Testing prices became a focal point in the fight against the Covid-19 pandemic. Starting from Rs. 4,500 for testing at private labs at the beginning of the lockdown, the prices for Covid-19 tests came down significantly after the fourth phase after testing kits became available in large numbers. While testing at private labs has come down to under Rs. 3,000, the tests remain to be free of cost at private hospitals.

However, The Indian Express found that the Sanjay Gandhi Post Graduate Institute (SGPGI) of Medical Sciences and Ram Manohar Lohia (RML) Institute in Lucknow, both state-run institutions, have started charging Rs. 1,500 from patients coming for non-Covid treatment for their mandatory Covid test.

The explanations by SGPGI and RML is not one to soothe the common man’s dismay with the exorbitant prices charged for tests. It was reported that patients going for an elective operation at SGPGI will have to pay for PPE kits, N-95 masks, gloves and other essentials used for the protection from the infection. Both hospitals confirmed to IE that only, patients coming to the emergency or fever clinic or those suspected of having the infection will be exempted of the charges.

SGPGI Director, Dr. SK Dhiman told IE, “A suspected case of coronavirus does not have to pay any money [for Covid test] as the Centre has made such an arrangement. If there is a patient who possibly does not have the infection but has to be admitted for a surgery, pregnancy, or some heart-related issues, we will charge them and their attendants for the test. This is because Covid test is mandatory. In simple terms, we have a separate Rajdhani Covid Hospital and all tests are free of cost there. In the main wing we will charge Rs 1,500 for the test.”

Dr. Shrikesh Singh from RML also confirmed the same protocol to IE.

Government run hospitals soon to charge for Covid-19 tests?

Principal Secretary (Health) Amit Mohan Prasad told IE that the charges were decided by the hospital itself and that there are no charges for the RT-PCR tests. He told IE, “Being a government hospital does not mean there will be no charge. If there is SGPGI, there is a charge for the treatment. However, nothing is charged for the RT-PCR tests as the government is paying for that. The health department is not yet charging for that, but after two months we will also start doing so,” said Prasad. On SGPGI charging for PPE kits and N-95 masks, he said that he couldn’t comment on that as the matter was “concerned with the medical education department.”

Oppositions slams UP government

In light of the news, Congress spokesperson Amarnath Agarwal questioned the government’s silence calling the move “shameful”. He said, “This exposes the dual face of the BJP. On the one hand they claim that the poor are getting benefits under Ayushman Bharat Yojana and on the other hand, a government hospital is charging money for Covid testing and PPE kits,” reported United News of India (UNI).

Adding that people were already reeling under an economic crisis, he asked for the decision to be revoked lest others start following in UP’s footsteps soon.

Samajwadi Party MLC Sunil Singh Sajan too alleged that the move was a ‘loot’ at every level. UNI reported him as saying, “It is an open loot, everyone is looting the poor in whatever way they can. People are already facing bad times and now if a government hospital is charging money for Covid-19 testing, where are the funds going? The government must come clean on the issue and issue a clarification on why a government hospital like SGPGI has to charge for tests and PPE kits from the patients. What is the difference between private and government hospitals?”

Private hospitals continue to bulk up charges

While this is a new revelation about charges by government hospitals, private hospitals have earned the citizens’ ire for bulking up bills as state governments capped testing and treatment rates.

In Mumbai, the state government had capped the treatment charges for 80 percent of hospital rates, leaving 20 percent in the hands of the concerned institution. However, it was found that to earn the lost revenue, private hospitals started issuing charges for care and hygiene, staff management and also for N-95 masks, gloves and face shields! The same practice continues to be exercised in private hospitals across the country.

@drharshvardhan @narendramodi @PMOIndia @RahulGandhi @ArvindKejriwal
Please look into shameless loot displayed by private hospital ।8 times more than fair price ।even 4500 covid test is much more as 500 rupees kits made including testing charges pic.twitter.com/Lk0G53Vt8Z

— Janshakti (@Janshakti_org) June 12, 2020

Recd in my WhatsApp. Shocking. Private hospital bill of corona patient. When govt has directed for free testing and treatment how this can be done on such a high price.@PMOIndia @drharshvardhan pic.twitter.com/III1RFOJVQ

— B S HARIHARAN (@bshariharan) May 23, 2020

@ArvindKejriwal pls something sir it’s price list for private hospital pic.twitter.com/hhFQpPAwNr

— Piyush (@piyush1501) June 22, 2020

In another report, Deccan Chronicle reported that private hospitals are now demanding caution deposits from Covid-19 patients before admission. Those who cannot pay up are denied beds. The publication reported that deposits are said to range from Rs 3 lakh to Rs 5 lakh. Some hospitals charge Rs 25,000 to Rs 50,000 as deposit. They state that these amounts are collected in advance for additional expenses for personal protection equipment, isolation wards and disinfection.

The discoveries of such strong-arm measures to force the poor into paying up for basic healthcare, especially at such a time, makes hospitals nothing short of mafias. With government hospitals being one respite for the poor, even that seems to be slipping away from the common man’s reach.

Related:

Will Maharashtra Covid-19 testing prices in private labs go down soon?
ICMR removes Covid-19 price cap, asks states to negotiate with private labs to lower price

The post Two state-run hospitals start charging non-Covid patients Rs. 1,500 for Covid tests in Lucknow appeared first on SabrangIndia.

A C-section delivery, as opposed to a normal vaginal delivery, requires incisions in the abdomen and uterus and is viewed as a life-saving procedure for the mother and the child in case of certain complications. These include clinical emergencies that may affect the pregnancy or labour– foetal distress, prolonged labour, excessive bleeding and high-risk pregnancies with a history of diabetes or HIV.

The Lancet report flags the proliferation of C-sections in private hospitals as the prime driver of this trend. In doing so, it questions the rise in unnecessary C-sections, conducted even when pregnancies are low-risk. Annually, 50% of the 6.4 million unnecessary C-sections around the world were located in Brazil and China.

Avoidable surgical procedures act as long-term impediments to the health of the mother and child and could end in death or disability, WHO had warned in this 2015 statement. An often ignored fact is also the relatively slower process of recovery post a C-section delivery and the trauma it can cause. It also increases the expense burden on the patient and her family.

“The bills went up to more than Rs 1 lakh and now that’s something that we’ll have to consider in case we decide to have a second child,” said Apoorva Panwar(23), who gave birth to her daughter through a C-section in April, 2018.

A first child delivered through a C-section procedure also increases for a woman the likelihood of complications in the next pregnancy, as per a 2014 Lancet report.

In Chandigarh, 98% deliveries through C-section
Is there an acceptable percentage of C-section deliveries? In 1985, WHO had advocated that 10%-15% of deliveries in a country could be through C-section procedures. But in a 2015 statement it clarified that it should be provided to any woman in need. As a country’s C-section rate rose towards 10%, there was a corresponding decline in child and maternal mortality, it said. But there was no evidence of it making an impact on child and maternal mortality after the rate crossed 10%.

If more than 10%-15% of deliveries are conducted through C-section it means overuse and misuse of the procedure, The Lancet report said.

In India, C-section rates vary widely — it is 6% in Nagaland and Bihar and 58% in Telangana, showed National Family Health Survey-4 (NFHS-4) data. “C-section rates crossing 50% is simply unacceptable,” said Arun Gadre, a Pune-based gynaecologist and senior coordinator for Support for Advocacy and Training for Health Initiatives (SATHI).

The highest number of C sections in the country was reported from Chandigarh (98%), way beyond what Gadre considers acceptable. For every one child born through normal delivery, 60 children were delivered via C-section. In Delhi, the percentage stood at 67.83%.
At 6.1%, south Asia has witnessed the fastest increase in caesarean rates in the last fifteen years, as per the Lancet report.

However, in the sub-continent, India has lower rates than Bangladesh (30.7%) and Sri Lanka (30.5%), but higher rates than Nepal (9.6%) and Pakistan (15.9%).

Private facilities conduct more C-sections: 45% in cities, 38% in villages
Health activists believe that the private section is fuelling the boom in C-sections. “The declining face of public healthcare and the aspiration for better services push families into choosing the private sector,” said Gadre. “This is the basic pathology of Indian healthcare. In the last 14 years, nothing has been done to been done to hold the private sector accountable and unregulated c-section run amok. The private sector is categorically profiteering through C-sections.”

In India, 45% of Caesareans were conducted in urban, private facilities and 38% in rural private facilities. And 56% deliveries in private hospitals empanelled under the Central Government Health Scheme (CGHS) were Caesarean procedures, as per a 2017 reply by JP Nadda, union health minister. Data collected from 20 out of 31 cities (64.5%) with private hospitals empanelled under CGHS were disproportionately inclined towards Caesarean deliveries.

A C-section delivery seems to be the new “normal”, new mothers living in urban India told IndiaSpend. Most women in her office had undergone a C-section, said Reshma Kuckyan (29), who birthed via a C-section when it was found that her baby’s growth was lagging. “My colleagues kept telling me that I would be fine, and since 90% of them had a C-section, I was prepared to have one myself.”

Among cities, Pune recorded the least number of C-sections at 38%, still above the acceptable limit.

C-section deliveries have moved upwards from 28% to 41% in private hospitals between 2005-2006 and 2015-2016. Public facilities, on the other hand, have recorded a decline, as per data in NFHS-4.

Women in wealthiest quintile seek more C-sections
Why are C-sections more common today? Changing dietary habits, late pregnancies and the fear of labour pain are some of the reasons, said doctors.

“I have had mothers with unrealistic expectations insisting on having babies at a specific time,” said Suchitra Pandit, director and consultant obstetrician at Surya group of hospitals, Mumbai. “One patient who was in labour said she wanted to have her baby only at 5pm.”
When she was warned about the dangers of delaying her delivery her family said they were willing to put down the specification in writing.

Among women in the wealthiest quintile (top 20% of the population by income), the choice of undergoing C-sections has gone up from 10% to 30% in the 20 years upto 2014, reported IndiaSpend in 2017.

The increased rate of C-section deliveries also reflects of medical advances that allow detection of emergencies that necessitate it, said doctors. Colour doppler ultrasounds and neonatal intensive care units (NICU) have made it easier for doctors to assess the risks attached to a foetus’ growth.

“The presence of high-capacity NICU in tertiary settings can save the life of many premature babies. If we can salvage a life in times of complications, then we have no choice but do a C-section,” said Pandit.

At 3.5 million, India has the most number of preterm babies in the world, according to WHO.

Keeping a check on numbers
WHO recommends Robson classification, a checklist of 10 obstetric parameters  to determine the need for a Caesarean. These include factors such as the history of a pregnancy and gestational age.

In 2017, an online petition signed by more than 1 00,000 people had raised attention to India’s tryst with continually rising rates. The ministry of women and child development pushed for the display of Caesarean numbers by private hospitals, reported The Hindu on July 4, 2017.
“You tend to lose count of the number of deliveries and surgeries you conduct. But when you see the numbers, it acts as a check,” said Seema Jain, a Delhi-based gynaecologist.

(Chhetri is a graduate of Lady Shri Ram College for women.)

Courtesy: India Spend
 

The post Caesarean Deliveries More Expensive, Can Imperil Children, But They Have Doubled In India, Mostly In Urban Private Hospitals appeared first on SabrangIndia.