|Year : 2022 | Volume
| Issue : 4 | Page : 188-190
Has the corporatisation of our health sector in India helped us?
Javid Ahmad Peer, Samiran Nundy
Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India
|Date of Submission||14-Jun-2022|
|Date of Decision||08-Jul-2022|
|Date of Acceptance||19-Jul-2022|
|Date of Web Publication||30-Aug-2022|
Dr. Javid Ahmad Peer
Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Peer JA, Nundy S. Has the corporatisation of our health sector in India helped us?. Curr Med Res Pract 2022;12:188-90
| Article Information|| |
Marathe S, Hunter BM, Chakravarthi I, Shukla A, Murray SF. The impacts of corporatisation of health care on medical practice and professionals in Maharashtra, India. BMJ Glob Health 2020;5:e002026.
| Introduction|| |
After the liberalisation of the Indian economy in the early 1990s, there has been a major inflow of both local and foreign investment into the newly opened health sector. Together with a decline in public health services, there has been an emergence of large, private, for-profit, corporate hospitals and the takeover or closure of medium-sized nursing homes and charitable institutions. Concurrently, employment for doctors has shifted from jobs in practitioner-owned small and medium hospitals to larger corporate entities and there has been a major change in medical education from government medical colleges to expensive private establishments owned mainly by businessmen and politicians.
In this study, the authors from Maharashtra and Britain (which has a successful, largely free, National Health Service) studied the changes in terms of the 'reprofessionalisation' and 'restratification' that the corporatisation of health care on medical practice has brought about in the state of Maharashtra. They interviewed 43 respondents who had detailed knowledge of health care in the state and gathered data from a witness seminar on the topic of its health system.
Their main findings are that employment opportunities for doctors are now more attractive in the corporate sector rather than in government or doctor–owner facilities. However, this has been accompanied by widespread use of performance targets, an inflated cost of health care, increased malpractice and a deterioration of doctor–patient relationships. The 'star' doctor's emoluments and privileges are disproportionately better than those who are junior and less well known. The difficult working conditions, political and bureaucratic interference and poor pay offered in government hospitals are not experienced in private hospitals. The corporate hospitals have a larger capacity to absorb the growing number of graduates with specialist training. This study has also brought to light the competition that is faced by the new starters who lack the client base and reputation of established practitioners, so many doctors have no choice but to work for fixed salaries as underlings in bigger hospitals. However, doctors working with corporate hospitals do not need to make investments or worry about the time required in setting up their own medical practice and renewal of medical licenses. Being in a well-known institution also has a positive effect on their patients as big hospitals with brands are assumed to employ the best doctors and they also provide more opportunities for greater professional advancement because of their better infrastructure. In keeping with the times, corporate hospitals have a deployment of security personnel within the hospital premises to protect the doctors from the violence of patients.
Access to these bigger hospitals is, however, limited by the small number of unoccupied posts and preference for those who are trained in complementary medicine, who are cheaper to hire and can perform many of the same tasks as conventional medical graduates. Many conditions are enforced while the doctors are employed and they are made to sign bonds and contracts. Some of the full-time contracts prohibit practicing elsewhere and they have heavy workloads and low pay. The authors also found that, as a result of the increasing competition and difficulties in practicing as a doctor, some medical graduates are opting for different professions such as business administration, law or hospital administration.
The 'not-for-profit' hospitals which are largely run by charitable trusts, tend to shun this 'business' model. This is mainly because their ultimate aim is not to make a profit for their shareholders but to provide health care which is ethical and less costly. Although still fairly expensive compared to public sector institutions, they do not need to put so much pressure on their doctors to earn more and in many, the staff are paid a monthly salary which is based on their patient care, teaching, research and contribution to the public good. Indeed in the USA, the most renowned hospitals such as the Mayo Clinic, Cleveland Clinic and the Massachusetts General Hospital are 'not for profit'.
However, for some doctors, corporatisation has proven to be quite lucrative. There has been an ascent of 'star doctors' – renowned doctors who have become media celebrities. These doctors attract wealthy patients, command higher fees and they also hold multiple appointments across several hospitals. As a result of having a star doctor, these hospitals charge very high fees from patients. The star doctors have become valuable to the hospital marketing teams and great efforts are being made to retain them.
While the pay and conditions in these corporate hospitals are better than in smaller private hospitals, there has been a significant reduction in autonomy for medical professionals. The use of treatment protocols by these hospitals is considered to have helped to standardise prices and improve transparency for hospital bills, but some doctors feel that it has eroded the autonomy of health-care workers from providing discretionary fee waivers to patients considered unable to pay.
Earlier the doctor–patient relationship was personalised with an assurance of continuity of care. The transactions between general practitioners and patients, though commercial in nature, were also rational and socially embedded., The corporatisation of health care has led to the adoption of business practices making these corporate hospitals no more than patient factories. The doctors have been pushed away from small hospitals and public health-care systems into the race of joining bigger corporate sectors. The trust between patients and doctors has been eroded. The patients' perception of malpractice by doctors for financial gains or impressions of medical negligence has increased, leading to distrust by patients and their relatives and culminating in increasing violence against doctors. The performance targets that have been set for doctors in these corporate setups encourage overtreatment, unnecessary procedures, a battery of investigations, exaggerated diagnoses and malpractice. In contrast, the patient has to pay the price for the inflated costs of the health care. Corporatisation of health care reflects a 'medical–industrial complex' system, where in health care, it is mainly politicians, financial capital, religious organisations, insurance and other non-health organisations play the major role in framing policies for medical devices, pharmaceuticals and health-care provisioning while doctors remain on the sidelines.
The authors suggest that the government and medical professional bodies should pay more 'attention' to this situation.
| Commentary|| |
For rich Indians, the quality and provision of health care in this country are now much better than they were 30 years ago as a result of the entry of the corporate sector. Larger hospitals with better infrastructure, better equipment, and access to advanced technology have led to improved patient care, and better trained human resources. They have also attracted doctors from abroad to return, decreased the number of those who went to foreign countries for better pay and a wider experience so that now few patients seek better treatment in England and America. This has all been, however, at the cost of the deterioration of the public health sector because of the transformation of health care into a, not always ethical type of a business and above all the erosion of trust between patients and doctors has aggravated the gravity of the issue. Unfortunately, despite these known shortcomings, more than 70% of Indians prefer to 'go private' and health-care expenditure is a major cause of their bankruptcy.
This important research has emphasized that government and medical professionals urgently need to control and stem the transformation of health care into a solely for profit-driven activity by the 'medical–industrial complex' and to greatly enhance the support provided to the public health sector.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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