Last week, as the Union Home Minister Amit Shah stepped in to manage the COVID-19 situation in Delhi, a committee was constituted under Dr Vinod K Paul, member of NITI Aayog, to fix rates for COVID-19 treatment at private hospitals, after several patients and health activists brought the issue to the fore.
“The committee has recommended Rs 8000-10000, Rs 13000-15000 and Rs 15000-18000 including PPE costs for isolation bed, ICUs without and with ventilator respectively, to all hospitals as compared to the current charges of Rs 24000-25000, Rs 34000-43000 and Rs 44000-54000 (excluding PPE cost),” the union home ministry said in a statement today.
The issue of heavy costs incurred by patients has been raging in other states, too, and some such as Telangana, Tamil Nadu, Karnataka and Maharashtra have already capped prices. Not only were patients facing the prospect of huge bills running into several lakhs, but families of COVID-19 patients have also been complaining that several private hospitals would insist on taking a heavy deposit before admission.
The matter had also reached the Supreme Court in May, where a PIL filed by advocate Sachin Jain had argued that since private hospitals had received free land, they should not be charging for COVID-19 treatment. In an intervention application filed by All India Drug Action Network and Jan Swasthya Abhiyan, Mumbai, organisations have been providing support to patients and their families in accessing healthcare services in public and private hospitals as many families have faced financial hardships in paying for treatment in private hospitals.
“The current scenario in cities with high burdens of disease and growing infections is one where public hospitals are overcrowded, overwhelmed, and suffering from high COVID-19 infection rates amongst health care workers (HCWs). Thus, facilities of charitable, private/corporate hospitals need to be added to fulfil the government’s responsibility to provide care to all COVID- 19 patients. Most charitable hospitals in India function virtually as private/ corporate hospitals,” AIDAN has pointed out to the court.
The application includes bills charged by top hospitals in Delhi, Mumbai and Kolkata that have ranged from 16 lakhs for 30 days treatment including ICU care, to a bill of 2.8 lakhs for five days of ICU treatment. “The public health crisis has brought about huge charges for the use of PPE kits and PPE components (gloves, N-95 masks, 2 & 3-ply masks, head covers etc.) for which cumulatively patients have even been billed up to Rs15,000 a day,” health groups have pointed out.
With beds filling up fast in government hospitals, patients are being forced to seek treatment in private facilities, application in court states. “As such, the question of seeking treatment for COVID-19 in a charitable/private/corporate hospital is not a matter of choice any more, rather, an inescapable reality for numerous Indians, who are being left with no other option but to access private healthcare. Thus falling prey to the unregulated and often excessive rates charged by private hospitals. With increasing numbers of infected persons, this inevitability is only set to increase, and with it, the exploitation and deprivation of the helpless,” the application reads.
Even in cases where the patient has private insurance, insurance companies are unwilling to cover many charges which can end up being significant costs of the treatment, AIDAN said in the application, with bills from several patients as evidence. “Further, the depletion of insurance cover in the treatment of COVID-19 is a serious concern, especially true for patients with existing chronic and life-threatening conditions like cancer, etc., and which may leave them vulnerable and without coverage in the future for non-COVID-19 treatment.
Insurance cover will drain quickly when patients end up with more severe health outcomes and require extensive critical care interventions and support. Insurance itself does not guarantee financial protection for patients because COVID-19 treatment costs can quickly exceed coverage limits,” they pointed out in the application.
LocalCircles, an independent community engagement and social media platform, too had written to the chief secretaries of all states citing results of their survey in 237 districts of India, where 57 per cent of respondents said that their top concern with respect of COVID-19 treatment at private hospitals was high charges. Sixty-one per cent were of the view that private hospital charges for COVID-19 should be standardized or capped for ICU/ward bed and treatment based on hospital category so that profiteering can be controlled. The capping should also apply to prices that can be charged for PPE kits and masks on a daily or per use basis.
Recently, the Delhi government had asked 22 private hospitals in the city to reserve more than 20 per cent beds for COVID-19 treatment. Though the government had not capped prices yet, a large majority of those beds have already been filled.
Last week, as the Union Home Minister Amit Shah stepped in to manage the COVID-19 situation in Delhi, a committee was constituted under Dr Vinod K Paul, member of NITI Aayog, to fix rates for COVID-19 treatment at private hospitals, after several patients and health activists brought the issue to the fore.
“The committee has recommended Rs 8000-10000, Rs 13000-15000 and Rs 15000-18000 including PPE costs for isolation bed, ICUs without and with ventilator respectively, to all hospitals as compared to the current charges of Rs 24000-25000, Rs 34000-43000 and Rs 44000-54000 (excluding PPE cost),” the union home ministry said in a statement today.
The issue of heavy costs incurred by patients has been raging in other states, too, and some such as Telangana, Tamil Nadu, Karnataka and Maharashtra have already capped prices. Not only were patients facing the prospect of huge bills running into several lakhs, but families of COVID-19 patients have also been complaining that several private hospitals would insist on taking a heavy deposit before admission.
The matter had also reached the Supreme Court in May, where a PIL filed by advocate Sachin Jain had argued that since private hospitals had received free land, they should not be charging for COVID-19 treatment. In an intervention application filed by All India Drug Action Network and Jan Swasthya Abhiyan, Mumbai, organisations have been providing support to patients and their families in accessing healthcare services in public and private hospitals as many families have faced financial hardships in paying for treatment in private hospitals.
“The current scenario in cities with high burdens of disease and growing infections is one where public hospitals are overcrowded, overwhelmed, and suffering from high COVID-19 infection rates amongst health care workers (HCWs). Thus, facilities of charitable, private/corporate hospitals need to be added to fulfil the government’s responsibility to provide care to all COVID- 19 patients. Most charitable hospitals in India function virtually as private/ corporate hospitals,” AIDAN has pointed out to the court.
The application includes bills charged by top hospitals in Delhi, Mumbai and Kolkata that have ranged from 16 lakhs for 30 days treatment including ICU care, to a bill of 2.8 lakhs for five days of ICU treatment. “The public health crisis has brought about huge charges for the use of PPE kits and PPE components (gloves, N-95 masks, 2 & 3-ply masks, head covers etc.) for which cumulatively patients have even been billed up to Rs15,000 a day,” health groups have pointed out.
With beds filling up fast in government hospitals, patients are being forced to seek treatment in private facilities, application in court states. “As such, the question of seeking treatment for COVID-19 in a charitable/private/corporate hospital is not a matter of choice any more, rather, an inescapable reality for numerous Indians, who are being left with no other option but to access private healthcare. Thus falling prey to the unregulated and often excessive rates charged by private hospitals. With increasing numbers of infected persons, this inevitability is only set to increase, and with it, the exploitation and deprivation of the helpless,” the application reads.
Even in cases where the patient has private insurance, insurance companies are unwilling to cover many charges which can end up being significant costs of the treatment, AIDAN said in the application, with bills from several patients as evidence. “Further, the depletion of insurance cover in the treatment of COVID-19 is a serious concern, especially true for patients with existing chronic and life-threatening conditions like cancer, etc., and which may leave them vulnerable and without coverage in the future for non-COVID-19 treatment.
Insurance cover will drain quickly when patients end up with more severe health outcomes and require extensive critical care interventions and support. Insurance itself does not guarantee financial protection for patients because COVID-19 treatment costs can quickly exceed coverage limits,” they pointed out in the application.
LocalCircles, an independent community engagement and social media platform, too had written to the chief secretaries of all states citing results of their survey in 237 districts of India, where 57 per cent of respondents said that their top concern with respect of COVID-19 treatment at private hospitals was high charges. Sixty-one per cent were of the view that private hospital charges for COVID-19 should be standardized or capped for ICU/ward bed and treatment based on hospital category so that profiteering can be controlled. The capping should also apply to prices that can be charged for PPE kits and masks on a daily or per use basis.Recently, the Delhi government had asked 22 private hospitals in the city to reserve more than 20 per cent beds for COVID-19 treatment. Though the government had not capped prices yet, a large majority of those beds have already been filled.
Active cases have continued to rise since the capital opened up — on June 18, Delhi recorded 2877 new cases and 65 deaths — and doctors fear the health systems are on the verge of being overwhelmed. The central government, too, has swung into action. On June 14, Union Home Minister Amit Shah held a meeting involving all stakeholders in Delhi, the first such high-level meeting on coronavirus in the capital. The meeting was followed by Shah's 'surprise visit' to the Delhi government-run LNJP hospital, a day later. Instructions to the Delhi chief secretary to install CCTV cameras in coronavirus wards for monitoring, back-up canteens for food supply, and counselling for healthcare workers, were issued.
With Shah taking charge, a slew of other measures have been announced — in the coming days, testing would be first doubled, then tripled, eleven districts in the capital have got designated laboratories to avoid backlogs in testing, 500 railway coaches have been allotted to Delhi ( adding 8,000 beds), and contact tracing has been emphasized. Rapid antigen testing began in the national capital on June 18, and 7,040 people have been tested in 193 testing centres, according to the union home ministry.
According to the ministry, 27,263 testing samples have been collected in Delhi from June 15-17 against the daily collection which varied between 4,000-4,500, earlier.
Three committees with four members each have also been constituted for “rapid assessment” of healthcare infrastructure. The members include doctors from both the state and central government hospitals and municipalities.
“We have to work on a war-footing now. Teams have already visited a few hospitals, and over the next few days, we will be making the rounds of several others in the city, including bigger corporate hospitals. The idea is to handhold them to ensure that the situation can be managed better. During our visits, we have found that there were issues of not enough capacity in mortuaries, shortage of manpower, supplies such as oxygen support, ventilators and beds. The fact that over 200 HCWs had contracted the infection in Delhi has lead to a shortage of staff,” said Dr Mahesh Verma, professor emeritus, MAMC, one of the members of the expert committees formed by the central government to suggest ways to manage the situation in the national capital.
Verma insists that things have already started to change: at LNJP, split air conditioners have been installed in wards and central air-conditioning is being restored for patient comfort. “We have suggested that to manage manpower shortages, doctors and staff from other specialities need to be roped in, too, and government hospitals should be allowed to procure supplies at market rate. The MS of a government hospital should also be allowed to hire extra staff as per need. Portable containers that are used to transport flowers can be used for dead bodies,” said Verma, vice-chancellor, Guru Gobind Singh Indraprastha University.
"Let’s go by the Delhi government’s estimate of 5 lakh cases by July 31. Of these, even if 50 per cent recover, we will still have 2.5 lakh cases. Of these, about 15-20 per cent will require hospitalisation, and 5 per cent could require ICU care. That means, we have 12,500 ICU beds. Delhi has 6,000 ICU beds and these would be hard to increase. And it’s the ICU patient that are at high risk of mortality,” says Dr Sumit Ray, Head, critical care medicine, Holy Family Hospital.
— With inputs by Soni Mishra
