There has been a perceptible rise in the cost of healthcare services provided by private hospitals. In absence of adequate and quality government hospitals, people are forced to opt for private hospitals, especially for life threatening diseases and injuries. You recently visit one of your friends admitted in a famous private hospital. You found out that the hospital is charging a huge amount of money, which seems to be unreasonable. You confront the staff and ask them to explain the rationale behind such high charges. Their response is that the charges are fair for the kind of services they are providing. (a) What are the ethical issues involved in this situation? (b) Given how other professions price their services, discuss the feasibility of capping the amount of fees charged by doctors and private hospitals. (c) How can the provision of quality services and need for profit be reconciled with society's interests in this case?

(a) Ethical issues involved in this situation

(i) Institutional integrity vs Societal welfare Private business thrive on demand and supply and the cost is fixed according to services provided. Along with that issue of societal welfare as a health is important subject.

(ii) Health as a social capital vs other business Health cannot be equated with other business objects as it is a social capital and should have different ethics.

(iii) Failure of state to provide healthcare Public healthcare is essential need and the situation shows the failure of healthcare being provided by the state.

(iv) Poverty vs Wealthy individuals Poor people are deprived of healthcare only because they are poor.

(v) Out of pocket vs Insurance culture Lack of insurance culture further worsen the situation.

(b) Feasibility of capping the amount of fees charged by doctors and private hospital

Arguments in favour:

• This will reduce corruption and high cost of services.
• Standards of procedure will ensure people are not charged extra.
• Health care will be in the reach of poor which is a necessity.

Arguments against:

• Delivery of services will get effected as healthcare has become very expensive with rising costs like of machines, x ray etc.
• No incentive for doctors or hospitals to provide state of art facilities.
• Poor will still suffer as capping could not reduce substantial amount.

(c) Provision of quality service and need for profit reconciled. National health services of UK where the country spends 8% of GDP on health care is an example. In India changes at multiple level are needed.

The first stage of corruption starts with high education fees which doctors extract from patient.

(b) Public healthcare - Mere 1.3% of GDP is spent on healthcare.

• Increase it to 5% of GDP
• Strengthening of rural infra with AYUSH and other medical systems.

(c) Insurance penetration

• 70% is out of pocket expenditure
• Only 20% have any kind of health insurance.
• Universal health insurance through state funding.

(d) Private healthcare

• Standards of care for hospitals
• Medical ethics need to be promoted and commercialisation of healthcare stop.

(e) Legal - Hospital responsible in case of death or disease due to negligence.