Pune: Less than four percent of COVID-19 patients admitted to Maharashtra’s private hospitals benefit from the state government’s scheme for free treatment at select private hospitals, because of its limited applicability, an analysis by NewsClick found. The scheme was launched in May as a part of the state health insurance programme, the Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY).
NewsClick studied records from Pune, the state’s second city, which has 58,365 active COVID-19 cases. It is the highest number of active cases anywhere in India.
Of the 155 private hospitals that offer COVID-19 treatment, 42 are covered by MJPJAY. The facilities are supposed to offer free treatment to all COVID-19 patients, as per a government resolution (GR) issued on May 23 by state health minister Rajesh Tope. The scheme was extended to all, including those with white ration cards (above poverty line). It was meant to end on July 31 but has been extended indefinitely, said Amol Maske, head of MJPJAY in Pune.
However, the scheme benefits only a miniscule percentage of patients for two reasons: First, it covers only a small fraction (22.6%) of Pune’s private hospitals offering COVID-19 treatment. Secondly, it applies only to acute critical care services that few COVID-19 patients need. For instance, fewer than nine percent of all patients require ventilator and ICU support and fewer than 15% need oxygen support, according to Pradip Awate, state disease surveillance officer at the Public Health Department’s Integrated Disease Surveillance Programme.
Take the example of Pune, the city which reported the maximum number of active COVID-19 cases, which were 57,298 on September 30. Back then, Pune had a total of 2,93,264 cases, including ongoing, recovered and fatal cases. However, only 5,192 patients in Pune have received free treatment under the MJPJAY till September 30, said Maske.
“About 75% of patients opt for treatment at private facilities while 25% go for government hospitals,” said Saurabh Rao, divisional commissoner, Pune division. A back of the envelope calculation would peg that number at around 2,19,948 patients who were treated at private hospitals.
Pune Zila Parishad (attaching press note) data shows that about 60% of patients needed hospitalisation while the remaining were in home isolation. Thus, a total of 1,31,968 patients have been treated at private hospitals by September 30. As a result, we know that only 3.93% patients take free treatment at private hospitals under MJPJAY.
Health activists argue that given the high cost of treatment at private hospitals, even those being hospitalised for non-critical care need to be covered by the scheme. “This GR excludes most patients, regardless of whether they are asymptomatic or only on oxygen, patients are overcharged by private hospitals. More people should benefit from the scheme,” said Abhijit More, coordinator of Jan Swasthya Abhiyan (JSA), Maharashtra, a community health initiative.
Maharashtra has the highest number of cases in India since April, and as of September 30, it had 14,16,513 COVID-19 cases, as per Ministry of Health and Family Welfare (MoHFW) data.
The free private treatment scheme was designed to provide relief at a time when public health facilities have been overworked. However, patients opting for private hospitals in the hope of getting better care found themselves being overcharged. NewsClick has been reporting on the financial burden on patients due to private facilities.
NewsClick reached out to the state’s Public Health Department (PHD) for the latest data for patients on ventilator support, those in need of intensive care. However, several attempts did not elicit a response.
Sudhakar Shinde, CEO, MJPJAY and Pradeep Vyas, principal secretary of the PHD, could not be reached either.
Twenty Critical Care Areas Covered
The state scheme covers 20 critical complications in COVID-19 patients: need for ventilator support, acute respiratory disease (ARDS), multi-organ failure and disseminated intravascular coagulation (DIC) plus ARDS, septic shock, acute bronchitis and pneumonia with respiratory failure and rapidly progressive renal failure. (sharing the data soft copy)
“Patient is considered for MJPJAY if his SPO2 is below 94 and he requires Oxygen mask even though he falls under category of above processes,” said Dr. Sagar Patil, MJPJAY.
“The cost of treatment for ARDS, with multiorgan failure or DIC and other procedures mentioned in the GR begins at Rs two lakh in private hospitals,” said More. However, as a report in The Indian Express showed, private hospitals have been charging well over this limit for the procedures.
Patients Left Confused
Only 5,192 patients received free treatment in Pune under the scheme, according to Amol Maske. The district has 3,03,138 COVID-19 patients, 43 government hospitals and 143 private hospitals that offer COVID-19 treatment, of which only 42 are covered under the scheme, according to the dashboard of the state PHD.
Most patients and their relatives NewsClick spoke to assumed that all COVID-19 cases would be treated for free at the private hospitals listed on the MJPJAY website. Sixteen-year-old Sahil Sable was treated for the virus at Sahyadri Hopsital in Pune and was charged Rs 66,588 for seven days of hospitalisation. His sister, uncle and two aunts, all of who have tested positive, are being treated at the same facility.
“The three of us do not have private health insurance cover but I chose a private hospital because I was under the impression that all COVID-19 patients receive free treatment,” said Somanth Sable, Sahil’s uncle. “When I saw the hefty bill for Sahil, I argued with the hospital’s billing department. They said free treatment is not available to asymptomatic patients,” he said.
The hospital charged Rs 14,000 for seven days for personal protective equipment (PPE) though Sahil was in the general COVID-19 ward with 14 other patients. As per the GR, hospitals need to divide the PPE cost among patients who share a ward. “It should have come to less than Rs 2,000,” said Somnath Sable.
When spoken to, the hospital authorities refused to explain their billing process but said the facility adhered to government regulations.
Health Facilities and Available Beds
Our investigations showed that private hospitals were not upfront with patients about the terms of the MJPJAY scheme. They had an MJPJAY desk to assist patients but those manning them did not appear to be well-informed, as found out when this reporter called Bharati Hospital, Pune, and Symbiosis Hospital and Research Centre, Pune. An executive at the MJPJAY desk at Bharti Hospital, Pune, told this reporter on July 10 that the scheme had ended a week ago. It was originally slated to continue until July 31 (and has since been extended indefinitely). The hospital has 240 beds for COVID-19 patients and 32 ventilators.
Executives manning state helpline numbers for COVID-19 said they did not know the names of private hospitals covered under the scheme.
Clamour for Private Hospitals
Satish Pawar (name changed), 39, a resident of one of the slums in Pune, had to pay Rs 1.66 lakh for eight days of treatment in May at a private hospital. Pawar, who works as an administrator at an NGO, did not want to go to a government hospital because he was worried about hygiene and having to share a ward with eight other patients. “My wife arranged to pay the hefty bill by borrowing from friends and relatives. After 15 days, I called the hospital and asked for a reimbursement but they kept transferring the call,” he said.
Pawar, like most patients and families NewsClick spoke to, was unaware of the fact that free treatment can only be availed by patients who need certain types of critical care.
The number of isolation beds for confirmed COVID-19 patients at government hospitals stands at 10,294 as per the Pune Divisional Commissionarate dashboad . However, the number of active patients is over 57,000. Patients have no option but to go to private hospitals.
The state has converted private halls, hotels and complexes into COVID care centres but patients said they did not trust these facilities since they do not have enough healthcare professionals, ICU beds, oxygen or ventilator support.
Patients and relatives also try to avoid government hospitals, said Shweta Raut, a health system researcher at the Pune-based Support for Advocacy and Training to Health Initiatives (Sathi), an organisation working for the rights of patients. “They don’t want to be treated at government facilities because these are infamous for their negligence and lack of hygiene,” she said.
If Hussain Jaad, a cab-driver who stays with parents stays at a chawl in Majgoan in Mumbai, knew the names of hospitals where free COVID-19 treatment was available, he would have taken his 75-year-old father Ibrahim Fatakdawala there, instead of to Saifee Hospital. The hospital handed over 80 pages of a bill worth Rs 8,09,893 for treating his father for 40 days between May 5 and June 15.
“I took father, who was having difficulty breathing, to nearby private hospitals for a regular check up. Hospitals refused to examine him without a COVID-19 test. My friend helped me get a bed at Saifee Hospital for the test which came back positive the next day. If I knew he had COVID-19 I would have taken him to a government hospital or a private facility under MJPJAY,” said Hussain.
The hospital has charged him Rs 3,800 for PPE per day and Rs 5,000 as a bed charge per day. Aside from that, he was also charged for food despite the government notification saying meals were included in the bed charge.