Pune: The possibility of patients footing private hospital bills themselves being charged more than those insured emerged as a key concern at an online interaction organised by Jan Swasthya Abhiyan (JSA) and Working Group on Access to Medicines and Treatments with media representatives.Experts highlighted that hospitals negotiated package rates with insurers and for govt schemes such as CGHS (Central Govt Health Scheme) and PM-JAY (Ayushman Bharat Pradhan Mantri Jan Arogya Yojana). Patients without insurance, on the other hand, are vulnerable to higher and non-standardised rates.Jyotsna Singh, co-convener, Working Group on Access to Medicines and Treatments, said on Monday, “Negotiations between hospitals and insurance companies often tend to lower the price and the overall bill, but a patient paying out of own pocket may end up paying more. Reason: The patient or the relative will not have the same negotiation power or skills.”Dr Abhay Shukla, co-convener, JSA, said, “Private healthcare has expanded enormously in India, but regulation has simply not kept pace. There is no regulation of rates. Leading corporate hospital chains have been earning huge surpluses, estimated in the range of Rs22 lakh to Rs55 lakh per year from each bed, in the past few years.”Shukla said, “The CEA (Clinical Establishment Act) was passed more than a decade ago, but its non-implementation has produced zero results on the ground. It is high time that govt starts to regulate the procedures in private hospitals. Patients should know how much they will be charged before agreeing to a treatment.”IMA president (Maharashtra chapter) Dr Santosh Kulkarni argued that there could be no uniform charges for two patients. “Each individual human body needs different treatment, which cannot be anticipated in the beginning,” he said.He said, “Doctors are constantly threatened with legal cases since the inclusion of the medical field in the Consumer Protection Act. If a patient is saved, the doctor is not thanked. If something happens to a patient, the doctor is harassed by the system.”Steep mark-ups on medicines sold through hospital pharmacies are another challenge. Supreme Court drew attention to a case in which a cancer medicine supplied at around Rs2,700 carried an MRP of around Rs27,000.K M Gopakumar, co-convener, Working Group on Access to Medicines and Treatments, said, “When patients are required to buy these products from the hospital pharmacy, there is no price competition at all. The MRP cannot become a licence to charge patients many times the procurement price. Govt must urgently fix the trade margins on all medical products.”The groups warned that increasing financialisation of healthcare was affecting not just patients but clinical practice itself. Revenue targets and financial incentives within corporate hospitals can create pressure for unnecessary investigations, procedures or more expensive treatment options.“Healthcare cannot function like an ordinary market, where the patient is expected to shop around. India needs a strong regulatory framework that protects patients, ensures transparency and puts clear limits on what private hospitals can charge. The government has legal and regulatory tools at its disposal. What has been missing is the political will to use them effectively,” added Dr Shukla.Dr Gayatri Sharma, community health physician and researcher, demanded that the National Medical Commission should ban incentive-linked pay for doctors. Dr Sharma said, “Doctors should be able to make treatment decisions solely based on what is medically necessary for the patient.”Shishir Chand, Delhi co-convener of NGO People for Better Treatment (PBT), said, “Many patients come to us after receiving hospital bills running into lakhs of rupees, often without understanding how those amounts were arrived at. When they challenge it, they are forced to run from one authority to another.”
