Tuesday, March 3, 2009

Commisions in the medical industry - an axis of evil

In the Indian medical industry, there is an open secret. A part of almost everything that a patient pays goes to the person who has prescribed it.

Companies give commissions to doctors for promoting their products. This raises some serious questions. This kind of financial incentive to prescribe one product over another is very disturbing. The sole reason for choosing one product over another should be the efficacy of the product. Nothing else. The moment you bring in a financial incentive into the equation, you are compromising the patient. You are bringing in an incentive for the doctor to suggest an inferior product.

Doctors working in hospitals are given a commission on the tests they get the patients to undergo. Very often patients are asked to undergo expensive tests which are unnecessary. The hospital benefits because they make a huge profit on the test. The doctors benefit because they get a cut.

Who loses? Only the patient.

The MRP or the Maximum Retail Price of most medical products is greater than 100% more than the price at which it leaves the manufacturer. This huge differences is split eventually between the various players in between the manufacturer and the consumer.

I have first hand experience of this practice. Apart from the extra money I have shelled out throughout my condition, I can never forget an incident that involved a nephrologist. At that time, I was on Peritoneal Dialysis. I was evaluating PD cyclers. I was on CAPD using Baxter fluid bags. I was very happy with Baxter and was inclined to buy their cycler too.

However, my nephrologist suggested that I buy another company's cycler. This company was relatively new to PD. Also, their cycler did not have a facility to adjust the volume of exchanges. You could only do 2 liter exchanges. I tried arguing with the neph. He wouldn't listen.

I was firm however. I changed my neph!

Later, I found out the reason behind his insistence on not using Baxter's cycler. Apparently, he had wanted to attend some nephrology conference outside India and asked Baxter to sponsor his trip. Baxter refused due to some reason. That was it. He stopped promoting Baxter.

These are the kinds of things that happen when you bring in commercial aspects in the treatment equation.

Patients suffer in every way. Not only could they end up using inferior products but they also end up paying a lot more than they need to. It is an evil axis between medical companies, doctors, technicians and hospitals.


B said...

I think everybody is entitled to make money but the problem is when they cross the line. Its as if its daylight robbery when a doctor decides that this patient can 'pay' or whatever and make him go through the hoops. I guess its the general 'greed' in the society that manifests itself in one of the most honored professions. I always had great respect for doctors but when we see this attitute and behaving just like a mechanic in a car garage devoid of human sentiments. I guess sometimes mechanics are also very honest just as some doctors.

This is where atleast the Internet comes to help...atleast to know more...to see what they are doing and whether what they do is grossly outside of typical protocol. Not that we can second guess the doctor but atleast to have warning signs if something is amiss. Its a fact that they do not care (or cannot care) as much for you as oneself can.

I think such greedy behavious is more rampant in cultures where the aspirations are sky high but the means are not there (i.e. so much wealth being flaunted around and displayed on media etc...but not much opportunity for everybody to make tons of money). So, the sense of 'content' is not there and a culture of rampant greed sets in.

Madras Hash said...

To the various axes of evil that you mentioned, you can add two more:

1. Medical colleges. Donations of 30 lakh for an undergrad seat, and well over a crore for a post-grad seat are common. Can this student ever justify this kind of investment in terms of earnings over a lifetime? Does this breed a tendency to fleece a patient for whatever they can get.

2. Corporate hospitals. I was sitting with a surgeon at Apollo Hospitals when a young MBA poked his head in and said "Sir, your Business Plan" is over due. Can you do it by tomorrow. When I asked the Doc what Business Plan he was supposed to submit, he referred to annual targets for billing - patient nights, use of Scans, other diagnostic tests, etc..

You need to pray hard for good health to stay away from these various axes of EVIL.