Thursday, July 11, 2013

Cuts and kickbacks for doctors

It's a fact of life that kickbacks, cuts and commissions have become an integral part of the healthcare system in India. In fact, this is one of the reasons why healthcare has become so sick. However, you disguise them - in the form of referral fees ( the euphemism which corporate hospitals use when they pay family physicians to send patients their way); or consultancy fees ( the dignified term which pharmaceutical companies use to incentivize doctors to prescribe their brands), commissions are ubiquitous have become an accepted norm in the medical profession.

A lot of this was started by pharmaceutical companies, who provide doctors with freebies in order to influence them to prescribe their drugs. Doctors have become so used to getting so much stuff for free from pharmaceutical companies - ranging all the way from trips to go overseas to cars and even apartments, that most of them take these gifts as their right. They feel they are entitled to them, and do not even question the morality of their behavior.
  • While all doctors know in their heart of hearts that it's unethical to take these kickbacks it's extremely easy for them to justify what they do !
  • All doctors, including the leading lights of the medical profession do it, so why shouldn't I ?
  • I can't afford to take a holier than thou attitude - how will I be able to afford to pay the capitation fee to send my children to medical college ? 
  • Since everyone else in society is doing it, ranging from politicians to bureaucrats to policeman, so why should I be any different. Should doctors be held to a higher ethical standard?
While it's great to get free stuff, most doctors feel uncomfortable about taking kickbacks. Most of us do have a conscience, and while we learn to justify our behavior, taking kickbacks is not something which most doctors would rather do - they'd rather earn money honestly !

A lot of us fail to realize the harm these ubiquitous kickbacks do. For one thing they make the cost of medical care much more opaque , as a result of which patients often don't understand why certain tests are being advised; or why a particular brand of drug has been prescribed, even though it costs much more.

Patients are smart enough to know about the kickback system, because it's so pervasive. This causes them to start distrusting their personal doctor. They start treating the entire medical profession with suspicion, and this poisons the doctor-patient relationship. Patients no longer look upon doctors with high regards, and if they cannot trust their doctor, it becomes much harder for them to heal.

It's unfair on honest doctors as well. Everyone gets tarred with the same brush, so that patients automatically assumes that all doctors must be on the take !

I don't think there's any point in preaching to doctors that they should not be taking cuts and kickbacks because this is unethical. Good doctors know this - and bad doctors are going to improve.

We need to understand that cuts are given purely for financial reasons, and this is what we need to address. Cuts and kickbacks exists because there is a middleman - and the only way to cut out cuts would be to cut out the middleman. Thus, the reason a diagnostic center provides a kickback to doctors is to incentivize the doctor to refer patients to them. However, if diagnostic centers could reach out to patients directly, there would be no need for them to go through the middleman, and they would not need to provide these kickbacks anymore. This would help them to cut down the costs of their tests, thus helping patients as well.

A number of studies have shown that the healthcare industry is amongst the most corrupt in the world. This is a crying shame. The only way to fix the system is by encouraging openness and transparency and the internet provides us with a great platform in order to do this.

By making intelligent use of the internet, the healthcare insurance industry has a great opportunity to clean up the system. By publishing the costs of tests and medicines online, they can share this information with patients. Armed with this information, the patient has a much better sense of exactly how much each test should cost. He can then intelligently question the padded bills he gets, and by behaving as an intelligent consumer, he can get the most cost-effective testing done for himself, without having to depend on a referral by his doctor.

Agreed that it takes time for the system to change, but the good news is that it's possible for this to happen. And this is a great chance for us to start to clean up the system - something which is in everyone's best interests - patients, doctors, and society.

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