India's health disorder

Dismal realities about health care in the National Capital Region

A number of studies have documented both notable successes, as in the case of polio eradication, and failures in creating adequate public and private health facilities in India. An example of the latter is the substantial divergence between the numbers of deaths due to the Covid-19 pandemic as indicated by Indian official sources and the considerably higher figures cited by the World Health Organization. This article is not about the adequacy or the shortcomings in health care in India. It is about how difficult it is for those who are privately employed, even earning around Rs 30,000 a month, to receive affordable health care, and for the affluent to get objective medical counselling in Delhi and nearby areas.

Take the specific case of 53-year-old Avinash Chandra (name changed). Avinash is a chauffeur hired by a family resident in South Delhi. Given the prohibitive costs of health care in private hospitals Avinash’s employer Mr X suggested to Avinash that he should check out the availability and cost of medical facilities in Delhi or central government and municipal hospitals. He reported back to Mr X that while the costs are relatively low in publicly-owned medical facilities, there are long waiting lists for hospitalisation except for emergencies stemming from road or other accidents.

Given this ground reality, Mr X contacted several private insurance companies and bought health insurance for Avinash, his wife and minor daughter from a Mumbai-headquartered insurance company. A few months after this health insurance was purchased Avinash’s wife experienced sharp abdominal pain and had to be rushed to a private hospital. The ultrasound indicated fibroids in her uterus and the diagnosis was that a hysterectomy was required urgently. Avinash contacted the insurance company and was told that a hysterectomy was not covered under his insurance for two years, although the annual ceiling for hospitalisation related reimbursement was Rs 5 lakh. Mr X was not convinced that this information was correct but found out that under similar circumstances another large Mumbai-based insurance company too does not cover hysterectomies.

On further checking with the insurance company, Mr X discovered that this insurance, which costs Rs 30,000 per annum, has highly restricted coverage. For instance, any pre-existing ailments would be covered only after a waiting period of three years. Further, there is a two-year exclusion period for cataract, hernia, hysterectomy, joint replacement, pregnancy, dental treatment and external aids. Congenital diseases and non-allopathic treatment are not covered at all. It is unclear why ayurvedic treatment, which is low cost, should be excluded. Effectively, all that is covered is injury due to accidents when a person is rushed to the closest hospital. In any case, government and private hospitals are compelled to provide immediate medical assistance for emergencies. It is surprising that the Indian insurance regulator allows so many exceptions under private health insurance.
 

Illustration: Binay Sinha

At this stage, given that the condition of Avinash’s wife was deteriorating, the employer checked with private hospitals and the cost quoted for hysterectomies was Rs 80,000 to Rs 1,10,000. While the search for a suitable option was going on, Mrs X happened to meet a lady doctor heading the gynaecology department of a central government hospital and explained the situation to this doctor. Avinash felt that the risks of any mishap related to his wife’s surgery were lower in this government hospital. Finally, the hysterectomy was done in the government hospital at a total cost of Rs 42,000 about two months after doctors had first diagnosed the necessity of immediate surgery. This surgery would not have happened in two months but for the accidental meeting between Mrs X and the gynaecology department head in a government hospital. Avinash was told by the highly overworked lady surgeon who did the surgery at this reputed government hospital that for such operations the waiting period is usually eight to nine months.

Around the same time, Mr X discovered after a routine health check-up in a private hospital that he had about 95 per cent blockage in one of his heart-arteries. Mr X had normal blood pressure and no angina pain. He consulted a number of cardiologists and the uniform advice was to get an angioplasty done, including installing one or more stents in addition to statin and blood thinner medication.

Mr X happened to hear from his younger doctor brother who is a professor in a teaching hospital in New York about a 2020 study of the US National Institute of Health. Quoting from this research “taken together, the quality of life and clinical results suggest that there is no need for invasive procedures (read stents) in patients without symptoms”. Further, according to David Maron, MD, Director of the Stanford University Prevention Research Centre and the study’s lead author and principal investigator, “for those with angina, our results show it is just as safe to begin treating with medication and lifestyle change, and then if symptoms persist, discuss invasive treatment options.” It was surprising that eminent cardiologists in large private hospitals in Delhi did not apprise Mr X about this research available at, https://www.nih.gov/news-events/news-releases/nih-funded-studies-show-stents-surgery-no-better-medication-lifestyle-changes-reducing-cardiac-events.

It appears that the diagnosis of cardiologists in large private hospitals in the NCR is often driven by revenue targets.

The recent experiences of Avinash and Mr X provides a glimpse into the inadequacy of affordable health care for the less affluent and the lack of sufficiently professional diagnosis even for the well-heeled in Delhi. Effectively, health care in the NCR for lower income groups and the affluent is riddled with flaws of limited insurance coverage, inadequate numbers of doctors-nurses in government hospitals, high cost in large private hospitals and misdiagnosis. At the same time, any sweeping generalisation based on the experience of two individuals would do injustice to the state of health care in India. Some hospitals run by private philanthropies or those which are publicly-owned and happen to be managed by exceptional individuals are honourable exceptions.

j.bhagwati@gmail.com. The writer is a former Ambassador, World Bank Treasury specialist and currently Distinguished Fellow at the Centre for Social and Economic Progress