Families in Delhi see high hospital bills despite Covid-19 price cap – Quartz India

On the night of April 19, Mankeerat Kaur and her entire family tested positive for Covid-19. While her husband and son experienced mild symptoms, Kaur, 51, who was a volunteer with charities in Delhi, began to experience shortness of breath.

“We had three oximeters to be sure the readings were accurate,” said her husband Kavaljit Singh, 57. “They showed their readings at 84.”

With a brutal second wave of Covid-19 overwhelming hospitals across the city, families struggled to find beds for sinking patients. However, Singh managed to admit his wife to the Delhi Heart and Lung Institute on April 23 when her oxygen saturation dropped to 80.

Almost a month later, Kaur passed away on May 19, her body plagued by multiple organ dysfunction syndrome.

Upon her death, the facility issued a 22-page invoice for Rs19 Lakh (US $ 25,938) that Singh was unable to pay.

Out of the total bill, 2.2 lakh is Rs for intensive care – 15,000 rupees per day for four days in the intensive care unit for four days and 18,000 rupees for nine days with a ventilation unit. Approximately Rs 1.1 lakh fees for staying in a single room and coronary unit are at Rs 8,500 and Rs 9,000 per day for the remaining two weeks.

In June last year, the Delhi government set fixed prices for the treatment of Covid-19 patients at 60% of the beds reserved in private hospitals. It capped prices at Rs 10,000 for an isolation bed, Rs 15,000 for an ICU bed, and Rs 18,000 for an ICU with a ventilator.

The regulation states that these limits would include “bed, food, other amenities, monitoring, care, doctor visits, consultations, examinations … and standard care for comorbidities, oxygen, blood transfusions”.

But Singh was charged separately Rs 11.8 lakh in the pharmacy category, which includes medicines, masks, bandages, sterile swabs and N95 masks; Rs1 lakh for deliberations; Rs96,170 as laboratory fees for testing; 27,350 rupees as nebulization and intubation fees; 16,500 rupees for oxygen; and Rs15,000 as plasma therapy among other miscellaneous expenses.

Singh, who is in mourning for his wife, did not contest the hospital when the bill was presented to him and has no intention of contesting the charges now that he has had time to assemble.

But talk to Scroll.in, he pointed out that the hospital did not even provide basic information on the price caps, let alone provide clear information on the price caps. The hospital also did not explain how many beds had been reserved under the Delhi government order and whether his wife had received one. Scroll.in sent inquiries to the hospital about this. This article will be updated if you reply.

Public health activists say Singh’s experience speaks of a bigger problem: the Delhi government imposed price caps on Covid-19 care in private hospitals, but did not enforce them. This put the residents of the city, who had to struggle with trauma, agony and loss in the second wave, under enormous financial burdens. For some, it has wiped out their savings.

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Delhi government price cap on hospital fees for Covid-19.

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Sick and take care of bills

Between April and May, Delhi had an average of 20,000 registered cases per day. In the absence of a centralized bed allocation system, the patients’ families had to run around looking for beds. A lack of beds in government institutions forced several to go to private hospitals, even if they could not afford the cost.

“Private hospitals in Delhi were completely free to decide what to do and how to charge fees,” said Inayat Singh Kakar, public health activist and volunteer with the Covid Citizen Action Group.

The June 2020 ordinance clearly states that daily fees include treatment, medication, and other miscellaneous costs, with the exception of fees for a Covid-19 test, an IL-6 test that checks the inflammatory response, and experimental ones Treatments like remdesivir. But because of the lack of enforcement, Kakar said, private hospitals “are telling patients that the package tariff is separate from other expenses”.

What enables them to get away with it, she added, is that the government’s Delhi Fights Corona dashboard doesn’t show how many beds are reserved in each hospital under the price cap.

A petition filed by the All India Drug Action Network with the Delhi Supreme Court on May 31st sought to resolve these ambiguities and loopholes, as well as the lack of mechanisms to redress complaints for patients.

The network proposed that the government adopt a separate regulation that “clarifies the costs that are included in the package tariffs and also expressly prohibits hospitals from charging patients for these treatment costs beyond the package tariffs”.

The court has asked the Delhi government to provide a status report on patient complaints by June 23.

Inquiries to the Delhi government regarding the enforcement of the order went unanswered. This article will be updated if you reply.

Outstanding hospital bills

For families with a single breadwinner, the financial hardship is devastating.

Shivang Gupta, 28, a civil engineer in the construction department of Amity University, had to support Covid-19 treatment for his entire family from his monthly income of 8,000 rupees.

A resident of Ghaziabad, near Delhi, he, along with his parents and brother, tested positive for Covid-19 on April 20. A week later, his brother was the first to be hospitalized in Ghaziabad with a high fever, followed by Shivang Gupta himself. Her parents, who were short of breath, were also hospitalized until May 2nd.

While the brothers were recovering and being discharged from the hospital on May 3, their father died on May 5. Her mother stayed in the hospital for three more days. Meanwhile the family had hospital bills of Rs3.7 lakh, with his mother’s treatment alone costing them Rs1 lakh. None of the family members were insured except for Gupta, who was insured with his company.

His mother, a diabetic, was discharged from the hospital on May 8, but when she returned home, her stomach ached uncontrollably. The family took her to Sarvodaya Specialty Hospital in Ghaziabad, where doctors initially said she had developed a urine and blood infection, but later revised the diagnosis of mucormycosis, a fatal disease commonly known as black fungus. The hospital asked the family to take her to a facility that could treat the disease and issued a bill for Rs1.75 lakh for 10 days.

Max Patparganj in East Delhi, where Gupta’s mother was next admitted, put an estimate of Rs2.5 lakh for an operation to treat mucormycosis. But after an MRI scan, doctors said she was not infected with the fungus but had a “1.5 liter blood clot in her stomach,” Gupta said.

After surgery to remove the blood clot on May 21, she stayed on a ventilator for four days before being transferred from intensive care – only to be brought in on May 28 for a drop in oxygen saturation. “They said their heart wasn’t quite functioning and the muscles around it were weak,” said Gupta. The ventilator was removed from her on June 2, but is still recovering in the hospital.

In the midst of the emotional roller coaster ride, Shivang Gupta had to pay a bill of Rs. 17 lakh – Rs. 4.7 for drugs, Rs. 3.9 lakh for investigation, Rs. 2.2 lakh for room rental and Rs. 1.3 lakh fight as consultations under other fees.

For the family, this is far beyond their means. Gupta’s father and older brother run a small photography business that has been collapsing since the pandemic began, he said.

To keep the bills off, Gupta created an online fundraiser where he earned Rs 2.5 lakh. He borrowed money from friends and relatives after exhausting most of what he earned. “All of my savings are in there,” he said.

Kavaljit Singh / Scroll.in

Mankeerat Kaur.

So far he has been able to pay Rs 12 lakh. He still has to raise the remaining Rs5 lakh.

“Have to pay out of pocket”

Kavaljit Singh is more affluent than the Gupta family. As the director of Madhyam, a political think tank, he makes nearly 2 lakh rupees a month, he said. Still, his wife’s high treatment costs come as a shock.

“We are all emotionally raw and struggling to overcome the trauma,” he said. “There is trouble and our lives have been turned upside down by her death. Everything collapsed. “

Of the Rs19-lakh bill, Singh has been able to pay approximately Rs10-lakh so far, part of which was Rs4.8 lakh health insurance.

In the past, there was no reason to believe that their health insurance could drop dramatically. “We didn’t think of getting insurance for Rs20 lakh, we just bought it at the rates for other treatments,” he said.

He said he would make the outstanding payments out of pocket. “There is no time for crowdfunding,” he said. “Lots of relatives would like to help, but I don’t want to take a cent from anyone.”

Despite the financial setbacks middle-class families of Covid-19 patients have suffered due to exorbitant private hospital bills, activists say they are unlikely to change their health preferences. “I don’t think people will suddenly love public hospitals,” said Kakar. “Privatization is here to stay.”

Families could even invest more in purchasing larger health insurance packages to cover themselves. “More people will prefer to have private hospitals insured so they don’t have to go to a public hospital,” she said. “You will do it out of necessity.”

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