Private Hospitals overcharging amid SARS-CoV-2 Contamination: An outlook & Suggestive measures.

“Health is a state of complete harmony of the body, mind, and spirit. When one is free from physical disabilities and mental distractions, the gates of the soul open.” – B.K.S. Iyengar

The world is trapped by the impending contamination. The (SARS-CoV-2) virus causing coronavirus disease (Covid-19) has affected every man, woman, child & elder & citizen of this world. The state, economy & health infrastructure system has collapsed. It is for this worldwide contamination of SARS-CoV-2 we are stepping forward to question and understand the very prominence of healthcare & the right to access to health and the significance of the responsibilities of the state. According to W.H.O, The very definition of health implies that “Health is a state of complete mental, social and physical well-being, not merely the absence of disease or infirmity.” – (World Health Organization, 1948.) The very right to health, in the Indian legal framework, is not included in Part-III of the Constitution of India 1950. Rather the very duty has been imposed & directed to the State in Part-IV of the Constitution of India in the form of DPSP viz, Directive Principles of state policy.

Article 47 of Directive Principles of State Policy in Part-IV of the Constitution of India provided that “The State shall take steps to improve public health” that includes comprehensive creative, preventive & rehabilitative healthcare services and proper nutrition. DPSP, non-justifiable, non-enforceable in nature, which implies that no action can be brought in a Court of Law to enforce it. The right to health is central to all human rights & denial of such right would mean denial of the very inherent birthright of a human being that is “basic” to all men & women. Ultimately it is the effort of the Indian Judiciary that extended the scope of Article 21 of the Constitution of India and impliedly incorporated the right to health under the said Article (Art.21) through its various precedents & guidelines.

During this contamination period, many people were admitted to many private hospitals. It’s all due to the absence of an effective public healthcare system & infrastructure. Exorbitant bills, hospital overcharges forcing patients, their relatives & people in general into debt trapt leading untold suffering & pains. All these drove them into poverty and the absence of status, legislation, policy guidelines regarding reimbursement, compensation, audit & refund system made the situation even worse. All these force people to exhaust their health insurance limit.

Catastrophic healthcare expenses pushed a large number of households into poverty. It is not only the BPL population & Low-Income households but middle class & lower-middle classes in the middle of this contamination are in the middle of nowhere struggling the most as they do not belong to the rich class to afford commercial insurance, neither are they too poor enough to be covered under Government-sponsored Health Insurance Scheme. The Health Assurance Scheme “Atal Amrit Abhiyan” mostly targeted the BPL population & low-income families. But the said Scheme only covers some specific kinds of illnesses ( viz, cardiovascular disease. Cancer, Renal (kidney) diseases, Neonatal diseases, Neurological conditions, and burns) that too in some specific hospitals, thus the scheme looks good on paper but its existence or non-existence is on the same footing.

Apart from this, the hospital authorities seem to be a little indifferent towards the patients enrolled under the scheme. Another Insurance Coverage The Pradhan Mantri Jan Arogya Yojana (PMJAY) also covers as aforesaid only the bottom two income quintiles and commercial insurance even largely covers top-income quintiles, thereby creating a ‘missing middle’ class in between. Thus a large number of societies remained uncovered.

The bench of Justice D.Y. Chandrachud and Justice B.V. Nagarathna concerns’ ‘ wide strata of society consisting of patients and their relatives who have been overcharged during the pandemic, and the issue would merit serious attention”. “…There is no guideline concerning bills overcharged by private hospitals for treatment of Covid patients,” the petition in the said case argued. The petition has been filed by Mr.  Abhinav Thapar ( Dehradun resident) arguing that due to hospitalization for treatment in Private Hospitals, there lacks uniform policy as regards the claim of refund of expenses incurred during covid treatment on overcharged bills. Following that the Supreme Court of India issued a notice to the Ministry of Health and Family Welfare. Most states are yet to devise a uniform mechanism for audit and refund.

Dr. Abhay Shukla, the co-editor and author of the books ‘Review of Health Care in India’, ‘Report on Health Inequities in Maharashtra’, ‘Health System in India – Crisis and Alternatives’ and ‘The Rights Approach to Health and Health Care’, has “surveyed the cases of 2,579 patients, spoke to their relatives and audited the hospital bills. Ninety-five percent of them were admitted to private hospitals,” Dr. Shukla conveyed that”We found that 75 percent were overcharged. The amount that was overcharged ranged between ₹10,000 to ₹1 lakh,” and as many as 56 percent i.e. 1,460 families take out loans, borrow money from families and sell off their Jewellery to pay the overcharged amount. 220 women among these paid between ₹1 lakh to ₹2 lakh over the actual bill, and 212 cases were such that the patient or their relatives paid more than ₹2 lakhs in excess. Though the Maharashtra government had announced that the rates of treatment of COVID-19 at private hospitals will be regulated, the official instructions were not heeded, Shukla stated.

The All India Drug Action Network (AIDAN) has documented several cases of fraudulent practices by private hospitals that includes but are not limited to obtaining false consent at the time of admission; charging additionally for medicines, doctors’ visits, investigations, PPE kits, and gloves despite such expenses part of the government package rates.

A woman named Seema Bhagwat lost her husband to mucormycosis, a fungal infection that some COVID-19 patients contracted, said her husband was in the hospital for 38 days and they have presented a bill of ₹16 lakh. “Still, I paid three EMIs of the bank. There was insurance cover for the bank loan, but because I approached them late, they are denying my claim. How can they expect me to submit my husband’s death certificate the day after he died?” she asked. “I am not begging for help. But the hospital bill should be audited and if I have been overcharged, the difference should be refunded to me,” she said.

Shakuntala Bhalerao, convenor of the Abhiyan, said that”We fought two cases in Pune recently and the hospitals returned ₹83,000 and ₹90,000. They even admitted that they had overcharged. But we can not fight every such case. There has to be some state mechanism to protect patients,’ what is lacking is a law to regulate hospitals. A draft of the clinical establishment bill which seeks to create a regulatory mechanism is gathering dust, she added.

Mukund Dikshit, a senior activist, recounted that a police complaint had to be filed in Nashik because a hospital refused to hand over a patient’s body over an unpaid bill. “After intervention by the police and some activists, the body was handed over, but the hospital faced no action,” he conveyed.

Presently Health is a State Subject i.e. in List -II (consisting of 61 items) in  Entry Number __ of the Schedule Seventh h of the Constitution of India 1950. The Chairman of Fifteenth Finance Commission, N.K. Singh suggested shifting health to the concurrent list (List -III) of the Schedule Seventh of the Constitution of India 1950 and setting up of a Development Finance Institution (DFI). Singh stated that ” it is high time we moved health as a subject to the concurrent list, especially in the light of pandemic”. N.K. Singh also suggested increasing government spending on the health care sector to 2.5% of GDP by 2025. He also proposed in favor of forming All India Medical & Health Service as is envisaged under Section 2A of the All-India Services Act 1951.  He also stated that “….. not going as far as to make it a fundamental right, but taking it to the concurrent list, as a first step, would enormously reinforce the obligation of all stakeholders. It would also give the central government much greater flexibility in the enactment of multiple regulatory changes,”

 Unlike in the case of First World i.e Developed Countries, since health Care expenses are largely born by patients, and since private hospitals are overburdening patience with overbills in this second wave of the pandemic, as have already mentioned it pushing people into poverty & debt trapt, development of a uniform healthcare system or mechanism, autonomous regulator, audit & refund system, policy guidelines, etc. are the sole solution to the issue and the same should be “universally applied, adopted and audited,”. Further Coronavirus Health Insurance policy should also be designed to cover cases & expenses relating to covid-19 irrespective of the disease that he has been diagnosed with.