[ninjatalli]

Originally Posted by d.w.w.

I have noticed most doctors running private clinics in Chennai charge differently from different sections of the society.
...
Had similar experience from an ENT in Guindy and a Gastro in T-Nagar.

This is common across many doctors across cities. Not only doctors, but even vets. Our vet in Bombay charged almost nothing to folks from the lower strata while our bills would be normal rates; while both got same/similar treatment from the same staff members. It's a good thing that folks from the medical fraternity are opting to do this.

[sunilch]

Originally Posted by ninjatalli

This is common across many doctors across cities. Not only doctors, but even vets. Our vet in Bombay charged almost nothing to folks from the lower strata while our bills would be normal rates; while both got same/similar treatment from the same staff members. It's a good thing that folks from the medical fraternity are opting to do this.

While this sounds like a good practice and perhaps the Pros are doing this for a good reason, this doesn't sound scalable or adaptable for all. Not to mention on this being a totally subjective approach on who shall qualify in which bracket.

A better approach should have been same (reasonable or high) rates for all and no free lunches. Those who want to pay reasonable charges can go to respective clinics/places. Those who can afford higher charges (for respective better service or xyz factors) shall go to respective clinics.

For anyone in dire situations and needing free or no cost service, charitable trusts and govt hospitals can do the needful.

[am1m]

Originally Posted by sunilch

While this sounds like a good practice and perhaps the Pros are doing this for a good reason, this doesn't sound scalable or adaptable for all.

Contrary to the image of the greedy doctor and lawyer (and sure, there are enough of those around), I know more than a few members from each profession who reduce their rates a lot and also in some cases waive off their fee completely for those clients in need. I think they are quite qualified to judge who requires help or not and I think it's admirable!

Also know one doc whose similarly qualified colleagues/batch mates from medical college are earning more than 10x what this person is (judging by the cars they drive and their houses, compared to this person's), simply because this doctor chose to practice in a less affluent part of town for the past 30 years. (In fact, when I met some of this doctor's batch mates, all of them said this doctor was probably the best student of their batch and should easily have been heading a major corporate hospital today!)

I can say for sure that members of these 2 professions do a lot more for charity than most of us IT folks!

[ninjatalli]

Originally Posted by sunilch

While this sounds like a good practice and perhaps the Pros are doing this for a good reason, this doesn't sound scalable or adaptable for all. Not to mention on this being a totally subjective approach on who shall qualify in which bracket.

A better approach should have been same (reasonable or high) rates for all and no free lunches. Those who want to pay reasonable charges can go to respective clinics/places. Those who can afford higher charges (for respective better service or xyz factors) shall go to respective clinics.

Easy to analyse this (as we all are doing on this thread) to preach what could be a better approach; but the ground level truth is what is being done (on a voluntary basis) by the medical fraternity in the manner they can needs to appreciated.

The vet I mentioned had his setup about a km away from the slums of Ghatkopar west. Anyone could make out the lower strata level folks who came with their street dogs/cats for medical support. Anyway I could be wrong in identifying the economic levels, but the staff of the vet clinic were definitely able to differentiate.

I'd probably assume something similar for charitable hospitals/trusts over the years of operations at their end.

For anyone in dire situations and needing free or no cost service, charitable trusts and govt hospitals can do the needful.

A lot of these charitable trusts/hospitals operate basis doctors/etc providing services during their off hours (or consciously during their working hours too) to provide services. Doctors in the extended family have been doing this for years and across generations. Again, there's no requirement so each of them do it on a voluntary basis depending on their own thoughts/views. Some of my relatives don't and that's fine too.

[sunilch]

Originally Posted by am1m

I can say for sure that members of these 2 professions do a lot more for charity than most of us IT folks!

Originally Posted by ninjatalli

Easy to analyse this (as we all are doing on this thread) to preach what could be a better approach; but the ground level truth is what is being done by the medical fraternity in the manner they can needs to appreciated.

.....

How do you think these charitable trusts/hospitals operate? Doctors/etc provide services during their off hours (or consciously during their working hours too) to provide services. Doctors in the extended family have been doing this for years and across generations. There's no requirement so each of them do it as per their own thoughts/decisions. Some of my relatives don't and that's fine too.

I not saying what they are doing is in any ways the incorrect way to do. What I am saying is that it is not scalable or adaptable for all. The model can be enhanced further to increase the population that benefits out of it and it can target the intended audience (in this case patients) better.

Anyway, I am not a Medical Professional and only related to a few Medicos. We have had associations with a few Charitable Trusts (across different cities) and I somehow see that model as a good model to use.

I am not against any Medical Professional who decides to charge their customers differently based on their understanding.

[am1m]

Originally Posted by sunilch

The model can be enhanced further to increase the population that benefits out of it and it can target the intended audience (in this case patients) better.

Ah right, sorry, I focused on the wrong point in my response.

Yes, you are right, but I think that is what a universal, government healthcare system is meant to do/aim for?

[Thad E Ginathom]

Originally Posted by Sedate

This is quite scary! Everyone? Including old white guys who, despite nearly twenty years outside UK, still talk with an accent like David Attenborough?

UK is crumbling - Brexit and COVID just accelerated the rate of downfall.

And, in the bigger scheme of things, this is even scarier. And very sad. But Brits got what they voted for. And I'd better not go further into the P-word stuff!

[Just_A_User]

Adding to the point I've made before:
A Million Cuts: India’s C-Section Epidemic | Undercover Asia:

https://www.youtube.com/watch?v=zSRfUsiiLGU

Unfortunately there are very few doctors or hospitals in India that one can trust. Most people here have made the right choice by moving to western developed countries which have better healthcare standards and ethical doctors.

[Godzilla]

India has not only one of the best healthcare systems in the world but it also has the most AFFORDABLE and ACCESSIBLE healthcare. it is not perfect though especially for the underprivileged and lower income. However most medicines are priced lowest in the world. Most treatments too. One would be able to appreciate this more once they experience healthcare in other countries where they have to wait to see the doctor many weeks even for consultation.

The pharma companies tend to arm twist governments to fill their pockets. India refused to be bent especially with our indigenous COVID vaccines.

[Thad E Ginathom]

Originally Posted by Godzilla

India has not only one of the best healthcare systems in the world but it also has the most AFFORDABLE and ACCESSIBLE healthcare... However most medicines are priced lowest in the world. Most treatments too.

It's a lot more expensive than free.And that is something that I only came to really appreciate now that I no longer live in such a country.

[sunilch]

Originally Posted by am1m

Yes, you are right, but I think that is what a universal, government healthcare system is meant to do/aim for?

Yes that is what the aim of the universal healthcare is in theory and some developed nations have achieved it I suppose. But given our scale, our per capita income, our current infra and some cultural aspects, that may not be feasible to achieve in India.

So the current mix of Private, Government Aided (No Loss, No Profit) and some strict Govt intervention/control on a few aspects is a good path that we have taken. What needs to be fine tuned is the execution.

[msd7]

There is a myth that the public healthcare provided in government hospitals is free.

It is subsidised to a great extent in only the highest centres eg. AIIMS.

After spending more than 4 years in a central government tertiary care setup in western Uttar Pradesh, there are some findings which I would like to share;

A simple fever profile of CBC, LFT, RFT, Dengue NS1 and Malarial RDT causes INR 1035. Mind it this is a central government funded tertiary care hospital, which is the largest healthcare facility in the entire western Uttar Pradesh.

Considering the per capita income, an average Indian roughly earns 10000/month.

An average treatment cost including medications for a simple illness as Dengue or Malaria which are highly endemic here costs more the 2500 on an average which is nearly 25 percent of the monthly income.

It is a myth that healthcare in government setups is free for the poor. It's just the consultation fees and the ward fees that are waived off.

India has a lot to achieve in the healthcare sector. Our healthcare might be of low cost if compared with the western world, but compared to the income of our general population, a high percentage of our population can't even afford healthcare at our Government Setups.

[drmohitg]

Originally Posted by Sedate

A valid NHS number is not proof of eligibility for treatment - This is the statement mentioned in the NHS trust website.

Thanks for sharing that. I must be wrong then. At times when I have accessed the service in A&E and GP, I haven't been asked any details whatsoever. This includes 2 visits to A&E and 2-3 to GP over last 3 years.

[hothatchaway]

Originally Posted by msd7

There is a myth that the public healthcare provided in government hospitals is free.

It is subsidised to a great extent in only the highest centres eg. AIIMS.

After spending more than 4 years in a central government tertiary care setup in western Uttar Pradesh, there are some findings which I would like to share;

A simple fever profile of CBC, LFT, RFT, Dengue NS1 and Malarial RDT causes INR 1035. Mind it this is a central government funded tertiary care hospital, which is the largest healthcare facility in the entire western Uttar Pradesh.

Considering the per capita income, an average Indian roughly earns 10000/month.

An average treatment cost including medications for a simple illness as Dengue or Malaria which are highly endemic here costs more the 2500 on an average which is nearly 25 percent of the monthly income.

It is a myth that healthcare in government setups is free for the poor. It's just the consultation fees and the ward fees that are waived off.
.

These expenses should be covered by the Ayushman Bharat or the national public health insurance scheme which seeks to cover the bottom socio economic layers of the nation. Since you were based in UP, it is pertinent to mention this scheme, which according to reports has gained good coverage in the state. There are some states (TN/WB) which have their own version of this public health insurance scheme for the poor where no premium is to be paid and offers a coverage of ~5 lakhs which is decent for people seeking care in a public set up.

Treatment cost of 2.5k for dengue sounds reasonable in a govt hospital and perhaps just about covers the cost of care. I paid about 25x of that figure for the same disease at Manipal in Bangalore some years ago, covered by my private health insurance of course! There is no harm in seeking to cover the very basic cost of care with a universal and affordable health insurance cover. This ensures the continued health of the infrastructure used to provide that service.

I think public healthcare for the poor has made great strides in India and should not be seen with condescension just because there is more ground to cover. It is, any day better than the so called free and equitable system in some countries where you have to run from pillar to post just to get basic attention. It is the educated class in India, who have some safety net without being outright wealthy, who are at risk from rising healthcare costs. That risk is chiefly due to our own ignorance about how the system works here and blinded by some utopia which supposedly exists elsewhere.

[msd7]

Originally Posted by hothatchaway

These expenses should be covered by the Ayushman Bharat or the national public health insurance scheme which seeks to cover the bottom socio economic layers of the nation. Since you were based in UP, it is pertinent to mention this scheme, which according to reports has gained good coverage in the state.

On the Ayushman Bharat scheme, I have seen it only used for major procedures like dialysis or some surgical procedures. I would not like to comment on any government data having seen how such studies are conducted and numbers manipulated just to achieve targets.

For emergency admission and general illness have never seen any subsidies been given under Ayushman Bharat.

Also coming on the topic of easy specialist consultation in India, it is not as rosy as it seems. The healthcare system is supposed to be three tier system, with only those who actually require specialist intervention reaching tertiary care setup. What happens in India is that everyone directly reaches the tertiary care setups, because the primary and secondary are not available or developed.

This leads to an increased burden on tertiary setups which is a major reason for overcrowding of our government hospitals.

The need of the hour is strengthening our primary and secondary healthcare setups rather than setting up big tertiary care setups.