Readers might have come across the following headings in national daily news papers in the recent past: ‘Open secret: Doctors take cuts for referrals’, ‘XX.. hospital admits to offering doctors ‘incentives’, ‘Patients have become consumers and they are the losers’ [Times of India, 28.6.2014 & 6.7.2014], ‘Healthcare in India infected with rampant bribe culture’ [The Hindu, 28.6.2014], What is the complaint? Corporate hospitals are forcing or bribing doctors to write unwanted tests and procedures for patients admitted in their hospitals. This is in addition to the known secret of big pharmaceutical companies offering ‘everything’ to doctors prescribing their products left and right.

Admission
Nothing new about the above revealing, many knew it already. What is new is eminent doctors started admitting it and openly coming out against these practices, as it has reached intolerable level. Dr. Samiran Nundy of Sir Ganga Ram Hospital has wrote an article in British Medical Journal titled ‘Corruption: Medicine’s Dirty Open Secret’ in which he has elaborated all the bad practices in the Indian healthcare system starting from admission to medical colleges with huge capitation fees. Dr. M. K. Mani of Chennai Apollo Hospital has said that he had filed a complaint with proof as early as 1995, with Medical Council of India and yet council took no action. This author personally know, an eminent, foreign return doctor  - father of a pharmacy professor - has to resign, some 15 years back, because of his hospital management’s daily pressure to write unwanted tests and drugs to his patients. Thus, doctors who are not able to kill their consciousness are struggling, suffocating and suffering because of this dangerous infection of the system.

Diagnosis
What went wrong and where? All these problems begun only after top entrepreneurs and corporate houses were encouraged to start big hospitals. Remember? Few decades ago, only good Samaritans, philanthropists, started hospitals to offer treatment to poor people free of cost, similar to Christian and other Machineries. Now? After the advent of these big hospitals, the ‘business magnet’ owners of them want to have handsome return on their investment, as in their other businesses. When a scan or other electronic diagnostic equipment costs 10 to 15 crore rupees and has to be imported from Germany or Japan or USA, naturally the expectation of the owner is steady and considerable profit from that huge investment. If sufficient patients are not there to use that machine their idea is to bring in some patient even if he is not required to be tested with the particular machine. The doctor who is treating the poor chap has to do that, if not, his salary will be delayed or cut!

Disease progress
Dr. Samiran Nundy says, if the income generated by a doctor fall short of targets set for them, these hospitals ask them to justify their salary. At the end, even up to 30 per cent of salary is cut or they are forced to resign, he fumes. Dr. G. R. Ravindranath of ‘Doctors for Social Equality’ in Chennai wrote, on this topic recently in a Tamil Daily [The Hindu Tamil, 29. 6. 2014] that corporate crorepathies have made even the doctors as labourers as told by Karl Marx in 19th Century, “Capitalism make, doctors, engineers, scientists and other intellectuals as labourers getting daily wages,” he quote. Thus, the disease progresses from pressure, tension, disappointment and depression to humiliation and unemployment for doctors and debt, worry and even death for patients.  

Etiology
What is the root cause of this infection? Why Indian healthcare system is affected to this extend? All because of our Central and State governments apathy in meeting the health care needs of the people. The governments which are spending less than 2 per cent of GDP – the lowest among developing countries - has to be blamed for this pathetic situation. These governments are telling the people they have no money to start new medical colleges or new hospitals or even primary health centres! Thus our great ‘welfare governments’ started encouraging private investment in the very basic need of the people - healthcare sector - for the last few decades. Now the result is here for every one to see! Advocates of privatization of government institutions, please open your eyes. Like the big corporate hospitals, the owners of private medical colleges, who invest anywhere between 600 to 700 crore rupees, too want to have return on their investment. Hence they sell an MBBS seat for Rs.50 lakhs and an MD/MS seat for Rs 2 crores and so on. The bug never stops here, the vicious cycle continue…the doctors who graduate from these colleges too expect profit for their investment!! How the great economic brains of our governments going to break it?

Prescription
Having diagnosed the problem and found the etiology (reason) for it, the next thing required is a prescription. It is very simple: Start more and more govt hospitals and medical colleges in each and every district of India and see to that they work properly with sufficient men, machine and medicine. That will drastically reduce number patients going to those big private hospitals. When there is no more business possible they themselves will press the government for taking over their hospitals or convert them in to star hotels. Thus, nationalise at least corrupt corporate hospitals similar to the nationalisation of banks done by Srimathi Indira Gandhi. What is required is political will and courage (like her).

Treatment and cure
Some may be inclined to prescribe other remedies like bringing in more strict control over the hospitals. But we Indians have lot of experience, how our laws, rules and regulations are enforced by the corrupt bureaucracy. Hence that prescription may not cure the disease. Instead of postponing the cure and deteriorating the system further, drastic measures in the beginning itself is wise, we believe. Indian health care system is so infected; it has reached the stage of sepsis. Surgery is the only option.

Will our new government which came to power with so much good will and support of common people do this and show their gratitude to them?

(Author is ex- president, Indian Pharmacy Graduates Association, Madurai, T.N)