25 factors -Medical treatment costs becoming expensive: are doctors responsible?


Although doctors are blamed for expensive medical treatment, but the real cause  is the aberrant evolution of medicine and medical education to almost an industrial model. There has been tremendous rise in health care  expenses in last few decades and it is usually borne by the government, taxpayer, insurance or patient himself. Discontent is all the more if patients  are unable to bear these expenses and if the results are not as per  expectations ( realistic or unrealistic).

Following features have led to increasing dependence on investors in medical field which then has to run along the lines of an industry to ensure its financial viability-

1.Newer technology and  rapid advances in newer innovations in medical fields  for improvement in diagnostic and newer treatment modalities. If a hospital or doctor does not upgrade, it will be regarded as  having obsolete technology.  Most of these medical technologies  are extremely expensive and owned and marketed  by big multinational companies who  sell them.

Since cost involved is very high, there can be various types of deals involved between  middlemen  involved in selling and buying these equipments and technologies. Doctors  are the  end users of these technologies, but  not part of business process. They are actually the consumers and users  for  these technologies.

2.Expensive real estate:  A self made doctor at the start  or even during his life time, does not have the kind of finances  to build  a hospital which needs a large parcel of land with commercial location. Therefore there  is a need for big investment or investor to pitch in and invest funds.  And if they invest, obviously they would look for some returns.

3.Equipping the Hospital: Building of hospital with the  infrastructure  and equipping it well needs lot of money and investment which only an investor can provide. Same is true for maintenance of equipment, bills,  insurances, AMC  etc.

4.Staffing of Hospital: A hospital needs lot of skilled human resources, health care being a highly labour intensive industry.  Doctors , nurses,  technicians, para medical, administrative and clerical staff is required.  Employment of non medical  in hospital industry too has been increasing because of various regulatory requirements and complex processes other than just treating patients.

5.High regulatory requirements:  globally the requirements of regulatory authorities have been sky rocketing and it requires  a lot of manpower to maintain such data. Getting accreditation etc are  processes which requires manpower, time, and a legal team. All these legal  requirements are expensive.

6.Consumer protection act:  This single important factor can increase the cost of  healthcare for the patient. As doctors are increasingly scared of being dragged to court, they are always on backfoot and are forced  to do defensive practice. Investigations are required for documentation. Patient and courts will ask for proof and goes by documentation.  Medical problems are very complex and  sometimes it is difficult to judge  the future course of disease or decisions for surgery, or how patient will behave before or after surgery. A doctor, thus, will always try to play safe legally  in present scenarios. Because everything he does will be scrutinized later, with retrospective wisdom,  by courts. And   since doctors manage  so many patients everyday, they never know which one will harass and deceive them  later.  Mistrust has increased to such an  extent that patient relatives do not understand even if things are told in good faith and in patient’s interest.  Summarily doctors have to safeguard themselves from treatment as well as legal and  documentation hassles.

7.Expensive legal services:  Every case that goes to court involves lawyers and their expensive fees. Most of the time even though the doctors may be right, he has to defend himself with the help of  lawyers.  Law industry has been  benefitted enormously because of consumer protection act at the cost of doctors. Increasing mistrust and unhappiness in patient’s mind definitely does not  help patients and doctors. Strangely  doctor’s fee are quite low but lawyers charges them astronomical amounts, which are beyond any logic.

8.Increased expectation of patients : People want exceptional care, best in the world with best technology,  that also at a price less than  even a meal in restaurant, and then they want a quick relief!!  This is an expectation almost impossible to fulfil. Even government hospitals, which are funded by taxayer’s money find it difficult to provide free treatment with quality.

9.Large claims given by courts:  in a country where people  fight with their parents, brothers and  sisters for money and property, it will be naive to think that idea of making money from doctor  does not exist. With court compensations going into crores, doctors  can sense many times that some patient relatives  try to use the opportunity. They have nothing at stake so they try to make some noise on social media and harass the doctor in court or on social platforms. Even for patients, who had poor prognosis at the very onset of treatment, relatives can create problems. Doctors have no protection from these nuisanse. All these factors further enhance insecurity in doctor’s mind.

  1. Expensive and time consuming Medical education, on sale: Although an open secret , as reported routinely in news, medical seats are big business. Each private medical college seat sells for huge money. Such doctors, who have purchased seats have already  behaved as investors. Once these  doctors are in practice, they will try to  recover the investment. This can obviously push up the health care costs not to mention vitiation of the medical fraternity.

11.Requirement for maintaining huge data and audits:  to maintain standards, to have accreditions, for medicolegal issues , large data storage, audits and surveillance is required. These systems also need  new systems and manpower.

12.Employment of large numbers of  non-medical personnel:  earlier management work was handled by doctors. All senior doctors were given small and differnet  departments of  administrative work at very little  or no extra cost. But now for all these works separate administrators  are appointed. Now a days ratio of doctors to nondoctors is higher as compared to previous years. Increased regulatory and  and insurance system needs more non- medical staff.

But  productivity of hospital still remains by  doctor-patient interaction.  This change in arrangement in Hospitals has caused  increase in costs and hence pushed the health care  expenses. Advantages and disadvangages of these changes  in arrangement will be known  with time in future.

13.Non regulation of  businesses  associated with large health care industry: for example pharma industry,  suppliers , biomedical, equipments, consumables. Such individuals,  although play important part in medicine, cost, sale and purchase, but are largely  unregulated. Unlike doctors, who are regulated by multiple governing bodies. But doctors are  often perceived  as culprits for these costs escalation.

 

14.Increasing extinction of Single doctor and  small setups: for them it will be difficult to keep pace with newer technology and buying expansive equipments. It will be difficult  for them to manage requirements of new medical system, legal problems . At the most they will continue to provide cheap medical services,  but for only common and simple ailments. It will be difficult to manage serious patients and sick and complex patients in view of high public expectations . These set ups are under severe security threat and pressure because of non – acceptance of even genuinine complications of treatment.  As legal requirements increase,  these systems will become unviable and option of common public for cheaper, friendly services may become extinct. So it will decrease  the  easy and  sometimes last option of  doctors to settle with a small set up. Chances of them to work for investors  and insurance companies will increase, and they will be cheap labour for industry.

15.Medical and health Insurance becoming indispensible:  Insurance companies are every where.  They sell policies to patients , as well as doctors.  In fact, they are  positioned between doctor and patients. They make money from both sides. Obviously more expensive the treatment, more dependence on insurance. Therefore a cycle has been set up.  Increase in  insurance cost  will push health care  more expensive and a vicious cycle is set up. One should not be surprised, if in future treatment to a large extent will be dictated by insurance companies.

 

16.Conversion to a industry:

Because of above reasons Medical and health care has become an industry and needs investors. So as it is business proposition. Funded by investors and run on commercial principles, the  doctors are being slowly reduced to  skilled labour, alienated from the core.

  1. Aging, multiple diseases : as life expectancy is increasing, it is leading to multiple diseases and more complex diseases  and new expensive treatments.  In this changed scenario and  all people  want to prolong life as much as possible. Cost of prolonging life with multiple problems is quite high. It consumes more medication and resouces and hence consequently pushes up the cost of medical treatment.

18.Evolution of complex infections:

    Advent of antibiotics   and germ theory was thought to be game changer in medical history. But because bacteria proved to be smarter than humans and acquired resistant. New and expensive antibiotics have been gradually being rendered useless. Need for more antibiotics is causing treatment to be costlier.

 

19.Evolution  of  advanced treatment:  Invention  of Expensive and new diagnostic techniques along with highly technical treatments by industry is not without added cost.  Although it may be useful in certain patients, but how much it will help overall in masses, for general treatment, as it increases the  cost of overall treatment.

20.Increasing  need for heightened security:  It is not uncommon to have mobs causing physical harms to medical workers  and  damaging hospital properties. These incidents have caused increased need for security for the premises and adding to the cost.

 21.Complex interplay of various industries eg pharma industry and consumable industry:  large  number of consumables pharmaceuticals, sutures,  surgical instruments, IT industry, drugs, implants, medical supplies are required.  These industries supply their items on a price commanded by them and there is complex interplay  of various industries.

  1. Non uniform and variable care and cost:  each city has multiple hospitals. Care and cost varies in  every set up. Even all government set ups are  not uniform in facilities and cost. Private setups  vary in cost and care, to the extent of  maximum possible variations. All this non-uniformity has created confusion in the mind of patients and variation in financial issues.
  2. Poor public health care facilities: due to less expenditure on health care, government health care facilities have been under developed.  Less  investment by government has given way to private health care to flourish.

24: Conversion to a industry model  and entry of Investor: all the above investments are very expensive. Doctors usually do not have that much money to invest. Therefore   Investors and financers  have become indispensible part of health.   once investor invests money, it will be driven on business principles.

 

  1. Future course: I do not see in future that this arrangement is going to change , rather it will be strengthened more and more and quality care will become more costly. Doctors will  be totally  alienated  from financial  and business aspect, because industry will  not be sustainable without an investor.

 

As we look at reasons above, Doctors are no where in the financial picture and  to be blamed for increase in overall health cost.  But since only doctors are visible part of industry, who treat and interact with patients, often they are blamed for  the cost. They have actually being alienated from financial aspect, barring small percentage of doctors, who are financially literate. Consequently, the doctors who will be unable to entrench themselves in the business milieu will be unfit  in future and hence extinct.

20 thoughts on “25 factors -Medical treatment costs becoming expensive: are doctors responsible?

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  1. Very rightly described Public do not differentiate between Qualified specialist and quack lack of education). They do nott kn ow cost of treatment abroad .Cost of every thing is rising. If India provide costly treatment why do people come from abroad here for treatment Can Waste lots of money on marriages but not on health

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  2. Point number 9 seems very valid in context with recent social media made so called scandals in Fortis Gurgaon and Max case. Doctors tried to help relatives as chance of survival was nil in both cases. Now relatives have resorted to extortion.

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  3. Very nicely analyzed Sir. I do not think any Media will publish because it is not “at present” in their interest to increase TRP, may be after few years they might.

    Most of the high educated people in society also are aware of the raising cost of medical care and are well informed and I do not agree that Doctors do not brief patient relatives about treatment, treatment plan etc, today most of the leading Doctors have assistant who do briefing and taking questions and others during the rounds do inform and in my knowledge I have seen many young and old Doctors who inform every development to patient relatives. There is a gap in supportive department like nursing, lab etc in handling development with patient relatives.

    Yes, Health Care has become an industry and it is a business. Today there are CEO, COO, CFO, HR, in medical set ups who draw more salary than the Doctors who are responsible for getting the business to such establishments. From Security, Reception, Public Relation Officer, Accountants, Secretaries, Insurance personnel, Marketing Personnel, operational managers, store managers, Pharmacists etc are all benefited by this Industry and but at the same time all do blame Doctors, though it is through Doctors they are getting Business and their salaries.

    Soon there will be “Ambulance chasing” lawyers and soon there will be Doctors to authenticate whether other Doctor colleague has done correct treatment to patient or not.

    It might take few decades for common man and society to understand the medical field and to come to terms about it… meanwhile media will hype every death, common man will still get frustrated, mob will still vandalize a medical establishment and Politician will get popular in media with his ridiculous statement… till we all become “Humans” these things will continue..

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  4. Doctor’s getting beaten by patient’s relatives is because of attitude of doctors.The arrogance is visible in most such cases.Doctors need to understand patient may be just a number for them but not for relatives who have life long association with patient & would like to see that patient is comfortable till such time of his discharge.Doctor don’t consider it necessary to inform the line of treatment,side effects & expectation at the end of treatment.In most cases this does not happen in India.So when patient dies a painful death ,Doctor is likely to feel the wrath-not surprised.

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    1. Your thought process is not correct as you have little knowledge of very complex medical science. This little knowledge is being used by media to hype each non issues. You will get wiser once media highlights the truth and make people understand the complexity of medical science in a manner in which they understand.

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  5. Please print this in local dailes ,magazines as well as circulate on social media so that the common man becomes aware of the reality existing in the healthcare sector…
    Very well covered all the angles of soaring costs in the healthcare industry ..
    Excellent article …

    Liked by 1 person

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