News from here and there

Revenue targets for doctors in corporate hospitals As part of its series on ‘Corruption in medicine’, the BMJ, on 3 September 2015, published an article on the unethical practice of profit-driven targets that corporate hospitals in India set for doctors on their payroll. The article by Meera Kay, a Bengalurubased journalist, had viewpoints from the medical and nongovernmental organization (NGO) sectors. It raised the issue of lack of proper ethical guidelines leading to unnecessary tests and procedures being done on patients. While these practices increased the revenue that private hospitals generated, they also exposed the patients to substantially more risk of potential complications, especially when the diagnostic tests were invasive or when operative procedures were involved. Doctors involved in such practices were often under pressure from their administration to meet the targets and unable to voice their misgivings as it could potentially jeopardize their job security. The article quoted a report ‘Voices of conscience from the medical profession’ by Support for Advocacy and Training to Health Initiatives (SATHI), a Pune-based NGO. The report highlighted that over 50% of hospital beds in India were in private sector hospitals. Most of these profit-driven hospitals aim to enhance the financial returns for their investors. The article quoted Kunal Saha, president of People for Better Treatment, an NGO promoting corruption-free healthcare in India, who raised the issue of payment for surplus investigations and operations being an added out-of-pocket expense for patients or their primary caregivers in the absence of an effective medical insurance system in India. The Society for Less Investigative Medicine, established in 2014 by cardiologists at the All India Institute of Medical Sciences in New Delhi, has suggested using evidence-based recommendations in healthcare as a method to discourage unnecessary tests and procedures. Multiple internet portals offering second opinions in medicine are now available and a study published in the Times of India in January 2015 suggested that a large percentage of opinions about surgeries were reversed when a second consultation from an independent source was sought. The Clinical Establishments (Registration and Regulation) Act, passed in 2010, has provisions to assess the investigations and surgeries prescribed by doctors and hospitals and can be used to implement standards of care supported by evidence-based guidelines. According to Meera Kay, neither the Medical Council of India (MCI), nor Healthcare Providers India, the trade body for private hospitals, responded to BMJ queries regarding this subject, before the article was published. Not all private hospitals, however, exert such pressure on their consultants. Dr Nagendra Swamy, Group Medical Director and Chairman, Quality Council at Manipal Health Enterprises said: ‘It is our policy at Manipal Hospitals to never pay any incentive or compensation to doctors for prescribing investigations or medications. They are paid only for their professional services. We insist on evidence-based practice, to provide appropriate care based on clinical conditions in order to provide best possible relief as per accepted medical practices. We do discuss their performances, based on clinical outcomes, patient feedback and medical audits.’ This statement was confirmed independently by two physicians who were associated with the hospital.