Pune-based NGO, Support for Advocacy and Training to Health Initiatives, SATHI, recently published a report that sheds light on the corruption plaguing the Indian health care system. While medical corruption is nothing new, the fact that physicians have spoken out as whistle-blowers in this report and a subsequent book called “Voice of Conscience from the Medical Professions” is a first.
According to The Hindu, 78 doctors from across the country have contributed to the book released at the prestigious All India Institute of Medical Sciences (AIIMS). Many physician testimonies speak of a private medical sector that is so highly commercialized, not concentrating enough on the medical practice or the integrity of proper patient care. Among these stories, are physicians reprimanded for not persuading enough patients into surgery or other unnecessary procedures or the grasp that Big Pharma has on medicine dispensation.
This insider’s report is based on 78 practicing doctors in Mumbai, Pune, Delhi, Kolkata, Bangalore and Chennai. The growth of corporate hospitals is affecting all physicians, from general practitioners to specialists. Sanjay Gupta, Pune-based gynecologist and former national president of the Federation of Obstetric and Gynecological Societies of India, told The Hindu that corporate hospitals only want doctors who can make them the most money.
“As a result, doctors who practice ethically cannot last here. I know of a hospital where if a patient is charged Rs. 1,50,000, the doctor gets a mere Rs. 15,000. Ninety percent of the income goes to the corporate office,” Gupta said in the interview.
Younger doctors are hounded to have high “conversion rates” from outpatient to operative departments as per the corporation’s goals. This means that from the start, doctors are given perverse incentives in order to advance in their careers and/or to even keep their jobs.
The fee-for-service model that creates these incentives is not unique to India. Physicians in the U.S. are also financially incentivized to order more procedures and disincentivized to provide maintenance or preventive methods, since that takes more time, effort, and costs the patient less money. Profit-driven hospitals, like private hospitals in India, benefit from maximizing the number of surgeries and procedures they conduct.
I have seen the detriments of this wave of commercialization when a young girl I worked with in Mumbai was turned away from one hospital to another after suffering severe injuries. Doctors at several Mumbai hospitals deemed that she would probably die from the injuries. And because she was of low-income, they had no incentives to take her in the current system. She was a “lost cause” and would just be another statistic in their mortality rate. Finally, the organization I worked for had to call in a favor from a local authority figure and produce some sort of bribe to get her admitted to a hospital.
Stories like this are not necessarily unique. Bribes and kickbacks are ingrained into the health care system so much that they are expected. When my grandmother went through years of chemotherapy and cancer treatment, my family paid her nurses and other health care workers out of pocket. Sometimes health care workers would outright ask for the money, which definitely created tension. An
An article in the British Medical Journal by Dr. David Berger sparked much debate on how corruption threatens the doctor-patient relationship.
As a long-term volunteer physician in an Indian hospital, Berger witnessed and wrote about what he characterizes as unnecessary operations, like hysterectomies and procedures such as X-rays and MRIs. Bribes were routine and Berger describes seeing a lot of “needless deaths.”
Physicians speaking out and joining force with other organizations advocating for a more ethical medical system will make for a stronger case for fighting corruption in the medical arena. Previously, it has been non-profits like SATHI, health activists and organizations, ethnographic accounts, or patient stories that have shed light on the unethical means through which physicians and hospitals recommend treatments.
In a system where hospitals are setting revenue targets for physicians, it is no wonder that the sacred doctor-patient relationship is being muddied and building an inherent distrust towards health care providers. Therefore, the fact that Indian physicians are speaking out in this report is significant.
In June 2014, The Times of India reported that a group of leading AIIMS cardiologists had decided to start an initiative called the Society for Less Investigative Medicine (SLIM). SLIM’s mission is to take on the challenge of reducing excessive medical procedures, starting with cardiology.
One of the key members of SLIM Professor Balram Bhargava told the publication even though the U.S. has rampant privatization, there are “audits and guidelines regarding [medical] investigations.” According to Bhargava, there are “no regulations or audits on investigations [in India] to determine if [procedures] are necessary.”
Bhargava and SLIM are in the process of creating guidelines for when certain diagnostic methods and procedures are needed, also targeted towards cardiology. SLIM hopes to eventually expand to other medical disciplines and create guidelines for all fields.
A checklist along with the rise of technology platforms that put the patient more in control of their health could help reduce the amount of corruption. However, to regain the general public’s trust in the medical system, there needs to be a higher standard of ethics that doctors can be held to in their practice of medicine.