Healthcare costs 1

Modern healthcare costs money. People do not like the ambience and facilities in a government hospital. The queues are long, one must wait and there may not be personal attention. The government could not keep pace with the exponential growth healthcare industry has undergone in the last three decades. Private entrepreneurs have taken the opportunity to create facilities and provide state of the art healthcare. Tremendous advances were made in understanding of the disease, new treatment methods, new drugs and in biotechnology. Computers, construction and manufacturing industry also has seen a lot of advancements.

All these have transformed the healthcare delivery in the last three decades. All these come with a cost – starting from hospital building, air conditioning, computers, latest CT/MR scanners, laboratory equipment, disposable items, medicines, staff salaries, maintenance, everything. Healthcare costs for primary and secondary care will not be very high. Many people can afford the cost, especially for ailments that can be treated within fixed cost packages.

Problem arises in providing tertiary care, for emergencies and complications. In these situations, the amount of treatment needed, stay in hospital and cost of treatment is purely an educated guess. No one can forecast how much treatment is needed and when one can expect improvement and the potential outcome. With increase in our capability and availability of facilities, we are treating more and more complex cases which were hitherto denied treatment and left to natural outcome. The more complex the disease status, more treatment and cost. In these situations, the outcome cannot be guaranteed. However in desperation, when a option of treatment is available, people want to grab it. If the outcome is bad, they are trying to blame the hospitals and doctors.

Doctors also tend to give an optimistic picture before treatment, which can come back to haunt them in the event of a bad outcome. Patients and attenders mostly meet their primary treating doctor only. They think that he/she is responsible for everything, especially the bill. In a big tertiary care facility, primary consultant is just the face of the team which has so many people working behind the scenes. When everything functions well only, the treatment process runs smoothly. The doctor can give and direct the treatment as necessary, but billing is certainly not in the hands of the doctors. The billing department works in the background and charges the services used.

Generally, the longer the treatment in a tertiary care ICU and use of more support systems means, the less likelihood of successful outcome. However, no one wishes to withdraw treatment. Both doctors and the family wish to continue treatment in the hope of improvement. When the improvement does not happen, everyone feels bad. The effort that goes into the treatment costs considerable amount of money. People do not want to pay for futile treatment. Problem is we do not know which patients do not respond to treatment and the treatment is going to be futile. The decision to continue or withhold treatment is individualized depending on several factors in each patient. The family needs counselling properly as to the available options, the cost and possible negative outcome.