Critical illness requiring intensive care and financial anaemia are a lethal combination. More than one-third of patients either sell their property or take loan to sustain the cost of intensive care treatment in corporate hospitals.
In such situations many people express concern but tend to avoid when financial or logistic assistance is sought.
The reality can be desperate at times. Some are forced to transfer their patients to a cheaper set-up with weaker infrastructure. There is a lack of trust which is unfortunate.
During the Covid pandemic, common people realised the value and necessity of intensive care. According to an estimate, there were 1.9 million hospital beds in India at the beginning of the pandemic, along with 95,000 ICU beds and 48,000 ventilators.
Projected figures indicated that 2.7 lakh intensive care beds were required during that period.
Common people have serious concerns regarding treatment in ICU
- Admissions are done mostly with commercial intention.
- Indiscriminate use of ventilators and unnecessary investigations increase the bill.
- Less accessibility to the ICU in-charge. Only medical officers give updates regarding the patient.
- Rude behaviour by some hospital staff.
- Hospital acquired infections should be the responsibility of the institution only.
With increasing bills there is further erosion of trust. Although this issue is complex, an assessment is essential.
Manpower
Other than doctors and nurses, many other employees are necessary for the proper functioning of any ICU. Though most are permanent, some contractual staff are also required. The experience of the staff and infrastructure determine the quality of treatment.
According to an estimate, the cost of the personnel employed may be around 45 per cent of the total budget. Support services are required to deliver proper care in the ICU.
- Non-clinical support services: This includes catering, laundry, cleaning, uniform, stationary, closed-circuit TV, central sterile supply department and administrative costs.
- Clinical support services: This includes physiotherapy, dietitian, lab services and other medical specialities. Thus functioning of any intensive care unit requires a large number of personnel and significant cost. They need to be taken care of even when the occupancy is low.
Equipment
A lot of equipment are imported as many local instruments cannot match up to the international standards. The cost may be around 37 per cent of the establishment cost. Also, the patients and relatives have a preference for imported equipment and drugs. The quality and brand value are considered superior by some people.
On some occasions the voice box needs to be removed for locally advanced cancers, which means permanent loss of natural voice. No person can be deprived of speech and therefore artificial voice must be restored. It is silence which isolates.
Patients always prefer the Provox prosthesis for artificial speech, manufactured in Sweden, though it is costly. Indian brands are not considered.
The cost of drugs, including antibiotics, are also significant. Although generic drugs are available at a lower cost, it is not preferred by all.
Indiscriminate use of antibiotics have caused resistance and there is no option but to prescribe higher molecules. Prolonged stay in the intensive care also multiples the cost.
Some allege that inferior quality equipment and drugs are provided in many intensive care units for higher profit.
Cost assessment
It is important to maintain the ICU structure as equipment become backdated with time. The cost of the land should also be included, though it is a one-time investment. The assessment of cost can be done in two ways:
- Dividing the intensive care budget by the number of patients.
- Cost of the individual patients according to the use of resources.
Critical care can be 20 to 30 per cent of the hospital budget.
The cost of intensive care can also be calculated in dollars, comparing various countries by the Purchasing Power Parity (PPP) system. The cost in India is comparatively low.
Higher accreditation of the hospital is also an issue for the high cost. Insurance may not cover the total cost of intensive care.
Personalised plans may be better. In terminal cancer the patient cannot always be kept at home.
If kept in intensive care, the cost increases though the patient deteriorates.In the medical undergraduate course finance is not included in the curriculum, though doctors have to deal with it in corporate hospitals.
Way forward
Crowdfunding to finance treatment has been appreciated but cannot be considered as a regular option. Requesting for money in such situations lowers self-esteem and confidence.
There have been many discussions and presentations but viable solutions remain elusive.
- Health innovation and alternative methods of financing are required.
- In genuine cases, payment option by installments over a year should be permitted.
- Some beds can be reserved for those who cannot afford high rates.
- People visiting thepatient can offer logistic or financial aid, insteadof being onlyinquisitive.
- Regulatory authorities need to formulate a policy rather than addressing individual cases.
Profit is necessary for further investment and development of corporate intensive care.
Although improvement in service, reasonable cost and attempt to cure are no less important.
What is your opinion!