One-off refunds do not make regulatory success. They are more signs of systemic failure
The Medanta refund to the family of the 7-year-old boy who died of dengue, at the behest of the health ministry sets a bad precedent at so many levels that it can perhaps be a case study in a healthcare management module.
In a spectacular admission of its own impotence, the Union health ministry wrote to the hospital asking for the Rs 15 lakh bill to be refunded on the ground that the family is poor and have lost a child. While the latter indeed is extremely tragic, they are by means the only poor family in the country that has lost a child. Why not refunds for all poor families who have lost children? Or for all poor families who have lost a family member? Or for all families who have failed to take their loves ones back from the hospital? The argument can be stretched to any length.
Earlier this month while approving the National Health Protection Mission that will provide a Rs 5 lakh annual health cover to 10.74 crore families, the government in a statement said: “In-patient hospitalization expenditure in India has increased nearly 300% in the last ten years. (NSSO 2015). More than 80% of the expenditure is out of pocket (OOP). Out of pocket (OOP) expenditure in India is over 60% which leads to nearly 6 million families getting into poverty due to catastrophic health expenditures.”
If even half of those 6 million families have lost a loved one despite suffering impoverishment, why are they not eligible for a refund?
businesâ€s by definition is NOT to earn money by deceit. It is a legitimate pursuit – and when it is so, a letter from the ministry of health cannot be the reason for a refund. It is only when there are gaping holes in the business policy of a company
There is something extremely sinister about making a precedent out of a case where a refund happens because a family has lost a loved one. Medicine in its very nature is a imperfect science – some of the biggest believers I know are doctors – there is in every hospital a very healthy (or, unhealthy) percentage of patients who do not go back home. For the simple reason that every human body is a unique machine that may or may not respond to external stimuli as chronicled in medical journals. The machine may also respond in the thousand other different ways not chronicled.
To be giving refunds to every patient that does not go back home fraught with complications; a far easier method both for hospitals and the government would be to put in place a billing system that is above board and where no company has to put up with such diktats from the government.
Because businesâ€s by definition is NOT to earn money by deceit. It is a legitimate pursuit – and when it is so, a letter from the ministry of health cannot be the reason for a refund. It is only when there are gaping holes in the business policy of a company when such muscle flexing needs to be succumbed to.
The Medanta refund is a regulatory lesson for both private hospitals and the Union health ministry. Will they learn?
