New Delhi: Over 82 percent cases of treatment in private hospitals across Maharashtra during the Covid pandemic involved patients being charged rates higher than the price caps set by the state government, according to a first-of-its-kind study by a Pune-based NGO.
The peer-reviewed study is based on a bill-by-bill comparative analysis of 120 Covid hospitalisations during the pandemic in private hospitals across 15 of Maharashtra’s 36 districts.
Conducted by researchers at the Support for Advocacy and Training to Health Initiatives (SATHI), the study was published in the International Journal of Medicine and Public Health Tuesday.
The researchers sought to understand patient experiences regarding expenses incurred on Covid treatment at private hospitals.
The study is based on in-depth interviews with 100 respondents — patients, their kin or representatives of hospitals — between November 2021 and February 2022. Fifty-eight respondents underwent successive hospitalisations in two to five hospitals.
According to the study, 50 percent of the hospitalisation cases were characterised by moderate overcharging, where the bills were up to 25 percent higher than they would have been if the rate caps had been honoured.
In 23.3 percent of the episodes, there was excessive overcharging — bills were up to 50 percent higher. Another 9.2 percent were associated with exorbitant overcharging, where the bill was more than 50 percent higher. Standard rates were applied in the remaining cases.
“This is crucial evidence to suggest how private hospitals indulged in massive overcharging — by charging up to 4-5 times the rates fixed by the government in some cases — and makes a case for stricter and sustained regulation of private healthcare providers,” Dr Abhay Shukla, co-author of the study, told ThePrint.
Maharashtra, the study notes, was the Indian state worst affected by Covid, accounting for 22.5 percent of all cases and 30.55 percent of all deaths during the massive second wave in 2021.
Reached for comment, Dr Ravindra Kute, president of the Maharashtra chapter of the Indian Medical Association, a large network of private doctors, said it may not be appropriate to accuse private hospitals of profiteering during the pandemic without considering the circumstances of the time.
ThePrint reached Maharashtra Health Secretary Milind Mhaiskar over the phone for a comment on the study, but did not receive a response.
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‘Blatant overcharging’
In April 2020, the Maharashtra government decided to regulate 80 percent of private hospital beds — to be used for Covid treatment — by putting a price cap. In June the same year, it said bills will be audited if complaints of overcharging arise.
The state government determined Covid treatment rates for private health establishments based on insurance reimbursement rates set by the General Insurance Public Sector Association.
According to the government notification on rate-capping, there were three categories of packages: Rs 4,000 per day for the general ward, Rs 7,500 per day for ICU without ventilator, and Rs 9,000 per day for ICU with ventilator.
These packages were supposed to cover bed charges, the cost of monitoring and basic blood investigations, X-Ray, ECG, oxygen, consultation, nursing, meals, and basic procedures like Ryle’s tube insertion (for feeding and administering medicines when patients are not conscious), and urinary catheterisation.
Maharashtra was among 15 states where governments had introduced price caps for Covid treatment.
The SATHI study, however, said the majority of private hospitals utilised diverse stratagems to circumvent rate regulations, including double-charging on items included in the official packages.
“With a background of commercialisation of healthcare and pre-existing regulatory hiatus in India, gaps in design and implementation of Covid-period regulatory measures and state’s inadequate regulatory capacity formed the context for the limited effectiveness of regulatory measures,” the authors say in the study.
India and other low- and middle-income countries with large private healthcare sectors should develop “comprehensive yet pragmatic frameworks” for regulating private healthcare, including standardisation of rates, which can strengthen regulatory efforts, enabling equitable and affordable access to healthcare for all, they add.
Dr Kute of the Maharashtra IMA said private hospitals were not to blame.
“The operational cost of hospitals was way higher than the standard rates due to higher wages charged by healthcare personnel, higher equipment costs, vast usage of PPE kits and scarcity of crucial lifesaving medicines and equipment such as Remdesivir, oxygen concentrators, cylinders and ventilators,” he said.
On top of it, he added, doctors and other healthcare workers were taking huge risks to serve the patients 24×7.
“Now coming up with a study or report simply saying that hospitals overcharged during the time may be easy for civil society or the government but the situation was entirely different that time,” Kute said.
‘No detailed itemised bills’
The mean age of the 100 patients was 47 years. Of the total patients, 28 had some comorbidity. Thirty-four patients recovered with treatment, while 66 died in the hospital.
In 77 percent of the cases, the hospital stay was shorter than 14 days.
Twenty patients said they had first approached government hospitals but resorted to private hospitals since government hospitals lacked beds or critical care services.
Currently, there is no rule or accreditation guidelines requiring a standard format for hospital bills. In this study, the researchers found that most hospitals did not issue detailed itemised bills.
In one case, Rs 48,000 was sought as “procedure charges” with no mention of the procedure, the study notes. Although corporate hospital bills were more systematic and itemised, these also contained irregularities, it adds.
Some respondents reported receiving handwritten bills for large amounts up to Rs 200,000. In one case, even the hospital’s name was missing on the handwritten bill, the study notes.
“This is one issue that needs to be fixed urgently as the medical bill is an important document for patients and their families,” said Shukla.
The researchers say that their analysis revealed that the scale of overcharging was proportional to the size of the establishment.
Among other things, the researchers found that 66 patients had medicine expenditure above Rs 1,00,000, which led them to conclude that overcharging for drugs got worse during Covid.
Medicine expenditure was more than half of the total hospitalisation bill in 29 percent of the episodes.
(Edited by Sunanda Ranjan)
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