I write on the Q & A website Quora. Quite often I get questions which keep complaining of the high consultation charges of doctors; high costs of tests, medicines, and surgery in private hospitals in India. Most Indian people feel that doctors are responsible for the high cost of healthcare in India.
Some examples of the questions that I get are the following:
- Are doctors in India more concerned about money than treating the patients?
- Are Indian doctors getting paid more than they are supposed to?
I never see such kind of questions about doctors of any other country. Only Indian doctors have to justify the money that they charge and have to feel guilty for earning a fair professional fee. When I say that doctors should be paid a fair compensation for the service rendered, many Indians are up in arms. I only attempt to point the hypocrisy that is inherent in their feeling of entitlement of healthcare in such questions. It is another matter that medical care in India is among the cheapest in the world which is what is responsible for the booming healthcare sector.
Contrary to popular perception, it is not the poorly educated or uneducated people who argue with stupid arguments. It is the double educated, half logical people who can come up with half-baked arguments. It must be very easy to write opinions about doctors while sitting in their cushy chairs in air conditioned rooms drawing 6–7 figure salaries no one asks justification for. Keypad warfare is pretty easy, making a positive difference is not. These people find free public healthcare beneath their noses to avail of but want world class medical facilities for “nominal cost” where “nominal cost = something that you tip the waiter in a restaurant”.
In this article, I intend to dispel some of the myths that lay people hold regarding doctors and healthcare in India.
Myth 1: Doctor fees are high, they give no refund if treatment doesn’t work, and they take fees on subsequent visits.
When you visit a doctor- you are paying a doctor for their time and not the guarantee for your cure. They will diagnose you and advise treatment and may ask for some investigations if required. You are paying consultation money and not some ransom payout (with an “or else” clause).
Always remember that you and the doctor are on the same side and both of you are battling the disease/condition together. Doctor- patient relationship is not an adversarial relationship. I just don’t know how people can ask for a refund for a service already given. You don’t have to pay fees because doctors spend 10–15 years of their life becoming a doctor. They chose the profession, they paid the price and no one forced them to join it. Doctors aren’t doing you a favour by treating you, they are giving you a professional service. You should pay for every visit to the doctor because doctors are treating you and not the disease. Would you pay your carpenter for only the first day of a 5 day job? So if you need 5 visits to cure your disease- it is a 5 day job so the treatment is worth 5 consultation fees. The time spent with you is time they could use for another patient. They may subsidize your secondary visits but they don’t have to.
In any healthcare system, patients should not be paying complete healthcare expenses out of pocket- it should either be free of cost as in government hospitals or subsidized in private hospitals by insurance companies. If one has medical insurance your co-pays should not be more than 20% of the consultation fees and rest should be paid by insurance companies. When you have low-deductible comprehensive insurance plans- 100% is paid by insurance companies (cashless). If one doesn’t have medical coverage, have poor lifestyle habits, have poor diet and then they fall sick- whose fault is it? Doctors? Private hospitals?
Myth 2: Doctors and hospitals have no right to earn money because medicine is a noble profession.
Last I checked nobility paid no bills of anyone working in a hospital- receptionist, manager, nurse or doctor. Nobility did not feed their families, did not give their children free education and did not subsidize any service that they take from other industries. All of them have to pay the full fee when they want the services of a lawyer, an architect, an engineer, an accountant, restaurant etc. I don’t see any subsidized pricing for medical professionals. I don’t see any other professional other than a doctor having to justify their salary in India.
Myth 3: Government is spending so much on medical students and they have to give back to society by doing free service.
This is the lamest argument available because government subsidy on medical education is not very high. They spend less than they spend on IITs, IIMs and every one of the 40+ central institutions in the country. India spends about 1.3% of it’s GDP on healthcare which is among the lowest in the world which got even lower in 2014 when India slashes health budget by 20% and has been going lower every year since then. This budget also includes medical education subsidies that these people are talking about and if one have an idea of the number of poor people availing healthcare facilities in India the share of medical education in this small pie isn’t much. Even so, if doctors took state subsidized medical education and training – it doesn’t make them slaves of the country. How many of those passing out of IITs and IIMs are asked for their pound of flesh for all the state subsidized education that they receive?
Myth 4: There is so much “corruption in healthcare” and “all doctors are rich”
I get repeated ad nauseum comments about corruption in healthcare in my answers when I say that doctors should be paid a fair fee for their service. I don’t understand how that’s even relevant in the discussion. If I tell you lawyers’ fees in India is low compared to the quality of the work that they do, will you come back with comments of instances of lawyers cheating you or that Ram Jethmalani charging 22 Lakhs for a court appearance? If I tell that Engineers in India are paid less for the work that they do, will you come back at me telling of the bridges that collapsed due to bad quality construction or that Infosys CEO earns in millions? If I say policemen are paid poor salaries will you talk about all the corrupt policemen you have unfortunately met? They paint a picture as if doctors and hospitals are the only corrupt entities in India while the rest of the society are saints. Why is there corruption anywhere? When the compensation doesn’t match the work done, people find less ethical ways to match it and when such acts don’t get punished it, it becomes systematic corruption. Corruption can only be beaten when being honest pays more than being corrupt- this is in every field and not just healthcare.
Myth 5: Doctors are not treating economically poor patients and are looting everyone.
I prefer treating poor patients instead of rich patients. Some times I treat them even for free if they cannot afford the fees. I volunteer my services for philanthropy and I’m associated with a NPO which provides mostly free eye care facilities in the remote areas of India and other parts of Asia. The recipients of this service are genuinely grateful and don’t have the sense of entitlement that the rich people have. They don’t badmouth doctors once they get treated and cured. The people writing the hate comments don’t pay one rupee towards charity but want everyone else in the world to work for free. I wish they see the hypocrisy in themselves before making this argument. I also wish somebody would pay me for treating only poor patients for free. Sadly no one does that because government hospitals don’t have enough jobs.
One more pertinent point…..
Healthcare is expensive. Somebody has to pay.
I see people complaining of the doctor’s fee being Rs. 300-500. These people want doctors and private hospital to provide them world class facilities at welfare price, at cost or even at a loss. How does an establishment pay for the land, building, infrastructure, staff salaries and still stay open to do more business. Does anyone offer free land and buildings to hospitals? Does anyone provide expensive machines at “nominal cost” to hospitals? Does anyone else pay the salaries of all the staff- from the receptionist to the doctor? 500 rupees is a pittance to pay for the facilities that one gets in private hospitals and I would actually argue that they should charge more. I don’t know what parameters people use to judge how much a consultation should cost in a private hospital. Private medical care costs money- real estate, personnel, the latest equipment, and drugs. How do they factor all that in a hospital without knowing how much anything costs? It is just that people take it for granted and feel entitled to treatment because they convince themselves that they are overpaying doctors though they have no justification for it.
There are a few conclusions that I have come to from these perspectives I see among the public and I’m going to be constantly updating this list.
- Indians are frustrated with the healthcare system in India and high costs associated with private health expenditure. The costs are high because our government spends more on guns & missiles than healthcare & education. This makes doctors soft targets for TV, print & social media.
- Mob violence against doctors is at an all time high. This despite none of the causes for patients’ frustration being the doctor’s fault. People somehow expect doctors to work for free or for cheap forgetting that doctors too have their own family to take care of and also have aspirations just like any one of us.
- People think they are only paying the doctor in a consultation when in fact they are paying the hospital for all the facilities on offer. If someone finds healthcare expensive in India, it is not because of doctors. Despite low government investment, the private healthcare people receive in India is quite subsidized-even if one feels they are paying through their nose.
- Doctors in India are among the best in the world- despite their many ungrateful patients. As technological advancements in modern medicine increases, the costs are only going to go up. It is the same thing all over the world. We can’t have a race to the bottom in the name of reducing healthcare costs.
It is the government’s responsibility to provide universal health coverage (UHC). Governments have to pick up the tab for increasing healthcare costs. Note that I say “universal health coverage” and “not universal free healthcare” because free has “zero” value. Citizens should be accountable for their own health and should be covered by medical insurance which should be made mandatory. Priorities are the problem in India. In a space where there is no competition from any government hospitals, private hospitals will flourish. Government can do a lot that private hospitals can’t do especially since they can be non-profit. Complaining about private entities are not the solution. Making the government invest more of their resources on healthcare and education is the real answer. If people still can’t understand why their doctor’s consultation and cost of healthcare is high, I can only say this:
“Get well soon!”
DR. RAGHURAJ HEGDE 