Only salary, no commission to doctors

With increasing disease burden, there is also a subsequent leap in services, as well as the cost of health care. While people are turning more health-conscious and going for regular check-ups, hospitals are responding with a plethora of supplementary packages. Even as India's $75-billion (Rs 4.45 lakh crore) health care sector is projected to grow at a compounded rate of 25 per cent annually, hospital care still remains unaffordable for many. In such a situation, best practices opted by hospitals, as well as by medical practitioners, often come under question.

A poll of 10 leading hospitals from across the country, conducted by Business Standard, revealed many facts about corporate hospitals conduct, when it comes to best practices.

While most of these hospitals maintain they pay "only salary and no commission" to their resident doctors, several say they have prominent consultants and pay "variables" to doctors as part of their salary, depending on performance. Some others say doctors were paid "as per hospital's published tariff." This was in response to a questionnaire on commission, marketing tie-ups and other practices, sent to the 10 hospitals, of which five replied. Medanta Medicity, Max Health-care, Jaslok, Apollo and Moolchand Hospital did not reply.(SELECTION CRITERIA)

While patients increasingly complain of tests being recommended by doctors in leading hospital chains, most facilities claim there are no direct incentives given to doctors to encourage unnecessary diagnostic procedures.

"Most of our doctors are on a fee for service model, where they are paid only for professional services as per the hospital's published tariff," says S C Nagendra Swamy, president, Manipal Health Enterprises and chairman of its quality council. Swamy emphasises that the hospital strictly follows ethical practices and pays its doctors and staff only for their "professional services rendered". Manipal Hospital does not have any reward scheme for its doctors or any other hospital staff for referral of a patient, he adds.

Fortis, which has the largest network of hospitals in the country and also operates globally, says its audits and clinical excellence processes emphasise "outcomes rather than the number of procedures done".

However, when asked if the hospital had any reward scheme for patient referral or additional intervention or consultation by another specialist or consultant, Fortis said: "Remuneration is paid in the same manner to all employees of Fortis and consists of a fixed and variable component that is dependent on the overall annual performance of the individual and the company. There are no direct specific incentives for patient referrals or for additional interventions."

Experts say hospitals these days are driven by renowned and popular doctors, who are highly paid and therefore, given targets as hospitals need to recover the cost. However, there are defined clinical pathways, which any doctor in any hospital needs to follow.

These pathways set clear guidelines on how a patient should be diagnosed, what should be the period of hospital stay and what medicines to be given.

"Hospitals need to evaluate whether its doctors are following those defined pathways or not," says Vikram Anand, head-providers, IMS Health India.

Many patients complain that doctors in leading hospital chains insist on getting diagnostic tests done in their own facilities, which are often set up in collaboration with private laboratories.

Experts say private hospitals are under peer pressure, where on the one hand, they have to pay hefty salaries to attract renowned physicians and on the other, they need to get high-end equipment. This adds up to a huge investment for a hospital, which has to be recovered from patients through procedures and diagnostic recommendations. "These are the latest tools of marketing. So, for a hospital with multiple facilities and capital equipment, the challenge is to push the revenues to recover the cost," says Anand.

According to him, 20-30 per cent of a private hospital's revenues are generated through diagnostics.

In response to queries related to such practices and marketing tie-ups, most hospitals say they have their in-house diagnostic facility.