A day after the Karnataka government fixed the prices for COVID-19 treatment in private hospitals, 26 civil society organisations (including doctors, public health professionals and patient rights groups) have criticised the lack of transparency in the process. Some of the signatory groups to this statement include Drug Action Forum - Karnataka (DAF-K), All India Drug Action Network (AIDAN), Naavu Bharathiyaru Karnataka and Campaign for Dignified and Affordable Healthcare (CDAH).

The joint statement said the organisations are extremely concerned about why the government took the decisions to cap prices based solely on discussions with private hospitals and the Association of Healthcare Providers (AHPI), leaving public health professions, patient groups, and civil society out of the loop.

According to a notification by the Karnataka government, for patients referred to a private hospital by a public health authority, the cost per day for general ward will be Rs 5,200; for high dependency wards it will be Rs 7,000; for isolated intensive care units (ICUs) will be Rs 8,500; and the same with ventilator support will be Rs 10,000. For other patients who directly go to private hospitals, general wards will cost Rs 10,000; high dependency wards will cost Rs 12,000; isolated intensive care units (ICUs) will cost Rs 15,000; and the same with ventilators will cost Rs 25,000. All these costs are on a per day basis.

The statement opposing these prices said, “The AHPI is a lobbying front for large corporate hospitals that operates solely for economic benefit of private hospitals, pandemic or no pandemic.” The statement argued that even though the AHPI was earlier criticised for having conflict of interest and methodological flaws, it has not stopped them from creating proposals for package rates that are “flawed and clearly intended to hike up costs for patients/government.”

They argued that due to the prevailing public health crisis and economic hardships faced by people, it is imperative on the government to ensure free treatment to all COVID-19 patients not just as a matter of right but also as prudent public health policy to curtail the disease. 

Calling the government action of taking over 50% capacity of private hospitals long overdue, the signatories added it falls short of ensuring financial protection.

"The notification has not provided the specific number of beds that will be made available in each hospital under each category. This provides leeway for private hospitals to reserve the more expensive and profitable beds, i.e. the ICU beds with and without ventilator support,” the statement added.

Further, the fixed rates do not cover the costs of unforeseen complications, surgeries, other comorbid conditions, pregnancy. This is a worrying issue, the statement said, given these are the most high-risk patients.

To keep a check on the private hospitals and due to lack of a grievance record mechanism, the joint statement said that a nodal officer be appointed for the same.

Their list of demands have been reproduced in full:

1. In taking decisions related to requisitioning capacity of the private healthcare sector, pricing and setting rates, and healthcare provisioning during the COVID-19 pandemic, the government must ensure that all actors and stakeholders, including public health professionals, patient’s groups, civil society and people’s groups are included in the consultations. The consultation process should be transparent, and minutes of meetings should be made publicly available. 

2. In order to successfully curtail the pandemic, a whole health systems approach is sorely required. This is missing in the current approach where provision of healthcare is seen in a segmented manner. There is a dire need to bring public, private, charitable, medical colleges, corporation facilities under a single umbrella with transparent and well-functioning referral and reporting mechanisms. The government could use the COVID-19 situation as a good opportunity to improve the reporting and assisted referral mechanisms from the various public as well private facilities so that the patients are not distressed going from one hospital to another.

3. The treatment given to COVID-19 patients must be in strict adherence to Standard Treatment Guidelines which should be issued by an appropriate government agency. 

4. The government needs to ensure that a transparent oversight mechanism is set and enforced to ensure that differential quality of treatment is not provided to patients referred by the government, those paying fixed rates out of pocket, and those paying full rates through their private insurance. 

5. A nodal officer has to be appointed for monitoring functioning of private hospitals and addressing grievances. The contact details of the officer must be made publicly available. Strict action must be taken against hospitals found to be violating the fixed rates, providing differential quality of care, violations standard treatment guidelines, or denying anyone care. 

6. The fixed rates for private patients mentioned in point 2(b) of the Notification dated 23 June 2020 should be extended to patients covered by private insurance. 

7. Co-morbidities should be included as part of the package for private patients of COVID-19, especially for those requiring ICU and ventilator support. The rationale for the treatment should be documented in detail. 

8. Many seriously affected patients often require lengthy admissions of several weeks combined with critical interventions like oxygen and ventilator support. Even at the prescribed rates for private patients, the cumulative cost over several days could make treatment unaffordable for many families. Moreover, many patients would require access to experimental treatments that can be highly priced. The government has not catered for measures to protect them from financial adversity. 

9. Just stating percentages of beds is not sufficient. Private hospitals need to mention the exact number of beds allocated, in each category - general ward, DHU, ICU without ventilator, ICU with ventilator, within each private hospital to be made available and regularly updated. This must be reported on a daily basis and made publicly available for the general public to identify the bed availability. 

10. The government needs to urgently take control of the situation and invoke its powers to bring part or all of select private hospitals, facilities and services under common public health command, at its own terms and conditions, and delegate tasks to them. In this respect we welcome the Circular issued on June 23, 2020, directing certain corporate/charitable hospitals to each ready one of their branches for converting into a dedicated COVID hospital. The government must requisition further capacity in private hospitals, particularly of critical care facilities, as the need arises. 

11. Payments to private hospitals for patients referred by the government should be made within a stipulated and reasonable timeframe (e.g., two weeks) in order to ensure the full cooperation of the private sector. There have been extensive complaints from private hospitals about pending payments under various government schemes. During a national health emergency, the government needs to ensure provision of healthcare services without any disruption. Therefore, in order to ensure cooperation and viability of service provision through the private hospitals, the government must ensure that reimbursements for COVID-19 treatment are done regularly within a stipulated time frame. It may be advisable for the government to also clear the backlog of previous pending payments to hospitals.