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EDITORIAL
Year : 2019  |  Volume : 6  |  Issue : 3  |  Page : 103-104

Can we make private Medicare more affordable for masses?


Department of Obstetrics and Gynecology, MGM Medial College and Hospital, MGM Institute of Health Sciences (Deemed to be University), Navi Mumbai, Maharashtra, India

Date of Submission20-Feb-2020
Date of Acceptance24-Feb-2020
Date of Web Publication16-Mar-2020

Correspondence Address:
Dr. Sushil Kumar
Dr. Sushil Kumar, Department of Obstetrics and Gynecology, MGM Medial College and Hospital, MGM Institute of Health Sciences (Deemed to be University), Navi Mumbai, Maharashtra.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mgmj.mgmj_15_20

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How to cite this article:
Kumar S. Can we make private Medicare more affordable for masses?. MGM J Med Sci 2019;6:103-4

How to cite this URL:
Kumar S. Can we make private Medicare more affordable for masses?. MGM J Med Sci [serial online] 2019 [cited 2020 Apr 6];6:103-4. Available from: http://www.mgmjms.com/text.asp?2019/6/3/103/280755



The past few decades have seen rapid growth of newer and more accurate methods in the diagnosis and treatment of the patients with complex but curable ailments. However, very few people in India as well as in other third world countries have access to it. Public sector health care is overloaded like local trains in Mumbai and cannot take more loads, and the cost of such treatment in corporate or private sector health-care system is beyond the reach of common man. Question is—How can we reduce the cost of Medicare in private sector to make it affordable for middle and lower class of our society? After more than 40 years in medical field and specially the last 4 years of my encounter with the poorest of poor, I reached the following conclusions:
  1. Practice preventive care: Preventive care may be the best option. Vaccination against most of the infective diseases is working well. But some sections of population still do not get vaccinated against common diseases due to ignorance or nonavailability of primary health care in their vicinity. Free vaccination against human papillomavirus (HPV) causing cervical cancer is still not available. Safe drinking water, prevention of vector-borne diseases, and prevention of anemia in children and pregnant mother can reduce the disease burden of poor to some extent. Medical colleges with their manpower resources and nongovernmental organizations (NGOs) may play a greater role in the preventive aspect of Medicare.


  2. Ask for investigations that are really necessary: There has been trend among the medical fraternity to ask for large number of investigations. Some of these investigations are not even necessary. Private labs are also fueling the trend by aggressive marketing. Some time, patients present to us only with abnormal blood report, with a recommendation to get further tests. On questioning, the patients admit that they had no problem but got the tests done because there was a sizable discount and some of the tests were being done free of cost. We need to combine our clinical acumen with only essential laboratory tests to reach a diagnosis. This may save money as well as inconvenience to the patients.


  3. Avoid using multiple imaging modalities for the same disease: Very often we come across patient who has been advised ultrasound, computed tomography (CT) scan, and magnetic resonance imaging (MRI) for the same disease. Patients have to bear the expenses for all three, whereas in most of the cases, even one modality of imaging would have sufficed. Repeated imaging without any real benefit also increases the cost to the patient. Ultrasound is a common imaging modality for pregnant patient. However, three-dimensional (3D) and four-dimensional (4D) ultrasound that cost more is not really beneficiary to the patient. We may reduce the cost to the patient by getting basic ultrasonography done and that also not more than 3–4 times in pregnancy. A package deal for all essential ultrasounds in pregnancy may be considered.


  4. Avoid unnecessary paid consultations with other specialists: With the advent of specialization, every physician has become compartmentalized and refers cases to other specialists on one pretext or other. The reason could be fear of being wrong, litigation, and sometimes for other favors. The specialists these days forget that they are general physicians too and not so long ago a MBBS doctor used to treat almost everything. Use of modern methods of learning such as “You Tube,” “Wikipedia,” and other Internet resources may help in learning. Whenever in doubt, a simple phone call to other specialist can save considerable time, money, and inconvenience to the patient.


  5. Judicious use of drugs, intravenous (IV) fluids: Use older drugs (out of patent drugs) from standard companies or generic drugs. These drugs are considerably cheaper and can reduce the cost. As far as antibiotics are concerned, it may be better to use older antibiotics. Owing to very less use for so many years (antibiotic holiday), the bacteria again become sensitive to them. Hospital pharmacies do get substantial discounts on maximum retail price (MRP). These discounts can be shared between the hospitals and the patients. The common talk among nonmedical personnel is that “the moment they go to a private hospital, they are admitted and put on IV line and expensive injectables.” Unnecessary IV infusions are inconvenient to the patients, add to their hospital bill, and also may harm them.


  6. Always think “Why people move to expensive private hospital from free government hospitals”: This not a cost-cutting exercise but large number of patients seek expensive corporate or private hospitals because of indifferent behavior of staff and nonavailability of senior doctors in public hospitals. The other reasons could be—a very short waiting time in outpatient departments (OPDs), facilities for room and toilet to themselves, and short and comfortable hospital stay as inpatient. However, apart from good behavior of the staff, rest of the facilities will add to the expenditure, and therefore will cost money.


  7. Use of government health schemes and funds from NGO to help poor: Both state governments and central government have launched many schemes to help those below the poverty lines. Mahatma Phule Yojana covers mainly below the poverty line yellow card holders. This scheme does not cover common medical ailments such as normal delivery or cesarean section in private hospitals; also being a city of migrant, most of the poor patients do not hold a ration card. Ayushman Bharat Yojana or Pradhan Mantri Jan Arogya Yojana (PM-JAY) that covers every citizen of India (based on 2011 data) is a good scheme but is yet to benefit the masses. Most of the time those who are needy do not find their names in the list to get the benefit at the time of emergency. Its implementation needs more efforts. Certain other specific government schemes such as Central Government Health Scheme (CGHS) (for central government employees) and Ex-servicemen Contributory Health Scheme (ECHS) (for retired defense service employees) are also not very successful as their approved rates for various treatment options are ridiculously low. Efforts can be made to tap NGOs for capital investment in equipment or for direct help to those who are not covered by any government scheme.


  8. Insurance: Private insurance could be a good solution for educated class. But how can a poor man think of private insurance when he is barely able to manage daily needs of his family? Medical insurance is yet to penetrate the lives of our underprivileged countrymen. India is way behind the developed world where medical insurance is a norm rather than an exception.


  9. Establishment cost by the hospital should be as per need: One of the reasons for higher cost charged by corporate hospitals is the cost of establishment and the payment of interest against loan taken. Most of the capital expenditure is generally toward purchase of high tech instruments (equipment such as advance CT scan, MRI scan, digital subtraction angiography (DSA), positron emission tomography (PET) scan, gamma camera, cath lab, Intensity modulated radiotherapy (IMRT) and image-guided radiation therapy (IGRT), and robotic surgery equipment. Hospitals may off-load these services unless they are cost-effective. Even mere maintenance of these equipment cost considerable money. Beside they become obsolete in 5–7 years. There is pressure on hospital management to earn the cost of equipment, interest to bank, and profit in 5 years. The management passes it on to the specialist doctors. The doctors start prescribing them even though they are not really needed by the patients.


  10. Experience at MGM Women Hospital: At MGM Women and Children Hospital at Kalamboli, Navi Mumbai, Maharashtra, India, we had taken the following measures to reduce the cost to patient and to make the treatment more affordable:

    1. Use of older drugs and generics
    2. Reduce the use of antibiotics
    3. Reduce the use of IV fluids for vaginal delivery, caesarean section, and other major cases
    4. Use of ultrasound as main imaging modality in obstetric and gynecological patients; CT and MRI only after proper justification
    5. Special attention to treat anemia during prenatal period to reduce the use of blood transfusions at the time of delivery
    6. Stick to World Health Organization (WHO) recommendations on investigations and treatment


    With the aforementioned measures, we were able to reduce the overall cost to the patient. The average cost for normal delivery is now Rs 2,000–3,000, average cost for caesarean section is Rs 15,000–18,000, and for hysterectomy, it is Rs 18,000–20,000. Average patients in OPD and inpatient department have almost doubled after introduction of these measures. This experiment proves that hospitals have to be cost-effective to attract more patients. Larger number of patient generates enough to make up for the cost cutting done for various procedures and surgeries. However, we should remember that when we admit the patient in hospital, we are putting them at risk for iatrogenic diseases. Every test, procedure, or surgery causes discomfort. As the government does not have resources, the time is ripe for more affordable private hospitals in India.






     

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