By Dr George Jacob

Kochi, Sept 6, 2022: A 27-year old man was admitted with Acute Pancreatitis to Division of Surgical gastroenterology where I work. Acute Pancreatitis, a benign condition involving the pancreas is potentially lethal. It causes failure of other organs, entailing prolonged hospital stay, usually in ICUs.

Multi-organ failure mandates costly treatment modalities like ventilator and dialysis support, high-end antibiotics and other costly medication. It therefore drains patients and their families financially to treat it fruitfully.

This disease is also associated with development of pus within the abdomen which might need multiple interventions like surgery and imaging-aided interventional radiology procedures. These add to treatment costs substantially. Being a benign condition, the guiding philosophy to treat this particular disease is to ‘go all out’ to save these patients, who are usually young.

This particular patient also required ICU admission and drainage of pus from his abdomen by an interventional radiologist, and costly medication.

His father was a humble fisherman who ran from nonexistent pillar to post to manage money to pay his son’s mounting hospital bills. It is my responsibility to update the families of patients admitted to the ICU about the patients’ medical details daily. It was heartbreaking to talk to this fisherman whose financial woes mounted daily in his efforts to have his son back home hale and hearty. He would weep while relating about dearth of money, an important commodity when his son was seriously ill.

The patient required multiple admissions to the ICU with various complications of acute Pancreatitis. Every admission was an emotional rollercoaster ride, as briefing the humble, teary fisherman continued to be heart-breaking. All I could do was to listen to him patiently.

This is not a unique story told only in the hospital I work in. Such heartbreaking stories of human ordeal are told aplenty in modern-day hospitals. Especially in ICUs where attempts are made to save precious lives at a heavy cost monetarily all over the world and indeed this country too.

Modern healthcare is prohibitively expensive, especially if sought in private healthcare facilities, particularly in the corporate sector. It is a fact that umpteen diseases being treated in private hospitals can well be treated in hospitals in the public sector too. But, in reality healthcare provided in the public sector falls short to provide quality healthcare, for various reasons viz; dearth of man power, a ‘work-to-rule’ work culture nurtured by poorly paid personnel and funds to upgrade facilities.

These have people queuing up before prohibitively expensive private healthcare facilities. People don’t think of treatment costs when they fall sick, especially abruptly. It is when treatment proceeds and costs soar that tears are shed and heartrending stories of households rendered financially broken are heard in these ‘temples of healing.’

This is glaringly evident when emergency health care, especially trauma and accident services are sought. Some hospitals demand ‘advance payment’ in such life-and-death situations. Here, healthcare workers become sitting ducks before an irate public and families of the seriously sick brought to Emergency Departments.

This unpleasant scenario in healthcare dispensation will only increase, as advances in healthcare have paradoxically added to longevity, which in turn adds to people taking ill. Modern-day fast life has also added to the sick list by way of accidents and trauma and life-style ailments.

This paradox calls for solutions to a vexed social malady, which adds to stress and strain of healthcare providers, who turn victims of irate families who are drained financially by exorbitant treatment costs. This vitiates the atmosphere in modern healthcare facilities, which witness unpleasant and often violent attack on healthcare providers and ransacking of such facilities. Financially Broken families of patients, who required prolonged treatment seek ‘compensation’. This is especially true should such patients ultimately succumb.

Bad blood and violence sullying healthcare dispensation must stop. Tears of helplessness to pay for treatment must cease falling within hospital wards.

Schemes promulgated by state and central governments specifically to address this issue are aplenty. Pradan Mantri Jan Arogya Yogana initiated by Prime Minister Modi is one such. These schemes have failed to alleviate financial travails of the sick from poor socio-economic strata.

What can be done?
• Promulgate watertight schemes that will help people meet healthcare costs, especially of those needing emergency healthcare, without red-tapism and long-winding procedures. Many Hospitals empanelled into such schemes, especially those in the private sector evade them to have their way with charging patients. This must stop. Licenses of such hospitals must be suspended.
• The government must ensure friendlier attitude from companies providing health insurance, whose motto is somehow to refuse reimbursement and cashless facilities. Ideally the government must provide medical insurance that operates on menial premium from every Indian citizen. Considering the population of this country, the lump sum money collected will be sufficient to insure healthcare needs of citizens. Especially emergency healthcare.
• The government must allocate more funds to improve healthcare in the public sector. 1.2% to 1.6% of GDP has only been spent on healthcare in India between 2008-09 and 2019-20, which is one of the lowest globally.
• To initiate steps to attract healthcare personnel to serve in public sector. India has a doctor-population ratio of 1:1456, compared to WHO standards of 1:1000. However, distributions of doctors working in urban and rural areas remain skewed. The urban: rural doctor density ratio is 3.8:1, when 64.61% of Indians live in villages.
• Upgrading healthcare facilities in the public sector meant to address healthcare needs of the poor must be initiated by the government on a war-footing. If funds are in short supply, millions of patients in India seeking out-patient services in public hospitals can be charged nominal consultation fees, which alone would suffice to upgrade facilities in the public sector hospitals. Attempts to do this have been scuttled by vote-hungry politicians. It is the responsibility of people who have no qualms in spending on liquor and tobacco to also spend for their more important health needs that their tears stop falling within Indian hospitals.
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(The writer is the Consultant Surgical Gastroenterologist at Lakeshore Hospital, Kochi, Kerala)