Lessons from a tragedy

Delhi dengue death shows need for public hospitals

The death of a seven-year old boy in Delhi on September 7 of dengue, after he was not admitted into five different city hospitals, was a tragedy. But it is entirely possible that such tragedies have occurred before without being able to capture the attention of the news media. However, the tragedy was intensified and compounded when the boy's parents committed suicide in the days following his death, jumping from a two-storey building in the South Delhi district of Lado Sarai where they lived. Even a jaded news media could not ignore this. Shortly after the news story was broken by The Indian Express, the Delhi government swung into action: the five hospitals - Moolchand, Max Saket, Akash Hospital, Saket City Hospital, and Irene Hospital - that had reportedly refused the boy admission were sent show-cause notices, and asked why their licences should not be cancelled. According to the boy's grandfather, the parents had gone with the boy to six different hospitals between 2pm and 11pm on September 7, and he was only admitted by the last, Batra Hospital, by which time he apparently had only 15 per cent of his heart function remaining. He died of catastrophic organ failure. This came in the backdrop of the state government having already issued a warning to hospitals that they should not reject dengue patients claiming a lack of space.

The questions this sad case raises go beyond the conduct of these five particular hospitals as reported in the media. The question is one of the direction of India's health care system itself. It is unfortunate that an opinion seems to have gained ground within the government that a private provider-led model is suitable for Indian health care, if supplemented with the roll-out of insurance models. Such instances reveal how impractical this aspiration is. Private hospitals simply cannot be trusted to be the backbone of a health care system. In many other sectors, the government does too much; in this, too little. There are aspects of the health sector that mean it is uniquely unfit for private provision. The information asymmetries, for example, are acute; and then there is the dependence on urgent care in a given area during emergencies as opposed to the ability to shop around in a manner which would permit the mechanisms of competition to work. Sadly, as the National Sample Survey shows, the government has retreated from its duty and left it to private hospitals. For general health trouble, 51.3 per cent of men were treated by private doctors, and 24.3 per cent by private hospitals. The numbers were not too different among women. These numbers are reinforced by anecdotal evidence - it is impossible to visit a public hospital without realising that demand for its services far outruns its capacity.

Increasing the penetration of medical insurance will not help more than marginally, regardless of what government think tanks may claim. The paperwork hurdles would be formidable disincentives for the poor at moments of emergency. And cost escalation for the public payer would be uncontrolled, especially in a poorly regulated economy. It is not surprising that private health care chains are promising investors a secure cumulative annual return of at least 14 per cent per annum. Public health care is certainly a better solution, and the government should address its lack on a war footing.