The government has recently launched the Rashtriya Swasthiya Bhima Yojana (RSBY), an innovative insurance scheme that will cover hospital bills for people under the poverty line. I will not delve too deep into the details - those interested can read about them here. Suffice to say it is a scheme whereby hospitals will be reimbursed by the government for procedures on poor patients who are treated completely free. As this applies to private and government hospitals it has been hailed as yet another of the poor-friendly schemes this government has brought in. But for every government scheme in India, there will a certain group of Indians who will identify loopholes they can milk for money. And in this instance it is the doctors who are the culprits. I write this with a sense of disbelief and shame that members of my profession can stoop to such levels, but I realise how strong the pull of money is on the Indian psyche and know that incredible though they sound, these things are certainly possible.
It seems that there are many ways that the system can be corrupted. The first and easiest method is of course to perform unnecessary procedures on poor and illiterate patients who have very little clue about what happens to them in a hospital. In fact, before the advent of RSBY, it is probable that some of them would never have dared to darken the portals of a private hospital due to the prohibitive costs involved even to just meet a doctor. This of course, is a time-honoured tradition of milking an insurance system and is practiced, I believe, in all corners of this planet. Then we move to the more innovative schemes that our Indian doctors have devised. A common one is to bill the unsuspecting patient for a different (and more expensive) procedure than he or she actually recieved. A patient may have gone in for a lymph node biopsy, but is told he had a thyroidectomy, or at least, is billed for one. This may cause some problems in the future if he did at some point actually require a thyroidectomy, but that would be his problem of course.
And today, I heard of the most 'enterprising' scheme of all. It seems there is a huge network of touts, whose job it is to bring patients with the insurance card to the hospital, for which they get paid a cut. This of course, is yet another well-known Indian tradition. There are touts operating even in supposed Meccas of good medical prcatice like CMC, Vellore. But one senior surgeon decided to reduce the stress on the touts. And in the process, increase his profits! So he told the touts to bring him just the cards, without the patients! And then entered their names in his register and billed them for a variety of procedures! This may have continued for many years had he not gotten too greedy. Questions were asked when the numbers emanating from his clinic were hugely different from the numbers of the other practitioners in his town and after about a year of this lucrative enterprise, he was finally caught. Of course, by then he had made more than enough money for his get-out-of-jail-free card and is back in his practice now with hardly any repercussions.
This post sounds a little like a rant, and I apologise. The more I see the way my profession is headed, the more scared I am for its future. We are already at the stage when money and perks define nearly every decision of a doctor from the time he or she steps out after internship. And we seem to be fast reaching the stage when the desperate desire for money and more money make us silence even the little that is left of our conscience after the world of modern medicine has twisted and warped it. Can we ever return to the days when medicine was a noble profession and its practitioners were the moral leaders of society? Will doctors ever return to the Hippocratic Oath that we so hypocritically swear to? Or is our profession doomed to wallow for ever in the murky mires of greed and avarice? Only time will tell, but the signs are not too good.