasthan - stand? Many argue that healthcare cannot be treated as a product and medical tourism may distort prices and scale of attention to Indian patients. In that scenario, Indian patients may find solace in the lines of John Dryden, English poet (1631-1700):

Better to hunt in fields for health unbought.
Than fee the doctor for a nauseous draught,
The wise for cure on exercise depend;
God never made his work for men to mend.

Now, with the influx of high technology in diagnostics and treatment, the modern patient has to go beyond "a nauseous draught" prescribed by doctors in Dryden’s time.

Disclaimer: The views and opinions expressed in the above article are solely those of the author.