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Let us start with the premise that providing healthcare costs. Those costs have to be earned. In govt set ups through taxes + nominal charges on all procedures. In pvt through billing the patient. 1/n https://twitter.com/SonaliVaid/status/1272953357737422848
Continuing with the premise, healthcare is a capital intensive industry, which if practised ethically has a long gestation period of profit returns. 2/n
However the above caveats are crystal clear to anyone who enters healthcare with intention of earning through it, because the first thing anyone with MBA is going to ask before investing in an industry is EBTIDA. 3/n
Let us also be clear that pvt healthcare set ups are not all same - Corporate chains differ from stand alone hospitals which differ from small scale hospitals which differ from nursing homes & outpatient poly clinic units 4/n
The only similarity in them is that they need to first invest in healthcare, then earn out that investment to break even & profit from it to keep it running. The % of profit depends on the individual/groups running it. 5/n
I am going to address issue of billing specific to "corporate chains" here also specific to their concerns of costs of healthcare & losses they are making. 6/n
Articles like above championing the losses of corporate chains and also questioning its profitability literally give you a sense that people running these chains are actually saints doing charity. 7/n
However most of these articles fail to highlight a few hard facts & also fail to raise many unanswered questions. In my 15 yrs of career I am yet to find those answers. 8/n
Corporate chains earn through a mark up on - 1. Lab investigations (every investigation) 2. On consumables. 3. On medications 4. Miscellaneous costs 5. Bed costs. 6. Direct charges 7. Procedure charges 9/n
Then there are charges noone talks about. Eg. An angiography/angioplasty CD cost of Rs. 1000. A CD that costs Rs. 5 (maybe even less in bulk) with a 60 sec clip copied from a software. Let's start with the math..10/n
If a hospital does 10 angiography (gross underestimations) in a day. They earn Rs. 10000/ day(& this is hard cash most of the times not shown in billing) multiplied by 30, Rs 300000 per month. Unaccounted!! 11/n
They charge Rs. 1000 (& more) as record Maintainence charge for every admission that a patient has (even day care). Assuming a 100 admissions per day (10 per speciality). Back to math 12/n
It becomes Rs. 1 lakh per day, 30 lakhs per month ( do th rest yourself) and many hospitals charge this separate from your main bill. They charge you a separate TPA processing fee apart from this. 13/n
These hospitals charge you between 9-11k for ICU bed with the inclusion of AC, electricity cost, food & linen cost & monitor. And then charge you for everything (even a alcohol swab) 14/n
And most of these chains have supplementary incomes through their own health insurance companies, pharmacies, lab chains, home care delivery!!! 15/n
Despite making losses from hospital business, insurance business, lab business, pharmacy business...these chains decide to make more losses by acquiring more such loss making hospitals!! 16/n
Either they are saints (which I doubt anyone of is gullible enough to believe) or they are lying through their teeth to all of us about their actual costs & profits. To Patients, doctors & govts included. 17/n
Now coming to hospitals buying their own land. And that land costing them. Knowing the EBTIDA they invest in this. They earn from it for 25 yrs, 50 yrs on a daily basis. Hotels can have slumps. Hospitals don't. 18/n
Coming to inclusion of food & laundry cost in the room cost, the food provided in hospitals is not exotic. It is mass produced. Even at its fanciest best will not more than Rs 250 per meal. 19/n
And they feed only the patient, attendant pay for the food. Even we the doctors & everyother healthcare workers pays for it from our own pocket. And hospital laundry cost is peanuts. 20/n
I am not even getting into practically 500% or more markup on every single blood test that is done in hospitals. So the above arguments are bullcrap that hospitals feed to their workers who are either naive enough or complicit enough to take it. 21/n
Coming to how the "pandemic" has essentially turned these so called loss making expansion loving chains into further loss making entity. 22/n
The loss they say comes from - 1. Decrease in procedures 2. cost of PPE 3. Salaries of workforce. From my personal actual ground experience allow me to demolish these reasons. 23/n
Hospitals are not making the same profits that they were making pre-covid. But that baseline has changed for every industry. However this doesn't imply that theyvare making losses. 24/n
For 1 month in April they all had a slump. However they cut the salaries of their workers to the tune of 30-70% from March. Many HCW's have been laid off. So cost of salaries has already been reduced. 25/n
Most hospitals have recovered from the slump in terms of patient visits, to the tune of 50% in terms of procedures & increased admissions due to covid infact enough to cover up the loss of 50% procedures 26/n
They are overcharging for PPE from every single patient be it OPD or IPD & in the meanwhile making staff reuse N95 for 3-5 days. Not providing more than one PPE per shift in case the need to pee/eat etc. 27/n
They are charging every patient individually even for the PPE that is being used by workers who are catering to multiple patients using one PPE for eg. A ward doctor or ICU doctor who is seeing 10 patients wearing the same PPE. 28/n
Most even in times of corona have a bed to nurse ratio of 2-3 patients for 1 nurse (and in many places are paying that nurse half their salary due to paycut & in many making them do work of GDA & sanitation workers) 29/n
The nurses whose salaries have been halved & are posted in areas which are not currently functioning optimally are being used to supplement workforce in ICU & isolation. New haven't been hired. 30/n
I know pvt hospitals which are making staff pay even for testing them for corona, asking them to come to work even if they have fever, asking them for a fee deposit before admission for treatment 31/n
So next you hear of the idealism & humanitarian services they are providing please know that they are providing you those by screwing up their workers & over-charging you by a lot. 32/n
And, anyone who refuses to baad their defence of corporate chains without first acknowledging these & questioning them for the same is either naive or complicit with them. 33/n
Till the time these doctors demand that no pvt hospital should be either a direct or subsidiary owner of a pharmacy, lab chain or health insurance company. They have no moral ground to justify costs. 34/n
So if you want to run it as a business, please have the decency to say we are out here to make profits out of you. Please have the decency to be transparent with your billing & with the workers.
Say it on the face we are out here to make money instead of saying we make losses.
Say it on the face we are out here to make money instead of saying we make losses.
Cc @SonaliVaid my response to the article you had tagged me in yesterday.
These healthcare businesses should atleast have the decency to use their hard working employees who merely earn their salaries as a scapegoat to justify their profiteering.
