Commercialisation of healthcare has pushed secondary level hospitals and nursing homes to be financially non-viable with ethical practice and needing external support like subsidy by the state. The entry of corporate sector has further escalated the profit-oriented business practices in the health sector.
With the dismantling of family physician system of medical practice and evolution of nursing homes to private owned hospitals and their corporatization, medical profession has taken a big leap towards commercialization wherein the poor and marginalized sections of society have been left out of the healthcare and profiteering and corruption rule the roost notwithstanding the Ayusman Bharat. Besides, practices of inflating the narrative on disease conditions when a patient is admitted, extending stays, ICU admissions, the new low of corrupt medical practices can be seen in the form of ascribing disease to make patients out of healthy persons and, in many instances, declaring them lifelong patients. Laboratories and diagnostic centres, involved in cut practice and kickbacks, are ready to conduct ‘sink tests’.
Competition for survival and increasing profit margins among corporate and other private hospitals requires attracting more patients by evolving mechanisms of cut practices and financial kickbacks. Increasing number of partners in the net profits is accommodated by increasing the cost of care. According to well documented papers both in the Medical Council of India and the Union Ministry of Health as well as various well-meaning research works, kickback channels involve referring practitioners, diagnostic laboratories, radiology centres, pharmaceutical and medical instrumentation retailors/wholesalers, and hospitals.
At the time of country’s Independence, two-thirds of the physicians were in the urban private sector, largely in single doctor clinics as family doctors or in the few private hospitals. Much of the private sector clinics and hospitals were owned and run by doctors. The nature of practice was of family physicians where the relationship was of a personalized nature. That is no longer the case now as the 1970s and 1980s witnessed significant changes in the private sector’s rise with beginnings of a shift from clinics to nursing homes and hospitals which accelerated further in the 1990s. It also witnessed entry of non-doctor ownership of hospitals with investor-led corporate group ownership emerging in the healthcare industry. Most doctors became merely workers in such hospitals where the terms and conditions were set by the hospital management with financial concerns often overriding rational and professional practice.
In the corporatized hospitals, specialists became consultants with practices in several hospitals. In the process, nature of practice changed from that of family doctors to consultants offering services in big hospitals with a consultant-client relationship, thus decreasing the continuity of doctor-patient relationship and care. Corporate hospitals with their five-star hospitality services have changed the notion of what a hospital can and should be. Hospitals are no more places of providing health care that are needed for the patient in a comfortable setting but have become sites also for fulfilling desires of hospitality services in a luxurious ambience. Such models of delivery of health services are unsustainable without overpricing, irrational and corrupt practices. Other dimension involves hospitals ensuring their profits by giving doctors targets to be fulfilled through available patient loads or by increasing patient numbers, thus putting doctors into malpractices of over-diagnosis of problems in patients and over-prescription of diagnostics and therapeutic procedures. Apart from giving targets to consultant doctors, business models are moving patients from general practitioners and small hospitals into these multispecialty and corporate hospitals.
Commercialisation of healthcare has pushed secondary level hospitals and nursing homes to be financially non-viable with ethical practice and needing external support like subsidy by the state. The entry of corporate sector has further escalated the profit-oriented business practices in the health sector. The sheer scale of investments for building and running a hospital and for providing technologically advanced and hospitality services demand commensurate returns. Financial viability and aspirations of upward social mobility push even the hospital owners and doctors into corrupt practices. There is a thin line between technologically advanced medical care and irrational use of technology, the commonest examples being use of injectable and intravenous fluids. The scale of corruption multiplies in the case of unnecessary MRIs, CAT scans, hysterectomies, cardiac stents and bypass surgeries. These explain how ruthless profiteering practices in healthcare sector have vulnerable and weak patients at the receiving end with inelastic demand for rational medical needs.
Crass commercialization of health care in the private sector and poor and overcrowded public healthcare infrastructure aided and abated by primacy of private sector medical education have pushed the general public on the margin of deprivation and penury making inclusive development in our democratic system of governance a sham and non-sustainable. It is time the elected governance corrected the shortfalls in the public healthcare and enforced with iron hands some benefits to the poor and the marginalized in the private healthcare and strengthened the public healthcare!