The devastating second wave of Covid-19 is on its downward spiral in most parts of India. This wave started in the first week of April and by the end of May it was under reasonable control. This was achieved mainly due to the lockdowns imposed in most parts of the country. Now that the country is slowly reopening, talks are already underway for the imminent arrival of the third wave. Many estimates suggest that the third wave is going to hit the country in the months of August – September.
The patients who are suffering from other problems like Back Pain, Gall Stones, Ano-rectal diseases, Uterine Fibroids, Ovarian Cysts, Cataract, Kidney Stones etc had a bad time in the last 15 months. They were neither able to go to the hospitals nor get personal consultation from the doctors. The hospitals were overburdened with covid patients and had no beds left for the other patients. The fear of contracting covid at these hospitals was also weighing in the minds of these patients. They have been postponing their treatment for far too long. The condition of many patients who require surgery is deteriorating. There is a small window of about 30-45 days during which these patients should get the surgery done before the onset of the 3rd wave of Covid.
The patients who can still postpone their surgical treatment should immediately get physical examination done by their doctor. This is the time when there are almost no covid patients admitted at most of the hospitals and the OPD’s are fully functional. Alternatively the patients can go to the clinics of the doctors which are covid safe. Many of these clinics have been functioning even during the peak of the pandemic. Leading Spine Specialist Dr Sudeep Jain who has been operating through his clinic in New Delhi says that `Ignoring back pain and postponing the treatment for long can take away the option of non-surgical treatment for many spine patients. We have been operational throughout the pandemic and giving physical and video consults to our patients from all parts of the world. This has helped many patients who could not travel to Delhi due to the lockdowns and travelling restrictions. Patients whose surgery cannot be postponed any longer should utilize this small window and get the treatment done at the earliest.’
Other patients who have experienced the problem for the first time during the pandemic should get clinical examination at the earliest and start the treatment. If and when the 3rd wave strikes, your doctor would be aware of your condition and can provide follow-up treatment through video and phone consultation. The pandemic is here to stay until significant population is vaccinated and there would be 4th, 5th and many other waves of the virus.
Vaccination is the key to keep the Corona virus at bay. Get yourself vaccinated at the earliest even if you get the first dose. Postponing the treatment for long period of time can make the treatment expensive and less successful. So far it was not in your hands as the conditions forced you to stay locked in. Utilize this window of opportunity and give yourself the gift of good health.
Every human being is born with sinuses. There are 4 types of sinuses viz Maxillary Sinus, Ethmoid Sinus, Frontal Sinus and Sphenoid Sinus. Maxillary sinuses are one in either cheek. Ethmoid sinuses are between eyes on each side of nose. Frontal sinuses are in the forehead area and sphenoid sinuses are behind the ethmoid sinuses i.e behind eyes. When there is infection or inflammation in any of these sinuses then this is called sinusitis.
Why Sinusitis Happens?
To understand the reason for infection, first we need to understand how the aeration in the sinus happens. The air we breathe through our nose goes into the sinuses where it gets humidified. This humidified air goes into the throat from where it goes into the ears through the Eustachian tubes behind the tonsils. So precisely the air we breathe travels from nose to throat and then to an ear which is why ENT (Ear Nose and Throat) is put under one specialty.
However, this circulation of air in many people is not normal as explained above. This can be due to many reasons:
- A Deviated Nasal Septum (DNS) – A Deviated Nasal Septum is a condition where the bone that divides the two nostrils is deviated towards one side. This can cause mild to severe obstruction in airway leading to lack of aeration in sinuses.
- Nasal Polyps – Nasal Polyp is a tissue growth which originates from the sinuses and blocks the airways. Polyps are notorious and tend to come back if not taken care of after removal.
- Hypertrophied Turbinated – Turbinates are long narrow passage in the nose when they swell up or are too large they can lead to blockage in the airway.
What are the types of Sinusitis?
Mainly there are two types of infective sinusitis which can be termed as bacterial sinusitis and fungal sinusitis. There is lot of hue and cry about black fungus which is actually a type of fungal sinusitis and it is nothing new it existed before the Covid era as well. Symptoms of bacterial and fungal sinusitis are almost same. “I have been getting lot of patients who have taken course of steroid during covid and are scared that it might be invasive fungal sinusitis. Let me be very clear that all fungal sinusitis are not invasive. Also to differentiate fungal and bacterial sinusitis you mostly do not need a MRI of PNS. Infact a simple CT scan of para nasal sinuses is also good enough. In the CT images we can differentiate between a fungal and bacterial sinusitis. The best part is that the treatment for both kind of sinusitis is same. In both the cases we need to operate upon the patient through FESS (Functional Endoscopic Sinus Surgery). Yes, there is definitely risk in case of fungal sinusitis as it can start eating into the bone and can invade to optic nerve as well as brain. Hence incase of invasive fungal sinusitis anti fungal needs to be started along with the debridement surgery at the earliest”, says Dr Priyanjana Acharyya Sharma, leading ENT specialist and surgeon in Gurgaon.
Why is oxygen therapy during covid leading to fungal sinusitis?
Fungus thrives on moisture that is why earlier cases of black fungus that emerged in India were mainly in the coastal areas and in the areas close to water bodies. However, when a patient is on oxygen therapy, oxygen is supplied through humidifier. Hence when the patient is on long term oxygen support there is lot of humidification that he gets through the nose which helps the fungus to grow. Invasive fungul sinusitis is mostly seen in patients who are immuno-compromised or having co-morbidities like diabetes.
Like every other disease if fungal sinusitis is diagnosed and treated in time then the risk of invasion can be reduced to minimum.
The Corona Pandemic followed by the `Black Fungus‘ scare has resulted in many patients searching for MRI Scan centre. It is easy for people to understand that all cars cannot be of the same price. Cars have engine specifications and many more features which determine their price. So you can get a car for 2 lac rupees and the price of a car can be in excess of 1 crore also. The same is true for an MRI Machine. You can get an MRI machine for 1 Crore and another machine can cost in excess of 15 Crores. When you are going to get an MRI Scan done, you are not buying the MRI Machine so how should you be bothered about the cost of the machine. A better analogy would be hiring a taxi. You can hire a taxi for Rs. 10 per kilometer and you can hire a Rolls Royce for Rs. 100 per kilometer. Both are serving the same purpose of transporting you from one place to another. Now you can understand why some diagnostic centres are offering heavy discounts and doing an MRI scan for Rs. 2500 while others are charging Rs. 10000 and not giving any discounts. In order to understand the price difference between different centres you must spend some time to understand the intricacy of an MRI Machine. This article will also be of help to many practicing doctors who are in the habit of writing MRI Scan on 3T without knowing much about the physics of Magnetic Resonance Imaging.
The most important thing in any MRI machine is the magnet and its specifications. The results of MRI Scanning depend on the quality of the magnet and not on the type or the magnetic strength. There are two types of magnets in MRI Machines – Permanent and Superconducting. The MRI machines with permanent magnet come in strengths of 0.2 Tesla and 0.3 Tesla. The best MRI machines with permanent magnet are manufactured by Japanese companies like Hitachi. The MRI machines with permanent magnet can be bought for 1-3 Crores and have low running cost. The magnet is C-Shaped and therefore these are also known as Open MRI. People who are claustrophobic can get MRI scan done on these machines. A permanent magnet MRI machine of 0.3 Tesla from Hitachi would give very good quality images and most of the MRI studies can be done on this machine. The superconducting magnet comes in strengths of 1.5 Tesla and 3 Tesla. Tesla stands for the strength of the magnet and not the quality of the magnet. The quality of MRI images depends on the Spatial Resolution. MRI scanners which have a high gradient and higher slew rate will have better spatial resolution. Most of the 1.5 Tesla MRI scanners have gradient of 30-35 and slew rate of 120-125. However Siemens Avento magnet has a gradient of 45 and slew rate of 200. This would give better spatial resolution than many 3 Tesla MRI Scanners.
Another very important factor in any MRI scanner is the number of Radiofrequency (RF) Channels. MRI machines currently installed have 4, 8, 16 or 32 independent RF Channels. More the number of RF Channels in the machine, better would be the image quality. MRI of any body part is done by putting a coil around that body part. These coils also have receiver channels. A Knee coil can be 4, 6, 8, 12 or 16 channels. An MRI scanner which is 32 channel would not give great images if the coil used is only 4 channel. A 16 Channel MRI scanner would give excellent images when you use a 16 Channel Knee Coil or a 16 Channel Shoulder Coil.
Most of the MRI Scanners have a maximum field of view of 50 cms. This means than any organ which is longer than 50 cms cannot be scanned in one study. Spine is one of the longest organ and this is the reason that the whole spine cannot be scanned in one go. However the magnet homogeneity is not very good over 50 cm. Almost all the Magnets give good homogeneity over 30 cm scanning. This means that smaller organs like knee, wrist, ankle, shoulder should not have the problem of homogeneity. However bigger areas like chest, abdomen and spine would have issues of homogeneity over different MRI scanners.
The quality of the coils plays a very important role in the quality of MRI Scan. Most of the centres have 4-5 coils which includes Head & Neck Coil, Body Coil, Spine Coil, Small and Large Flex Coil. The number of receiver channels in the coil determine the price of each coil. To give you an idea, an 8 Channel Breast Coil can cost in the range of Rs. 20 – 25 Lacs alongwith the application software for doing Breast MRI. The breast MRI can also be done by using a Large Flex Coil but the quality of imaging would not be as good. Similarly some centres would invest in a dedicated Knee or Ankle Coil while others would use a small or large flex coil for doing the scan. When there is so much difference in the cost of the product then how can the pricing for a particular test be the same. Centres doing Breast MRI with a Dedicated Breast Coil are charging Rs. 12-15 thousand for this scan while those doing it with a large flex coil are charging Rs. 6-7 thousand for the same scan.
Sequences and Applications
MRI Scan is done in several sequences like T1 Weighted, T2 Weighted, Diffusion Weighted, FLAIR, STIR, Spin Echo, Gradient Echo. There are more than 100 such sequences. Each of these sequences take 3-4 minutes to complete. There are many centres which are doing just 2 sequences in an MRI Scan and charging low amount for the test.
You must have seen that the same MRI Scan is being offered at Rs. 2500 at some centres through many websites. Other centres would be charging Rs. 8000 – 10000 for the same scan. If you have bought a 12 year old MRI machine with 4 channels and are doing just 2 sequences for any MRI Scan then you can afford to charge such low amounts. It is for the patients to understand the finer nuances of this highly technical field. If you are a patient who is looking to get an MRI Scan done then ask for the specifications of the MRI machine like Tesla Strength, Channels, Spatial Resolution, Gradient Strength, Amplitude, Homogeneity, Coils, Sequences and Applications before comparing the price. However if you do not value your health then keep searching for the lowest price. Everything that is round and red is not an apple and not all apples are of the same price. Similarly comparing the prices of MRI or for that matter any medical service across different centres has no meaning unless you understand the subject. The image quality is one thing and the quality of reporting is something else. A machine may produce excellent images but if the radiologist who is going to prepare the report is not experienced enough then those images have no value. So also check the qualifications and experience of the radiologist before choosing the centre for your tests. If you find the task too onerous then going by the advice of your treating doctor is not a bad idea while choosing the best centre for your tests.
Patients from all parts of the world come to India for getting high quality surgical and medical treatment at very low costs. Indian doctors are rated very highly even in the developed countries. However the cost of treatment in the developed countries is sometimes more than 10 times the cost of treatment in India. Most of the spine surgeries are being done in the price range of USD 6000 – 8000 in India. The same surgery would cost in excess of USD 100,000 in the US. Patients who are planning to come to India for their treatment try to gather information from internet. The most commonly searched query on google is `Best Doctor for Treatment in India’. Each patient would search the treatment for their disease. What pops up in the top search results are either the hospital websites or the aggregators. These digital aggregators would list hundreds of doctors of each specialty. For a patient it is impossible to find out who is the best doctor for their ailment. Health in India is a platform which tries to give you the correct information about each doctor and the hospital.
Spine surgery is being done by both the neurosurgeons and the orthopedic surgeons. The nerves coming from the brain and going into the legs and other body parts are present in close proximity of the spine. Since the nerves fall in the domain of the neurosurgeons, many people believe that neurosurgeons are better suited to do spine surgery. Most of the diseases of the spine are related to the curvature of the spine or discs. Spinal Tumors are also not very uncommon these days. Most of the spine surgeries involve correction of the curvature or instability of the spine using special implants. These implants are mostly titanium rods, cage and screws. These implants are used for fixation of the vertebrae in the spinal column. Some of the surgeries involve removal of the disc and replacing it with artificial disc. Disc is the soft cushion between two vertebra. The spine is divided into 3 parts – Cervical Spine (starts from the back of the neck), Dorsal Spine (middle part) and Lumbar Spine (Lower Back). Most of the problems of spine are in the Cervical region or the Lumbar region due to poor posture, lack of exercise and weak muscles.
Equipments and Techniques
Use of high resolution microscope, endoscope and specialized surgical equipments have made spine surgery much easier. The incision also is much smaller in most of the spine surgeries. Many spine surgeries are done as minimally invasive procedures. The results of the surgery would depend on the experience of the surgeon and the facilities available at a particular hospital. The price of the surgery would also depend on these two variables. Patients can share the MRI Reports and films with the Spine Specialists in India and setup online consultation before deciding to come to India for the treatment. The cost of online consultation with some of the best spine surgeons in India is in the range of USD 50 – 80 which is just a fraction of the cost of consultation in other countries. Do not fall for free consultation which is being offered by many hospitals and doctors. Anything which is offered free always has some catch which will be beyond your comprehension.
Best Spine Specialist in India
Every hospital will claim that they are the best in doing any procedure. India has more than 150 hospitals which get international patients. These include some of the top hospital chains like Apollo, Fortis, Max, Narayana, Global, Medanta etc. One must always consult 2-3 doctors before finalizing the destination for your treatment. The consults must always be `Video Consult’ as you get good idea about the personality of the doctor and their confidence when you are able to see the face. I have spent more than 22 years, studying the Indian Healthcare. The names listed in this article are not an exhaustive list of the spine surgeons in India. Some of the topmost spine surgeons from the field of Neurosurgery are Dr. Arun Saroha, Dr Sandeep Vaishya, Dr Rana Patir and Dr Sharad Kale. The best part is that 3 out of these 4 neurosurgeons are operating in Gurgaon which is 20 minutes drive from New Delhi airport. If you choose to come to Gurgaon for Spine Surgery, then you would have the opportunity to consult all the 3 top spine surgeons in India before opting for the hospital.
Another good thing is that Dr. Arun Saroha who is the Director of Spine Surgery at Max Hospital and Dr. Sandeep Vaishya who is working with Fortis Hospital Gurgaon are just across the road from each other. The top Orthopaedic Spine Surgeons in India are Dr. Sudeep Jain, Dr Hitesh Garg and Dr Manoj Miglani. Dr Sudeep Jain and Dr Manoj Miglani are working in New Delhi while Dr Hitesh Garg is at Gurgaon. If you want the best doctor and best equipment, then Dr. Arun Saroha at Max Hospital would be my first choice. However if you are looking for the best doctor with some flexibility in the price then Dr. Sudeep Jain would be the best choice because he is operating at 4 Delhi hospitals which fall in different price range. Dr. Sudeep Jain has enviable qualifications and excellent track record when it comes to the most complex spine surgeries. Whichever doctor or hospital you choose for your treatment, the decision should be yours. The best way to decide is to meet the doctor for consultation.
Most of the difficult decisions are made easier when you are sitting face to face with the doctor. Good doctors would radiate confidence and would be measured in their approach. They would not appear like a salesman to you. When in doubt, trust your inner voice.
Healthcare institutes in India are submitting themselves to the Digital Disrupters for the last several years. You can call them aggregators but they love to be called `Disrupters’. Many web portals have sprung in the last decade who are busy in listing all the doctors, hospitals, diagnostic centres and other healthcare facilities. Many of these portals display the services provided by the healthcare facilities along with “Discounts”. Patients are lured by these portals by offering discounts on services like Doctor Consult, MRI, CT Scan and other tests. Several portals are in the pipeline who would be offering discounts on the surgeries also.
The healthcare providers would do well to study the business model of these aggregators. Makemytrip promoter becomes a billionaire but the hotel owners become puppets at the hands of these digital behemoths. It may make some sense for the travel industry to be present on such digital platforms because their customers are spread all over the world. Most of the healthcare facilities have their catchment area within few kilometers of the facility. Their customers would not be coming from all over the country save for a few very big hospitals. These digital platforms add zero value to the services provided by the healthcare industry. What business do they have in demanding discounts on your services!
How Should Healthcare Marketing be Done
Most of the healthcare facilities do not spend money in hiring good quality marketing team and prefer to offer discounts through these portals for getting patients. Digital marketing is not very expensive and every healthcare facility would spend much less on their own digital marketing rather than hitchhiking on other platforms. If the healthcare institutes do not understand the perils of this business model, they would soon be dancing to the tunes of the digital disrupters. If you have installed a 15 year old MRI machine then keep your prices low as compared to those who have the latest technology but for god sake do not offer discounts on your rates. You are demeaning the entire medical profession and comparing it to consumer goods. Do not allow the concept of “End of Season Sale” to enter the hallowed profession of Medicine.
If the allopathic doctors and the healthcare facilities do not get off these digital platforms and start investing in their own marketing, they would be responsible for their puppetization. I am all for giving discounts and even free treatment to those who cannot afford it. When you do charity, you and only you should decide the beneficiary and not some digital platform. You are offering discounts to those who belong to the privileged class and denying it to the weaker sections. The best marketing for healthcare is “word of mouth”. Invest in improving your services and manpower and get patients on the basis of good services rather than price cuts.
There are enough groups like Health Insurance, CGHS, ECHS, ESI etc. who are hell bent on hammering down the prices. Do not create another monster in the form of digital disrupters. You would be responsible for the premature death of healthcare in India.
This is in continuation to my article yesterday which was written in sarcasm for the millions of Indians who are always abusing the Indian Healthcare and its Doctors. Indian Doctors and Philipino Nurses are considered the best all over the world but not in the eyes of fellow Indians. When it comes to buying Luxury goods like an iphone worth Rs. 70,000 we are ready to queue up since 6 am in the morning in front of the closed Apple Store but when it comes to queuing at AIIMS we abhor the idea. We expect the doctor to be waiting for us at Max Hospital or Fortis Hospital and we get angry if our appointment is delayed by even 15 minutes because we expect the doctors to be at our service. When it comes to making the payment for this high quality of healthcare we call the same doctors and hospitals as `Chor’ and `Lutera’.
India is one of the biggest market for cars costing more than 10 lac rupees and the flats in some Indian cities are more costly than even Los Angeles. Have you ever heard anyone calling these car companies or the real estate companies by the same names. Never. We Indians are not poor when it comes to eating out at swanky restaurants but when it comes to making the payment for high quality of healthcare we become `Below Poverty Line’. Actually the fault is not ours. We never deserved this high quality of heathcare because we cannot appreciate the difference. For us Tommy Hillfiger is a brand but a hospital giving us Hillrom beds has no meaning. Hospitals like Medanta and Fortis were fools to buy hospital beds costing more than 2 lac rupees each when a ‘Takhat’ is what we deserved. In the 90’s when the economic liberalization started and suddenly Indian economy was being watched with great interest by the rest of the world, our doctors made the cardinal mistake of upgrading their infrastructure. Till then the nursing homes were good enough to do deliveries and small surgeries and would charge slightly more than the expenses incurred at the government hospitals. Suddenly the hospitals started having MRI machines costing more than 6 crores, PET Scanners costing 12 crores, Linear Accelerator costing 15 crores, Modular Operation Theatres with Hepa Filters and Modular ICU’s. India today has more than 1500 Cathlabs each costing more than 2 crores. We had never asked for such expensive medical equipments or for such flashy hospitals. We were happy with the old dilapidated X-Ray machine and smelly waiting areas. Afterall healthcare was never a priority for the middle classes. For us the expenses on house, car, white goods and lavish holidays is more important then paying the same hard earned money to these doctors.
The hospitals soon realized their mistake and started providing their services to the international patients who could actually appreciate the fact that a knee replacement surgery in India costs Rs. 2 lacs while the same surgery in US costs 30 lacs. Most of these hospitals get almost 50% of their revenue through international patients and the remaining 50% through the actually poor people who also appreciate the role of these hospitals in saving precious lives. The noisy middle classes are actually not welcome at many of these hospitals because of our attitude. We are poor and vocally abusive. Why would someone, who has studied medicine for more than 10 years, tolerate our abuses. So before they show us our place, let us find it ourselves.
We could have gone back to the nursing homes from where we started but that option is also closed now. Most of the nursing homes followed in the footsteps of the corporate hospitals and upgraded their infrastructure. Today most of the nursing homes in Gurgaon are airconditioned. They also started calling superspecialist doctors for the treatment of the patients and now their charges are also beyond us. If Max Hospital is charging Rs. 72000 per day for ICU bed for a covid patient, these nursing homes are also charging close to Rs. 40,000 per day for the same. We poor people cannot afford these nursing homes also. That leaves us with the government hospitals. Let us find the ways and means of getting a bed at AIIMS, RML, GTB or Gurgaon General Hospital for those of us who reside in the NCR region. How many of you have actually seen the Government Hospital in Gurgaon from the outside, forget about going in. Most of you would not even be aware that the one which was located in the Civil Lines area is no more at that place. It has shifted to Sector-10. You can lambast the government hospitals on social media for the quality of the services and they would not be flustered.
We may blame Nehru for everything that is wrong in India but the real culprit is we the poor indians. Many of us do not even vote and even those who vote have never demanded world class public healthcare. Successive governments have managed to spend a miniscule amount on public health and education and still won elections. We are more interested in knowing when North Korea is going to destroy the world or how Pakistan is struggling to survive. We were made to believe that everything in India is absolutely fine for the last 6 years and then Corona struck. One person in Indian media has been waging a lone battle to bring the real issues in the forefront but all he gets is abuses and threats.
We can cry ourselves hoarse calling names to the private hospitals and doctors but nothing is going to come out of it. You cannot force any profession to work at prices which are below their costs. So even if the government caps the pricing for private hospitals, they are not going to entertain us. The other option is to actually go below the poverty line and join the `Ayushman Bharat’ where atleast the nursing homes would be accessible to us.
AB CHAHE THALI PEETO YA CHATI PEETO JANA TO SARKARI ASPATAL MAIN HI PADEGA.
In the last few days this has been the common refrain from most of the avid social media contributors. One picture is being circulated which shows that Max Hospital is charging Rs. 72000 per day for ICU admission. Another one says that Saroj Hospital is charging a minimum of Rs. 3 Lacs for admission to the hospital. This at a time when the entire treatment at the Government Hospitals is free, is nothing but a loot of the common people. There are around 8000 nursing homes and hospitals in the country which are on the cashless panel of insurance companies. These hospital have beds in the range of 20 – 1000. The total bed strength amongst these hospitals would be close to 5 lac beds. The powerful prime minister of India must show exemplary courage and acquire all these private hospitals in one stroke of his mighty pen. The total cost that should be paid to all these hospital owners would not be more than 2 Lac Crore of Rupees assuming the average cost per bed of Rs. 40 Lacs. The government which has so magnanimously given a package of 20 Lacs Crores can atleast spend two lac crore for the health of its citizens. Remember, India is spending 7 lac crores on Bullet Train which is going to benefit a very small segment of the society, if and when it becomes operational and if there are some fools who are willing to pay more than the airfare for a train journey. I would be one amongst those fools but will travel only once to gain the experience and not be fooled again and again.
After acquiring all the private hospitals, the government must send all the doctors on leave as these doctors are hand in glove with the hospital managements in looting the gullible public. The government must deploy its own staff at these hospitals to manage the affairs and make the entire treatment free for all the nice citizens of this great country. This will teach a great lesson to these doctors who were foolish enough to study when they should have been busy with Hindu Muslim and Indo Pak debates like us. Despite all our sufferings one thing which irks me is that the people of Pakistan are not being looted like us because they don’t have hospitals like Max, Fortis or Apollo and they still go abroad for good quality treatment. While we are on the acquiring spree of Private Hospitals in India, we can even donate a few of these hospitals to Pakistan to make their life miserable like ours.
These private hospitals do not know how to manage the costs and put the entire burden of their inefficiency on us gullible netizens. We trolls, charge only Rs. 200 for each tweet so why can’t these doctors see the patients in the same amount. Both the works are equally tedious. Do not underestimate our beloved and bold prime minister. If he can invalidate 15 Lac Crores of currency notes in one minute, acquiring these private hospitals is a very small task for him. We nationalist Indians are ready to donate our entire wealth to the PM Cares Fund to achieve this purpose. Why would we be needing this wealth as food and quarantine housing is already free and then the healthcare would also be free. Plus our 15 lacs are also about to come any time now into our bank accounts.
The MLA’s of our country should also be put under the Ayushman Bharat Scheme so that their prices are also capped and they cannot charge 15-30 crores for a simple vote in the Rajya Sabha elections. The worst hit would be the doctors who became MLA’s because of the price capping in the healthcare industry.
I know that the private hospitals would give a lame excuse like their costs for providing quality treatment. If we would have been so numbers savvy then we would have been doing something worthwhile in our lives rather than being trolls. The figures which are thrown at us are simply to confuse us knowing fully well how good our mathematics is.
Cost of Treatment at Private Hospitals – Number Crunching : They say that for every ICU patient there has to be one nurse and since there are 3 shifts in a day there would be 3 nurses taking care of one patient. We don’t need so many nurses and then they add another nurse as a reliever saying that the nurses also need 5 day week. But if they needed 5 day week then they should have joined a call centre like us. The salary for each nurse is Rs. 30000 per month which means that the cost for each ICU patient is Rs. 4000 per day just for the nursing alone. Why can’t they allow us to bring our own nurses.
There is one critical care specialist doctor for 3 patients in the ICU and with a salary of Rs. 5 lacs per month the cost per patient works out to be Rs. 22,000 per day. The doctors also want to work for 5 days in a week. This is ridiculous. The doctors are meant to work round the clock, even on Sundays. This is where the loot is. If they want to work for 5 days then they should be paid only for 5 days and not 7 days. This rule does not apply to us because we did not spend Rs. 3-5 crores in fee to become a critical care specialist so the rules for us would be different.
They say that the infrastructure cost would be Rs. 10000 per bed per day as the hospital has costed them Rs. 1 crore per bed so they depreciate it over 4 years. If we would have known things like depreciation we would have been chartered accountants. Airconditioning and electricity costs another Rs 1000 per bed. The salaries for support staff like Finance, HR, Administration, Dietitics, Bio Medical Engineers etc costs another Rs. 10000 per patient per day. This is not fair as hospitals should have only doctors and nurses and no other staff. We are not going to pay for the salaries of these unnecessary people as we have no idea that every hospital has to take care of more than 30 Acts of the Government. Another Rs. 20,000 is being charged from us for the quarantine of these doctors and nurses who are being put up in hotels. Why can’t they go back to their homes because even if their family members contract Covid they would still have the first priority in getting hospital bed.
The above costs have already gone beyond Rs. 50,000 so I am not interested in listening to your other costs like gloves, masks, PPE, Sanitization. I know that you would have full justification for this loot of Rs. 72000 per day. I simply want the government to put an end to this nonsense. Prevent these hospitals from looting the iphone public. You are charging us Rs. 72000 for the disease for which you do not even have a treatment. Your hospitals must be given to Patanjali because they atleast have a treatment for Corona virus. You do not know the power of our prime minister. If he decides to acquire your hospitals then you would be left with nothing but to fry `pakodas’ and do not forget that we would put your pakodas under Ayushman Bharat where you would be required to sell your pakodas for 25 paise per kg to 50 crore Indians. From the rest of the people you would be allowed to charge Rs. 1 for each kilogram of pakodas.
Do not think that we are fools. If healthcare was such a profitable business then we would not be doing Jio Dhan Dhana Dhan, rather we would be chanting Max Dhan Dhana Dhan. Now that you have made the mistake of becoming a doctor and on top of that, starting a hospital, so be ready to be crucified on the alter of our superior knowledge about your profession.
BUT THE LOOT MUST STOP.
Gurgaon has more than 2 million people but the information about the treatment of Covid-19 is all confusing. It took me more than 2 hours of Google Search to find the list of 23 hospitals where one could get the treatment for Novel Corona Virus, but could not find this crucial list. The one list which is available has 19 hospitals – 3 Government and 16 private. If finding the names was so difficult, forget about any other information like the contact numbers or the cost of the treatment. Gurgaon currently has close to 2000 covid cases of which close to 500 have recovered which means that the city presently has 1500 active cases. The total number of beds earmarked in these 19 hospitals is less than 1000 and that is the reason that the administration has now allowed the asymptomatic positive patients to stay in isolation at their respective homes. People who are staying in 2-3 bedroom houses can afford to do that till the time they show symptoms like breathlessness. As per Dr Sanjeev Sharma, Senior Physician and Critical Care Specialist at Sethi Hospital, Gurgaon, ” Most of the patients infected with Covid-19 would not need any hospitalization. They just need to isolate themselves at home, keep recording their temperature and oxygen saturation called SpO2 levels. Till the time patient is not having any difficulty in breathing there is no need to scout for a bed. Also I always advise that the patient should get a HRCT Chest done which gives a better picture about the condition of your lungs. A RTPCR test gives whether you are infected or not whereas a HRCT Chest would show us how much the lungs are affected due to covid through CT severity index.”
If you have fever then take paracetamol for symptomatic treatment and there is no need to get admitted to a hospital until you have more severe symptoms like breathlessness. When you are staying at home, it is a good idea to keep checking the oxygen saturation levels in your blood every four hours. A small medical device called pulse oxymeter is used to do this. It is a device which is attached to your finger in a non-invasive manner and the display gives the value of the oxygen saturation. If the oxygen levels in your blood are in excess of 94% and you are not breathless then stay at home. However if the oxygen levels go below the 94% mark then you must be headed to a hospital which has atleast oxygen supply if not ventilators. All the hospitals which are present in the list of 19 hospitals have oxygen supply available. However if the condition of the patient deteriorates and ICU hospitalization is required with ventilator then there might be a problem because most of the hospitals in this list would not have surplus ventilators.
In normal times the ratio of ICU beds to ventilators is 3:1 meaning that a hospital with 30 ICU beds would have close to 10 ventilators and this is mostly sufficient. At times when the number of patients requiring ventilators go up, the hospital can get ventilators on rent. However currently this facility of ventilators on rent would not be available as all the ventilators would have already been taken up. In this article, I am going to talk about the 16 private hospitals which are admitting covid patients at present. The list includes big names like Medanta, Artemis, Paras, Fortis, Max and Narayana. It is not known how many beds each of these hospitals have reserved for Covid patients and how are they providing ICU facilities to these patients. The ICU services in these hospitals is truly world class and there should be no second thought about going to these hospitals for covid treatment provided money is not a problem. The cost of ICU treatment at any of these hospitals could be in the range of Rs. 30 – 100 thousand per day depending upon the condition of the patient and other co-morbidities present. Since the Covid treatment could take 7-14 days in the hospital, the total bill could be in the range of 4-10 lacs and in some cases even more. If your insurance covers this cost, good luck to you.
The other hospitals like Sethi, Park, Columbia Asia, Neelkanth, W-Pratiksha, Signature, Kalyani, Aryan, Mayom, Metro and Medeor are not in the same league when it comes to providing Critical Care Treatment but would be a good choice if you require just the isolation and oxygen support. These hospitals also have ICU facilities but the level would be a step below the top daddys of gurgaon healthcare. However the costs would also be lower as compared to the top end tertiary care hospitals. In some of these hospitals the treatment cost is also being borne by the government. If you have a health insurance policy then always check with your insurer as to what all is covered in the treatment of Covid. Most of the insurance companies are not paying for the PPE, Masks, Gloves etc and the cost of these items could be almost 50% of your hospital bill meaning that if you run a bill of 3 lacs for your covid treatment, you might have to pay 1.5 lacs or so out of your pocket despite having a health insurance policy.
The good thing that is being noticed in Gurgaon is that the mortality rate is quite low with just 4 deaths in 2000 patients. The number of patients requiring ICU admission or ventilator is also below the national average. However do not get fooled into complacency by these numbers thinking that the gurgaon residents are super humans. These are early days as most of the cases in Gurgaon have been diagnosed only recently and the number of cases is still rising. The level of testing in Gurgaon is also very low at around 400 tests per day of which almost 50% have been found positive in the last couple of days. Most of the people with symptoms are already going for testing and this could mean that the disease in the city is mostly asymptomatic. If the current trend holds then only around 10 – 20 % of the positive patients might require hospitalization. The real problem would start when the number of covid positive patients cross the figure of 5000. I sincerely hope that we are able to flatten the curve before we reach that level and this is possible only if the residents are on their toes.
Where Should Non-Covid Patients Go in these times – If you are a patient who is suffering from heart disease, kidney disease, brain disease or any other major problem then there is no other option but to go to the major super specialty hospitals of the city – Medanta, Fortis, Artemis, Paras, Narayana etc. However if you have smaller ailments like ENT, Gynaecological, Gastrointestinal, Orthopaedic, Skin, Eye, Dental problem then you should go to the hospitals which are not treating covid patients but still take utmost precautions to prevent the spread of the infection. Some of these facilities are :
- Miracles Mediclinic, Sector 14 – Gynae, ENT, Surgery including Delivery
- Alpine Hospital, Sector 15 – Pulmonology and Physiotherapy
- C.K.Birla Hospital, Sector 51 – Orthopaedics and Gynae
- Apollo Cradle, Sector 56 – Specialist Consultations and MRI, CT Scan
- Suraj Diagnostics, Civil Lines Ultrasound
- Anand Diagnostics, Jharsa Road – Ultrasound and CT Scan
All said and done, the health facilities in the city of Gurgaon for the treatment of Covid are neither sufficient nor affordable for the common people. The best solution is to stay away from the dreaded disease. Stay aloof, chatter less, listen more through your earphones, hug less. There will be better times to express your love than these. Wash hands as the first thing when you enter your home. Do not touch things with your fingers and do not touch your face with your hands. Use elbows to do most of the work like pressing lift buttons and pushing doors. Walking and exercising is extremely important during these times but do it alone. Watching other people from a distance of 6 feet can be exciting as you get to see them in full. `Walk the Talk’ is always desirable but `Talk while you Walk’ is not such a great idea during the Covid times.
April 2021 – Second Wave
The second wave of covid-19 began in the month of March 2021 and is still raging as we sit on 20th of April, 2021. New Delhi has gone into lockdown once again, the migrants are jostling to return to their homes and the threat of nationwide lockdown looms large. Hoarding has started again and there is a mad scramble for beds, ct scans and RT PCR Tests. This grim situation is when the vaccination drive has been going on for the last 3 months now. Massive crowds at the election rallies and religious events means that the peak is still some distance away. The healthcare infrastructure is already crumbling. Beds, oxygen, medicines, ventilators, CT scans are all bursting at the seams. Frayed tempers can be seen amongst the patients queuing for availing medical facilities. The number of people getting infected is so high that lockdown is not very far off. The only way to protect our health infrastructure is to spread awareness about the issues. People are rushing to get HRCT Done even without doing RT PCR Test. The same people are then returning to get repeat HRCT 3-4 days later. This is depriving the people who really need Chest CT to get appointment for their test. Each CT Scan centre is doing 70-80 scans per day which is burning down the radiologists. Ideally people must get CT Scan at the right time and only for the right reasons.
We are seeing such a huge rush of patients that things are becoming unmanageable says Mr. Anurag Srivastava of EHL Diagnostics. Our phone numbers of +91-8800188334 / 335 / 336 are receiving more than 1200 calls every day. Patients who do not need HRCT are also booking appointments. Reports are getting delayed, machine is going down at a much higher frequency than normal. Our waiting queue is so long that we have to send patients to other centres.
A concerted campaign to malign the Indian Private Healthcare has been going on for the last several years. While the world looks at India as the prime destination for quality treatment at low cost, some phoney social media crusaders have been labelling it as exorbitantly costly. I call these people as phoney because they possess a smartphone but not the intellect to to use it sensibly. Most of these people are the same who would troll anybody and everybody on the social media. They mostly belong to upper middle class, have a nice home, financial security, fancy car and nothing to do. All they can do is Andh Bhakti or Senseless criticism. Yesterday one such person was complaining about Rs. 100 being charged extra by a particular hospital in Gurgaon in the name of Covid Protection. Don’t bother about such complaints and continue your march towards higher quality and patient safety. Prime Minister of India has given a clarion call to become `Atm-nirbhar’ or `Self Reliant’. Healthcare is one area in which India is not only self reliant but also provides its services to patients coming from several countries. In fact India ranks among the top five destinations for Medical Tourism in the world and in the process earns precious foreign currency for the country. Till late 80’s only a few of the privileged Indians including the politicians and the film stars were able to get Heart treatment as the only way to get it was to fly abroad. Then Dr. Naresh Trehan came to India leaving behind his flourishing practice in New York to setup Escorts Heart Institute and today there is no treatment for which Indians have to go abroad. Hospitals like Apollo, Medanta, Fortis, Max, Global, Nanvati, Asian Heart, Narayana and many others are offering world class treatment at extremely low prices. Patients from Middle East, Africa, Former Soviet Republics and even from the developed world come to India in search for low cost treatment. If patients from United States can travel to Mexico and Brazil for cheaper treatment then why can’t these phoney people travel for 50 kms to Bhiwadi to get an ultrasound done for Rs. 800 and that too on one of the best 4D machine by PGI trained Radiologists at Bharat Ultrasound. The same test costs Rs. 1500 – 3000 at Gurgaon. Plus there would be Covid Surcharge in Gurgaon. If patients from Middle East can come to India to get Heart Surgery done then why can’t these phoney people go to Jaipur to get a Bypass Surgery for Rs. 1 Lac as compared to 2.5 – 3 lacs at Gurgaon. These people must understand that the hospitals which are created and operated through tax-payers money are in the government sector and the private hospitals are established by someone’s hard earned money. The private hospitals are under no obligation to provide you cheap healthcare or to lower their pricing at your whims and fancies. In UK very few people are able to afford private healthcare because of the high cost, then why should you people have the luxury to go to private hospitals and then bash them on social media. You should queue up at the government hospitals or travel to other cities in search for that affordable price.
In India more than 65% of the healthcare is being provided by the private players which is not their fault. If the government does not spend enough on public healthcare then you should question the government and not those who are filling this gap. Wheat and milk are more essential items than healthcare but nobody raises their voice against the pricing for these essential food items. When the onion prices soar to Rs. 100, the government does not ask private vegetable vendors to reduce their price but starts selling onions at subsidized rates. The government is already doing the same for healthcare. You can get all kinds of treatment at the government hospitals at almost no cost so why queue outside the private hospitals. Most of the patients who come to the private hospitals from the lower economic strata are highly obliged at the services which they get. It is these phoney people belonging mostly to the upper middle class who are loudmouthed. Tell them on their face to go to the government hospital if they don’t like the pricing rather than being defensive or apologetic, is my advise to the private hospitals.
Hospitals which have taken NABH or JCI accreditation must strictly follow the protocols in order to ensure high quality regardless of the cost. The pricing at these hospitals must be Cost plus profit. A false impression has been created in the country that most of the tertiary care hospitals have received free land from the government. In Gurgaon only 3 tertiary care hospitals – Medanta, Fortis and Artemis have received the so called subsidized land from the government. The land allotted to these hospitals was at a price of approximately Rs. 4500 per square meter while Gujarat Government gave land at a price of Rs. 900 per square meter to the Tatas for their Nano project. Have you heard that the Tatas have to sell 20% of the cars free to the people below the poverty line. But these hospitals which got land at 5 times the price of Tatas are mandated to reserve 20% of the beds for free for the BPL card holders. So why should the price being charged from the remaining 80% of the patients be a matter of discussion. If you don’t like the price, don’t go there. Haryana government has given much cheaper land to many industries all over the state and does not mandate them to sell their products at prices which are lower than the cost.
The hospitals which adhere to the highest standards of quality must understand that the entire 135 crores of Indians are not their responsibility. More than 90% of the beds are in the Secondary care at the Nursing Home level and the prices in that segment are much lower than the tertiary care hospitals. A neurosurgeon of the stature of Dr Sandeep Vaishya or an orthopaedician with the experience of Dr Subhash Jangid should not be available for consultation for anything less than Rs. 2000 plus the covid charge. Top rated specialists like Dr. Priyanjana or Dr Sumita should not be seeing patients for anything less than Rs. 1200 plus the covid charge for sure. Do not bother about the criticism from these phoney social media creatures and carry on the good work that you have been doing. India has to maintain its `AtmNirbharta’ in this field for sure.
You must have felt related in the past while mentioning that you are a resident of the Millenium City. The city of swanky malls, luxurious highrises and Manhattan resembling Corporate World. The healthcare of Gurgaon evolved in the last 14 years to match your standards. Best doctors in Indian Healthcare are all available at Gurgaon Hospitals. From 1600 bedded Medanta to the 7-star Fortis Hospital they are all there to spoil you even when you are sick. The public healthcare of Gurgaon was never in good shape and when the top hospitals started opening shop since the year 2006, the state government decided to give Gurgaon a pass thinking that the private healthcare will take care of the health needs of the city residents.
When the Corona pandemic struck the country, gurgaon was spared the blushes as the number of cases were insignificant as compared to the rest of the country in the first two months. However since the last week of May, the number of cases are rising exponentially and have now reached close to 1000. With the easing of the lockdown, these cases are bound to increase. The 2 months of lockdown offered a great opportunity to the state government to get its house in order but nothing of this sort happened as the officials thought that gurgaon would be spared from the pandemic.
Where would a Covid Patient Go in Gurgaon – Home is the best place for a Covid positive patient to be, in the city of Gurgaon. If you have no symptoms then it is best to stay quarantined in the comforts of your home as nobody can take better care of your needs than your family members and there is no place more comfortable than your bedroom. However if you have symptoms, specially breathlessness, then you need to be admitted to a hospital. If you are a resident of New Gurgaon then there is a high possibility that you have never experienced the government hospital of Gurgaon and getting admitted to the government setup is not your cup of tea. The government has designated three facilities for Covid patients – ESI hospital in Sector-9A, Gurgaon General Hospital, Sector-10A and SGT Medical College in the village Chandu Budhera. Most of these facilities are beyond your reach and your class. In any case the three facilities between them have only 205 beds and by now most of them are occupied. The good thing is that the treatment at these facilities is free of cost. So if you are the one who is shouting from the roof top about the cost of covid treatment at private hospitals then you should definitely go to the government facilities. Switch on your GPS and you would reach these places. There is no guarantee that you would find a bed as getting a bed is becoming nearly impossible even in the private hospitals. The district administration has earmarked some of the private hospitals for the treatment of covid patients – W-Pratiksha Hospital in Sector-56, Narayana Hospital in DLF Phase-3, Signature Hospital in Sector-37, Columbia Asia and Metro Hospital in Palam Vihar, Park Hospital in Sector-47 and Medeor (formerly Rockland) hospital in Manesar. Most of the beds in these hospitals are also occupied.
Where is the Famed Healthcare of Gurgaon – Gurgaon is considered as the Mecca of Indian Healthcare and probably attracts the largest number of international patients in the entire country. So where is the famed healthcare of Gurgaon which comprises Medanta, Fortis, Artemis, Max and Paras Hospital. These superspecialty hospitals have more than 3000 beds between them of which atleast 500 are ICU beds. These hospitals are fully equipped to take care of the most serious covid patients. Why are they not present in the fight against Corona Virus. The reason is simple. There is no treatment for Covid-19, yet the hospitalization for such patients is quite expensive. The patients have to be kept either in isolation wards or in the Intensive Care Unit on a ventilator. The cost of this kind of treatment at the top end hospitals would not be less than Rs. 30,000 per day and can go upto Rs. 1 lac per day for patients having co-morbidities. Your insurance policy is not going to fully cover these hospitalization expenses as the cost of PPE, gloves, masks etc are not covered by most of the insurance companies. Almost half of your hospital bill will be made up of these items. For a 10 day hospitalization your bill could be 7-10 lacs of Rupees and you would end up paying half of this bill out of pocket. The hospital administrators are aware that the residents of the millenium city are going to make a lot of noise if they have to make any kind of payment from their pocket. These people who have never demanded that `Amul’ must supply free milk in these times expect that the private healthcare must be forced to give free or subsidized healthcare even to those people who can afford. The question is not whether you can afford it or not. Private healthcare will have to run on the principle of cost plus profit. Even if they forgo their profit, they will still have to recover the cost and even that cost is beyond your affordability. This is the reason that most of the top end hospitals are missing from the fight against Corona Virus. It is your shortsightedness in which you have killed the goose which used to lay the golden eggs. It is not that these top end hospitals are not taking covid patients. How would Dr. Sambit Patra get admitted to Medanta Hospital for Covid treatment if that was the case. However only those whose social media profile is clean, meaning that they have never abused the private healthcare (pun intended) may be lucky to get a bed at these superspecialty hospitals.
What is there for Non-Covid Patients – If you have any other medical problem then where could you go during these times. If you are pregnant and need to consult a gynaecologist or looking for a covid free place to deliver your baby then Apollo Cradle in Sector-14 would be a good choice. Here you would also find other specialists like ENT and General Surgery. However if you are looking for superspecialty services like Cardiology or Bypass Surgery then don’t look beyond Medanta. For Neurosurgery and Orthopaedics, Fortis would be your best bet while for Gastroenterology, Dr Rajnish Monga at Paras Hospital is highly recommended. Cancer Treatment at Fortis, Artemis and Medanta is equally good . Be ready to shell out a little more than the earlier times as keeping a place covid free costs a lot of money for the hospitals.
Best Advice – By now you must have understood that the treatment of Covid-19 in the city of Gurgaon is neither a cakewalk nor a freebie. The best solution is that you must try your best to stay away from contracting the disease. Whenever you have to step out of your house, cover your face with a mask, keep a bottle of sanitizer and use your elbows for most of the work like pressing lift buttons and opening of the doors. Make a conscious effort to not touch your face with your hands. Wherever you see water, wash your hands with soap in an appropriate manner. If you can’t find soap and water then keep sanitizing your hands. Strictly follow social distancing norms as listening to music is a better option these days than to talk to your friend or walking mate. If you stay away from Covid-19 then your social media profile would also be clean and you wouldn’t have to abuse either the government healthcare for being in shambles or the private healthcare for fleecing you.
National Accreditation Board for Hospitals and Healthcare (NABH) was started with the noble intention of bringing quality into Indian Healthcare. For the first 10 years of its existence the board was doing all the right things by motivating the top healthcare organizations for taking NABH accreditation. Top hospitals in the country were working hard to get the coveted Certification by adopting NABH standards with full honesty and dedication. Standard Operating Procedures (SOPs) were not only made but also implemented and non-conformity to these standards were being rectified. By 2015 there were 267 hospitals in the country which got the NABH certification. Not all of them were in full compliance of the NABH standards but most of them were.
By this time, NABH had created a pool of Assessors who wanted business. Since NABH was not known amongst the patients so there was no advantage for most of the hospitals to go for the Certification. Instead of creating a Brand pull for the NABH certificate, the board decided to go the `sarkari’ way. It convinced the Insurance Regulatory and Development Authority (IRDA) to pass a circular that only those hospitals which will have NABH certificate will be entitled for Cashless empanelment with the TPA’s and Health Insurance companies. At that point of time there were close to 9000 hospitals on the cashless panels of various insurance companies. The time given to these hospitals was 2 years which passed without any kind of movement on the part of the hospitals to go for NABH. Now IRDA had no choice but to extend the timeline for another year till July 2019. The game was very obvious – minting money for NABH. Which certification body will charge a hospital Rs. 1.65 – 4.40 lacs per year for getting such a certificate. When you give your Secondary, Higher Secondary or any other exam do you pay one time fee for getting that degree or you keep paying every year for the rest of your life. The logic behind annual fee for NABH Certification is beyond comprehension. You pay annual fee to an organization which provides you services every year but NABH is not providing any kind of annual service to the member hospitals. I have never seen any kind of TV commercial or a magazine advertisement to promote the brand value of this certification amongst the general population. NABH then managed to get the CGHS, ECHS and other Public Sector undertakings to link the payment with the NABH certification. Here also no extra money was being given to the hospitals which had this certificate but the hospitals which did not possess the certificate were docked 10% of the service fee.
The number of full NABH hospitals increased from 267 in 2015 to 968 by April 2020 and consequently the annual fee from these hospitals jumped from 4 Crores to 15 Crores. This was a windfall for Quality Council of India which owns the Healthcare Accreditation Board.
Now came the big move which has turned NABH Certification into a complete farce. Another level of certification called `Pre Entry Level’ was introduced with reduced standards and almost one-fifth objective elements. This is the golden goose for the Assessors and the Board which they can milk for several years in the future. The NABH Assessors who now number close to 2000 went to these hospitals masquerading as `Quality Consultants’ and promised the remedy for the removal of the Damocles Sword hanging over the head of these hospitals. This sword was the removal from the Cashless Empanelment of the insurance companies if the hospitals fail to achieve `Pre Entry Level’ by July 2019. The consultants were charging 2-2.5 lacs for getting you the certifcate. Yes they did manage to get the entry level certificate for more than 8000 healthcare organizations which is now being boasted by NABH on its website. So how was this feat achieved in just one year. The quality consultants copied the SOP’s and forms from one hospital to the other by just changing the hospital names using `Control F’ command in Microsoft Word. The hospital staff was assigned the task of filling up the forms and completing the files. The `Assessor’ came on the due date with flight tickets which were also booked by the hospital and in some cases returned home with fancy gifts. The certificates were issued in hordes and within no time the entire healthcare industry in India had the coveted NABH Certificate hanging on their walls. Most of these hospitals never had a nursing superintendant or an infection control nurse but hired these professionals for the day of the inspection. The farce was played out beautifully and everybody was aware of the reality. The hospital owners were paying fee to NABH for a certificate which is not even worth the paper on which it is printed. The only objective of getting the certificate was to avoid getting de-empanelled by the insurance companies. The golden goose is ready to be cooked and the hospitals will be milked by NABH for years to come. Once all these 8000 healthcare organizations get full NABH, the fee of the board will be in excess of a whopping Rs. 200 crore year after year. For an organization which has 29 employees as per their website this is a windfall.
So who is paying the price. It is not the patients because they can’t care less about the NABH status of a particular hospital despite of what the hospital administrators wish to think. It is actually the hospital owners who are paying the price for this mockery of the Quality Standards. They are paying money to the `Consultants’ and to NABH for no real improvement in the Quality of their services. If you go to any of these hospitals, not even 10% of the staff would have an idea about the relevant standards and the objective elements. The wise heads who created these standards did a wonderful job but those who are milking the product are doing grave injustice to the hard work of these enlightened people.
If the NABH standards are implemented in letter and spirit then real quality would be achieved and it would show in the outcomes of the treatment at the hospital. However for that to happen, the owners will first have to make a commitment towards quality rather than just paying lip service. Most of the hospital owners believe that implementing the NABH standards increases their cost by 10%. I would disagree with them in the sense that real implementation of these standards would increase the cost by more than 20%. However these higher costs should be recovered through higher pricing.
How can the quality payback – The investment on quality begins at the time of setting up of the hospital. A good quality cathlab costs Rs. 2.5 crores while a bad quality machine will cost only 1.25 crores. The same holds true for every medical equipment be it the hospital beds, monitors, ventilators or diagnostic equipments. A low quality ventilator in Russia took the lives of several people due to a blast in the equipment just a few days back. Similarly the implementation of the NABH standards would mean higher operational cost. Once a hospital has installed good quality equipments then the next step is to make processes which ensure quality. Hiring good quality staff and providing intensive training to the staff members is the next step. The role of training is the most important in the entire process. Once the staff is thoroughly trained in the processes then implementation of these processes becomes a cakewalk. So if a hospital has made genuine SOP’s, provided intensive training and rigorously implemented the standards then no power on earth can prevent them from getting any kind of Quality Certificate. This can be done without the services of these `Quality Consultants’ who can do things only on paper and not bring real quality into the organization.
The hospitals which introduce real quality into their services must showcase these quality initiatives in their communication so that the discerning patients would understand the value of quality and would be happy to pay a higher price for such services. The people who buy an i-phone from Apple do not wish to pay for the services of the hospital not because they do not appreciate quality but because we have not been able to convince them about our quality. NABH Certificate will not do the job as no patient knows anything about this certification. It makes no sense for any hospital to flaunt their NABH status as every other hospital also has the same. The solution for the hospitals is to create their own brand image associated with high quality service by showcasing their processes and quality initiatives. China is known for its low quality but still there are companies which have been able to buck this trend and establish manufacturing facilities in China. Similarly India is known for its shoddy certifications and `managed things’. However hospitals which truly want to bring quality into their services will get adequate compensation for their efforts. Despite all the fancy hospitals in the National Capital Region, the common refrain amongst the medically literate people is that – If you want to save the life of the patient then rush to `Gangaram Hospital’. This is called `Brand Value’ which has been created due to quality outcomes for several decades.
Most of the Indians are gloating over the fact that many Global Brands are planning to pull out of China and are going to come to India. This reminds of an old Indian adage – `Mungeri Lal Ke Haseen Sapne’. When the whole world is seeing the spectre of Indian migrant workers fleeing the urban centres in the most inhuman form, they are not going to take any fancy for India. These images will haunt the Indian Government for years to come despite all the flashy presentations that could be given about the attractiveness of the country. What has India got to offer to these global brands – hungry and desolute workforce. Different governments in the country are trying to force a labour code on the workforce in their attempt to emulate China. They are forgetting that India is a democracy which China is not. This will only create Labour Unrest in the country and no corporate honcho wants to invest in a country where there is slightest risk of their investment going down the drain. First of all, I do not agree with the fact that companies are looking to bolt out of China in any significant manner and even if some companies want to relocate, they would prefer countries like Taiwan, Vietnam and even Bangladesh. In the last few years we have seen the Indian society getting polarized on religious lines like never before and this does not bode well for any prospective investor. The present dispensation is highly indebted to the India Inc for their financial support during the elections and this is pay back time. So all the hullaboo about attracting foreign investment is nothing but to benefit the Indian corporates at the cost of Indian Labour. Only time will tell about the success of this attempt, as in a democracy it is extremely difficult to the muzzle the voice of the majority and these migrant labourers do form the majority.
The most important reason for India not attracting the Global Capital is the insensitivity towards quality. A very large section of the Indian Middle classes which is omnipresent on the social media is snobbish and uneducated. They are also the people who are mired in their religious identity and absorbed in the glorification of a mythological past. Such people can hardly provide leadership to the world in the 21st century. Scientific temper is sacrificed at the alter of superstitions and ancient achievements. Indian doctors and engineers are still considered best in the world but only when they are working outside of India.
Healthcare Institutes like Fortis and Medanta are vilified in the media and the society for their charges as nobody is bothered in finding out the reasons for these high charges. Quality comes at a cost and we Indians are not interested in quality. We are bargain hunters and always look for good looking products even if they lack inherent quality. Give us flashy hospitals with nice ambience dotted by low quality doctors and nurses and we would not complain. In any case very few of the Indians would know the difference between a DM and MD. For us a consultation fee of Rs. 1500 is exorbitant and the person charging it, is greedy. Our middle classes would be happy to consult a nicely dressed doctor in a nice consultation room charging Rs. 200 regardless of the experience and qualifications of the doctor. Most of them would not even know that it takes 12-14 years for a person to achieve superspecialization in healthcare.
This brings us to the Quality Accreditation system in the country. For ages we had ISI or ISO as quality marks. Very few would know as to what these standards are. Similarly healthcare has NABH as a quality accreditation certification for the last 10-12 years. This is a complete farce imposed upon the healthcare industry without any participation from the industry. For the last several decades, the healthcare in India was continuously improving its quality and the prices charged by each hospital were based on the quality of treatment given by them. The judge of the quality was the general public and their judgement was based on medical outcomes of the hospital and the doctor. The hospitals were happy to deploy the best quality of equipments because they could fix their own prices and there was no snobbish middle class to get shocked by these prices. In the beginning of this century the health insurance companies started burgeoning and started fixing prices for different hospitals. The guys who would come to negotiate on behalf of these health insurance companies or the TPA’s knew nothing about a Linear Accelerator or a 3 Tesla MRI. How would you expect these people to appreciate quality whose technical knowledge was zero. Then came CGHS where some babus decided that a doctor’s consultation fee should be Rs. 62 regardless of whether the doctor has graduated from AIIMS or from a private medical college through capitation fee. Now the Ayushman Bharat is imposing even lower tariffs on the private hospitals of India in the name of giving volumes. Who is going to bother for quality in such a scenario when the payment is not linked to any kind of quality measurement. I think our Prime Minister is right when he said that we should become self reliant. We should manufacture low quality cheap equipments for our own consumption because nobody values quality over here. There should be two categories of healthcare in the country – One which deploys the lowest possible quality and treats the panel and insurance patients while the other invests in quality and treats the cash patients. There is a big enough market in the country which appreciates quality and they are not from the snobbish middle class whose favourite pastime is to castigate the healthcare on the social media. Remember the labourers in this country are paying Rs. 7000 to be bundled in a container while the middle classes are travelling by Airconditioned trains for Rs. 4000. We should build our healthcare for these people who would pay for the quality of treatment and leave the `snobbish’ at the mercy of the `Babas’.
The second part will be about the farce of NABH.