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From Tehelka Magazine, Vol 8, Issue 5, Dated February 05, 2011

CURRENT AFFAIRS

HEALTH

No place to be sick
Even if you could afford it, a private hospital may be the last place you would want to be in. SOPAN JOSHI tracks the increasing unease about private healthcare in India, and what the doctors say ROHIT LUTHRA had heard stories of private hospitals fleecing patients. “They seemed exaggerated,” Rohit, the coowner of an IT company in Delhi, says. He had recently taken two family members to corporate hospitals for cancer treatment, and was ‘fairly satisfied’ with the handling. Then, in June 2010, Gajanand Singh, 40, an employee in his firm’s purchase department, fell ill. Gajanand came from a poor family in Munger, Bihar, and had been with the company for about seven years. He went home to a wife and three children. A dentist saw something unusual in Gajanand’s swollen jaw and recommended a biopsy. On 26 June, Gajanand found he had non-Hodgkin’s lymphoma, a kind of blood cancer, in advanced stage. Two days later, his first stop was the All India Institute of Medical Sciences (AIIMS). Panicked by the crowds there, he went to the Max Super Speciality Hospital in Saket, South Delhi. His company’s group health insurance covered him up to Rs. 8 lakh. The company also sent its employees to double up as attendants to Gajanand in hospital; he was a well-liked employee due to his quiet diligence and respectful conduct. Doctors at Max suggested chemotherapy. Gajanand wanted to go to AIIMS but feared the delay, so the Max doctors suggested he start the first course of chemo at Max, and could later move to AIIMS. Gajanand was admitted on 13 July and chemo drugs were administered over three days. On 16 July he developed well known side-effects of chemo: vomiting, dysentery and plunging blood counts. He did not recover. On 27 July, four days after the hospital had moved him to the isolation room of the intensive care unit, Gajanand died. The cancer he had is typically detected at a late stage, when treatment is ineffective. What did surprise Rohit and his colleagues, though, was how the hospital handled the case. “There was only one doctor taking the decisions, not a panel or a team, even after we asked for it. Senior doctors were not informed,” says Rohit. After Gajanand’s death, oncologists elsewhere told Rohit chemo is not advised to a patient at such a late stage of that cancer. And then there was the bill for Gajanand’s treatment. Rs. 7.95 lakh, just a shade under the maximum insurance cover. Gajanand’s life had run out remarkably close to his insurance limit of Rs. 8 lakh. “We think the doctors knew Gajanand wouldn’t survive. But they wanted to maximise the hospital’s revenues from the insurance company,” says Rohit. When Gajanand’s company complained to the hospital about the treatment offered, the response left them ‘very unhappy’. When TEHELKA contacted the Max Hospital authorities, they said, “The patient and his family were briefed about the patient’s condition, the prognosis and the estimated cost.” They say another doctor examined the patient on the request of the family, PHOTO: DREAMSTIME and that a multi-disciplinary team of the hospital’s tumour board as well as the medical oncology team discussed the line of treatment in detail, which was communicated to the patient and his family, who signed a written consent. On the bill coming so close to the insurance amount, hospital authorities say the thirdparty assessor or the insurer “does not disclose the coverage limit of the patient.” After all, Gajanand went to Max because AIIMS was too crowded. Most government hospitals have degraded to a point that the experience is dehumanising. In comparison, private hospitals offer immediate care. Patients are pampered even, and attendants feel reassured. Rohit says his confidence is shaken. He is now considering the only real recourse: the consumer court. His chances are, however, slim. “Almost all cases of medical negligence under the Consumer Protection Act fail because it is impossible to get a doctor to testify against another doctor. They fear being ostracised,” says Jehangir Gai of Mumbai’s Consumer Welfare Association. DELHI’S CONSUMER activist Bejon Misra conducted a study in 2004 of the number of medical cases that go into redressal (for the World Bank and the Union government). His finding: 1 percent. Consumer courts, though, deal only with cases of medical negligence. What can people do when they think they’ve been had — overcharged or rushed into tests, procedures or hospital admissions? Nothing. Most people have either experienced or heard of somebody feeling cheated Easy care Patients who can pay get instant care at private hospitals

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” he says. and there are service tax exemptions. “I had told the doctor I needed preventive antibiotics because of my diabetes and vulnerability to urine infection. quite common at my age. its president Ketan Desai was arrested on charges of corruption in granting approval to medical colleges. besides requiring lifelong http://www. Rs. There is no doubting. 100 percent foreign direct investment is allowed under the automatic route.asp?filename=Ne050211coverstory. A stent. “There is barely anything that can be doubted with regards to the line of treatment and urgency in the manner it was done. which is charged. As he watched his father’s life ebb. regardless of the party in power. “He said my father was going quickly. I feel defeated by the corruption in our society.” says Pradip. The country ranks 17 on spending in the private sector Mahajan’s family agreed. held its election in April 2009. encourages private sector in healthcare. So I asked the doctor attending him to send me the video CD of the blockage so I could show it to friends here and get a second opinion. higher chances of getting good treatment. The Maharashtra Medical Council. His cousin in Punjab. His father spent his last three days in an ICU. and that we should let him go in peace and not interfere.” say hospital authorities. he was told he had had a heart attack and needed a coronary stent.tehelka. They refused and told my cousin’s parents stuff that got them worried. healthcare policies do not work on a reimbursement model. “The oncologist told me relatives typically fall at a doctor’s feet and request they do something. “At Fortis the practice of medicine is evidence-based. After an ECG test showed alarming spikes. Agonising wait The infamous OPD queue at AIIMS repels patients PHOTO: SHAILENDRA PANDEY But the worry is that the medical regulation of the private sector is even more friendly than the financial regulation. He said I did not need it. smoking or old age. His father was quiet for two days. hygienic surroundings.” he says. and in the blink of an eye suggested a knee replacement surgery. and later dismissed from the Council. He was told he had had a heart attack. And there are so many things to do. Before taking a decision. Private hospitals offer freedom from the crowding typical of government hospitals. The Centre has practically left healthcare to the private sector.India's Independent Weekly News Magazine Page 2 of 5 by private health players — the bigger hospitals get talked about more than others because of their size and presence. among other things. Pradip saw relatives of other patients scrambling around. taking them through the paces of what was likely to happen. And then he accepted the truth. This is a serious impediment to epidemiological research as data from private doctors.“We are unfortunate to be born in this country. A World Health Organisation (WHO) survey ranked India 171 out of 175 countries in percentage of GDP spent in the public sector on health. He spoke to me like I were a novice. though. saw this up close when his father was detected with an advanced stage of lung cancer nine years ago and taken from Kolkata to Mumbai. An ECG and a rapid angiography later. however. But the state government has still not constituted it. he should think about the quality of time he could buy him. is a foreign body and poses risks. “The MCI and the state councils just do not have the investigative wings to catch unethical medical practices. Doctors at the Tata Memorial Centre suggested palliative radiotherapy.” Narendra Puri of Gurgaon went to a doctor after an attack of acidity. A second doctor said the first had placed the ECG nodes wrong A WHO survey ranked India 171 out of 175 countries in percentage of GDP spent in the public sector on health. nursing homes and hospitals is not reported for most diseases.11. who said there was nothing wrong with his heart and the first doctor had placed the nodes of the ECG all wrong. The Indian government. and are afforded greater dignity and privacy than government hospitals afford. blaming the family for not doing enough. He counselled the patient and the family. with the job of ensuring “the ethical practice of medicine by all registered medical practitioners”. a neurosurgeon in Delhi. anything. There are few regulations and. All test results are given to the patient. has the option of taking life and death decisions based on what they know. India has created a health system it doesn’t trust. But a young oncologist in Hinduja Hospital differed. had discomfort in his chest and was taken to the Fortis Escorts Hospital in Amritsar on 6 November 2009. the hospital denied the charge. When TEHELKA asked Fortis Escorts about a patient not getting a CD. former director and dean of Chandigarh’s Postgraduate Institute of Medical Education & Research. PHOTO:GETTY IMAGES Says Namita Sharma. Private healthcare has the status of infrastructure in India. he consulted another doctor. a filmmaker and designer in Delhi. is one of them. viewing the criticality of the patient. adding he saw no hope in going to consumer courts. State health departments and medical councils are supposed to regulate the medical practices of private hospitals.” says a retired high court judge who did not wish to be named. He doesn’t believe Mahajan’s situation was as critical as the hospital claims. Sachin Kandhari. “He had no risk factors like obesity. 2. The overall experience is far superior. says.” he says. burnt on a duplicate CD. and offered to speak to the elder Saha. I sought the opinion of a consultant. is for those who can pay. which is booming. I did get a urine infection and had to spend an extra 10 days there. “The private healthcare industry in India benefits from low government interference. The government brought in an ordinance to suspend the Council and appointed a board of governors comprising six eminent doctors to oversee its functioning till it is overhauled and reconstituted in May 2011. describes his travail. and he now walks around with a stent in his heart. Jasdeep Singh. About 80 percent of India’s total healthcare market is in the private sector. but if he loved his father.” he says. So there is little monitoring of healthcare in India. 28. “I’m a doctor and I could not prevent one of my relatives from going through this. “I had an ache in my knee.” says Pradip. It allowed his father dignity in his last days. He is still grateful to the young oncologist for his decisiveness. The effects are felt only when people go through bad experiences.” He told Pradip palliative radiotherapy would extend the patient’s life.com/story_main48.asp 5/20/2011 . THE STATE councils are answerable to the Medical Council of India (MCI). but almost all arms of the private sector healthcare are viewed with suspicion. only one government official handles its work. He realised what the family faced. In May 2010. so the issue of having patients undergo unnecessary tests is out of the question.” says Healthcare Services in India: 2012: The Path Ahead. including angiography. he was told he urgently needed a coronary stent to tackle a blocked artery. Patients have courteous attendants. Not everybody.Tehelka . borrowing money in desperate attempts to save a loved one without any idea of the risks. that the private sector has made a positive difference. that we should only manage his pain. director of the Amritsar hospital. a government doctor in Pune. unlike many developed nations. Ranjit Roy Chaudhury. “Doctors are minting money. All this.” Narendra Puri of Gurgaon went to a doctor after an acidity attack. a study by YES Bank and ASSOCHAM. Anil Mahajan. “It happened exactly how he had predicted. The government offers income tax exemptions for five years for setting up private hospitals in smaller cities. for instance. What chance do other people have?” asks Kandhari. He developed a urine infection after he needed a catheter for treatment at a prominent corporate hospital. Pradip Saha.566 cr INDIA’S TOTAL HEALTHCARE EXPENDITURE While the departments receive no complaints — the Delhi Health Directorate’s nursing home cell said it had no complaints against private hospitals — state medical councils are infamous for being dysfunctional. India ranked 17 on health spending in the private sector. though. he says. then angry for a few days.

professor at Delhi’s Jawaharlal Nehru University’s Centre of Social Medicine and Community Health. In private hospitals. which is why they stick to a code like the IAS officers do. It discourages initiative. but another doctor may not see it like that. who does not wish to be identified. Next time I see a borderline case. Rs. They often suggest unnecessary tests and even surgeries. “The world of medicine is highly feudal. “As our society gets more litigious. however. it should not be implanted unless it is absolutely necessary. The large capitation fees candidates have pay in private medical colleges only worsens this. This is actually a code. Senior consultants are paid as per the business they bring And it’s not just the business model. the choice is between working either in the public sector. Patients have become extremely demanding and customerlike. But when a doctor’s patient is admitted to a hospital for a procedure like a surgery.” says an associate professor at AIIMS. Overtesting. only one part of the story.” he says. He as well as Naresh Trehan say it is important that the patients ask questions of doctors. INDIVIDUAL PATIENT complaints are.asp 5/20/2011 . She has had government doctors who now work in private hospitals as consultants tell her that since remuneration is tied to the number of patients. Contracts are confidential. 750 just to keep his trust. one is typically above 31-32 years of age. “This is why I dread working in a private hospital. and have to work through the system to get to a stage where they are comfortable. he knows. “This is a big grey area. India has no clinical guidelines or national protocols on diseases and therapies. “Some doctors play a dirty trick: they put a star mark against certain tests on the lab request form and tell the patient that these tests are important. specialists are brought in on request. and wanted a complete check-up done. with a hospital typically deducting 15-30 percent for use of its premises. I’ll tend to admit the patient.” Younger doctors get a fixed salary. say doctors.” says Arun Bal.” says Rama Baru. “But even now. Trehan points out.” says Arun Bal.69. “This is the only vocation in which by the time one is ready for an independent professional life. The revenues senior consultants generate in OPD go mostly to them. That does not comprise negligence. says in the current medical model. Several senior doctors. Besides. makes them trust diagnostic tests rather than their instincts. “It is never easy to tell if a surgery or a diagnostic test is unindicated. post-graduation for a specialisation takes another three. appendectomies and mastectomies across the world.India's Independent Weekly News Magazine Page 3 of 5 medication.com/story_main48. 200. a doctor and consumer activist with 35 years experience in Mumbai. And we watch our friends in other professions settle down into a career around the age of 25. a doctor in a Thiruvanthapuram private hospital. senior doctors are consultants on call. “A lot of close mentoring goes into making a doctor. it promotes competition and individualism. Or there is an insurance company that asks questions about expenditure.” says Rama Baru. The patient now becomes a permanent customer and thus both the doctor and the lab gains. Each private hospital has its own way of putting the onus of generating business on senior consultants. It is well known that most doctors — especially general practitioners and those working in smaller nursing homes — get a cut of up to 40 per cent on diagnostic tests they recommend. What matters more than statistics and test results is a doctor’s judgement and experience. only textbooks. “I may think something is unethical. “Many complaints have to do with patients feeling mistreated or due to poor communication from doctors. the hospital would have had a logical argument for suggesting the procedure.” he says. is an outspoken critic of unethical medical practices. And there are senior consultants who are paid on the basis of the business they bring.1. 1. This also explains at least a part of the reason so many negligence cases fail. The lab guys make it a point to report these particular tests as ‘abnormal’. and that there is no way to stop this. He said he was not coming back soon.62.252 cr WHAT PEOPLE SPEND ON OVERALL HEALTHCARE IN INDIA There is a larger question: what is wrong with our healthcare system? The benefits of the private sector healthcare boom are at the cost of the patient-doctor trust? “We have no way to control or prevent a doctor from prescribing a more expensive drug or procedure from a cheaper one.” says the doctor who witnessed this. The most common test doctors suggest to milk patients is the MRI scan. Super specialists often end up studying/training/interning for 14 years before they begin to work as independent professionals.” says Bal. “I cannot stand the thought of having a manager asking me why the number of patients I’m bringing in is sagging. young doctors come through a system in which they do the work and their seniors get the money and the credit.” Roy Chaudhury says unscrupulous doctors conduct unnecessary hysterectomies. And yet. including Trehan and Roy http://www. The younger doctors get a fixed salary. Suraj Rajan. There are three broad tiers of doctors. and we do not deal with a machine but the highly dynamic human body.” What aggravates this is that junior doctors are paid a pittance. It boils down to a doctor’s judgement at that point and the Hippocratic oath. hierarchical. the senior consultant’s payment is often tied to the total bill.tehelka. and they then have to work as senior residents for another three years. Not more than 4 percent did we find justiciable.” Rs. There are ultrasound scan centres where they report appendicitis similarly. But health insurance penetration in India is not even 5 per cent. doctor and professor of community medicine at JNU. It is not an easy choice. they shop for doctors now. RITU PRIYA.906 cr PATIENTS WHAT PRIVATE HEALTHCARE PROVIDERS EARN EVERY YEAR FROM FOR DOCTORS. There are associates and junior consultants who get a fixed salary and incentives based on the business they bring. rather than collaboration. you will see the need for greater subjective (rather than objective) documentation.asp?filename=Ne050211coverstory.” says a doctor into his third year of practice. “It makes doctors compete rather than function as a cohesive unit. they have not given us the video of the angiography.” “What we have is a system that dumbs down a doctor’s instincts. and staff doctors are mostly junior. their tall claims aside. or more testing is necessary. “Doctors have a high level of commercial interests. and their terms vary from hospital to hospital. Not any more Another concern is the nature of contracts by which private hospitals hire PHOTO: TARUN SEHRAWAT doctors. Associates and junior consultants get a fixed salary and incentives.Tehelka . though.” says MCI board member Roy Chaudhury.” he says. has another side: the fear of getting sued under the Consumer Protection Act. or for the private sector. “A 56-year-old man I attended to was unhappy that I recommended tests worth only Rs. Loss of trust Gajanand’s family thought he was getting the best possible treatment. “We have dealt with more than 400 complaints of medical negligence.” Renowned heart surgeon Naresh Trehan says there is a term in for it in the medical community: “stretching the indication. which is resource-poor and crowded with patients. the seniors are like the portals that bring in the business. “There are arguments and counter arguments for every decision. I had to prescribe unwarranted tests worth Rs. An MBBS takes about six years. the medical model in private hospitals is also flawed. That can happen only when the patients are well informed. where the best of doctors in the best of hospitals have to make some adjustments with their conscience.” says a professor at AIIMS. The doctor then tells the patient that this test has to be either repeated in a few months.” Kandhari says.

MEDANTA. as well as research. And we are offering healthcare options like surgeries of the same standard as in the US for a tenth of the price. we would be spending only about $10-15 billion.Tehelka . Almost all our doctors are full-time staff. too. According to many.” In this regard. at this hospital. Several larger hospitals. A young man came to his hospital for a bariatric surgery — medical term for surgically removing fat he felt social phobia because of his obesity. The brand that matters to them is that of the hospital. It is managed by a 22-member committee. How do you view the government’s regulation of private healthcare? The government is not regulating. is at fault. Don the stock market frenzy. Such results depend on teamwork. Does that worry you? Yes it does. Next time he gets a similar case. Some of us took land in the old days with the promise of offering free services. Corporate hospitals make doctors compete with each other. unlike lots of other nursing homes and hospitals. But a hospital cannot do it cheaper. they cannot run on the profit motive alone. adding. there are more profitable avenues. lower than that in other high growth sectors such as IT. which includes the average billing that a doctor creates for a hospital? The income of senior consultants is 70 percent variable on the revenue they generate for a hospital. Another idea is that private players adopt a district each and develop the health infrastructure there. A doctor who worked in a corporate hospital summarises what several doctors say: rapidly. In return. it is not an orthopaedic surgery unit. run by a private charitable trust. “Imagine what the first doctor would have felt for taking a tough decision. and the relatively low returns on investment. Rohit Luthra. It is worrisome. the Sitaram Bhatia Institute in Delhi has a good reputation. of which 19 are senior doctors working in the hospital. Their pay depends on the quality of healthcare delivered to the patients. also heads the health committee of the Confederation of Indian Industry. I don’t know what they do but nobody is breaking the bank here. It tried to bring the stakeholders together and build a healthcare sector in India. PRIVATE SECTOR SHARE OF INDIAN HEALTHCARE 60% HOSPITALS 75% DISPENSARIES 80% Wary and wise Rohit Luthra says health and education cannot run on the profit motive alone PHOTO: TARUN SEHRAWAT ‘Several hospitals noted that profit rates are around 13 percent. chairman and managing director of Medanta: The Medicity. That’s when we realised we had no idea what was going on. One reason is: doctors decide on running the hospital. the long gestation period of such investment. it is difficult to keep a hospital afloat financially. The senior consultant told him he did not need it. http://www. rather than everybody being on their own. their salaries are fixed and medical audits check the performance of doctors as a team. its doctors are organised in teams. Sir Ganga Ram Hospital. A doctor recalls a case that illustrates Ritu Priya’s concern. whose IT business is a result of India comparison: “We need to discuss again the fundamentals of certain institutions. They have the money to buy talent from where it gets groomed. The corporate sector saw the opportunity and got excited. That’s how shameless people have become Heart surgeon Naresh Trehan. And the private sector. The government realises it must advance healthcare. To be fair to private hospitals. Gajanand’s death. Like any other profession. Hospitals operate on small profit margins. finance. is another. How can hospitals use corporate jargon like KPIs (key performance indicators) for doctors. and that the private sector will play a larger role in it. or retail. a doctor would open a small nursing home with his wife or somebody else from the family. that is wrong. and that he should try other means of losing weight.asp?filename=Ne050211coverstory. and it is worrying. We do emphasise growth of a doctor’s knowledge. The problem is also the definition of free. which most of the hospitals are not providing. And AIIMS has long been a good hunting ground. Mumbai saw some large trust hospitals supported by business houses. A hospital is the hardest way to do business.asp 5/20/2011 . Another surgeon in the hospital took his case and performed the procedure. year by year. “The single most important constraint is the high cost involved in setting up hospitals. say this is a common model of hiring doctors.tehelka. the Confederation of Indian Industry formed a health committee. That $25 billion incremental investment was required. That’s when a lot of activity started like buying up of trust hospitals.India's Independent Weekly News Magazine Page 4 of 5 Chaudhury. It said we shall commit to provide a minimum standard of health prescribed by the WHO. determined by measurable indicators. The pilot project will be Jhajjar in Haryana. have no incentive to train and groom doctors. Is a doctor’s income linked to the number of procedures/total billing that they bring in? Yes. “Several hospitals noted that profit rates are around 13 percent. Why do private hospitals push patients to expensive options? The cost is high from a patient’s point of view. hospitals by Rupa Chanda. a caesarean section costs nearly as much as a normal delivery. We commissioned McKinsey to figure out the health sector. meanwhile. In the 1980s came the first corporate hospital. The government will help with up to 40 percent of the capital costs. “Corporate hospitals don’t allow this much. most of them are veering to a model like that. This allows research and collective learning. It is to avoid it that we do not have consultants in Medanta. Which is why it has several doctors from AIIMS. the local doctor or quack was the one providing the services. the private partners will offer the first 30 percent of the beds to people below the poverty line. A doctor heads a team of doctors who work on different things. In villages. In the 1970s. But if hospitals resort to practices that inflate the bills. there are hospitals and greedy people who are doing bad things. with a powerful secretariat. The results are audited. a doctor’s pay should not be linked to the numbers. Max then took a trust hospital and gave it the flavour of a corporate hospital. That is the difference between a housewife and a whore.com/story_main48. it is outright hypocrisy to expect doctors to follow a superior moral code. is trying to become a similar hospital that creates teams of doctors and conducts research. lower than that in other high growth sectors such as IT. it takes 4-5 years to break even and 7 says. RUN by Naresh Trehan. In smaller towns. ‘I have had physicians ask for commissions for sending patients to me. Dr Prathap Reddy’s Apollo Hospital. Metros had bigger nursing homes. We found India and 134 countries had signed the Alma Ata Declaration in 1978. In 2000. Even senior doctors are not paid by the number of patients they attend to or based on the total billing of the patient. But the expectation of the government is also that the private players will have a sense of social responsibility. it has no incentive to push women towards caesarean sections.” says a junior consultant. But the jury is out.” says a surgeon who has worked at a government hospital and now works for a private one. professor of Economics and Social Sciences at the Indian Institute of Management Bengaluru. that does happen. When there is commercialisation all around. and that is why at Medanta we are doing the opposite. he will think twice before turning the patient away.’ says an IIM study “Several senior persons at leading corporate hospitals stated that they are in an expensive business involving huge upfront capital-intensive investments and high running costs. Then again. A doctor’s reputation cannot become bigger than theirs. We have full teams with different parts working in coordination. We are saying institute of bone and joint. PHOTO: How responsive have you been? We have almost finalised PPP (public private partnership) model and we are saying we can build good quality secondary care hospitals in B and C cities. and another 30 percent to the lower middle class. And at the current rate. built by doctors of a bigger stature. finance or retail. McKinsey’s data showed India was 40 percent of where we wanted to be and that we need to double the sector. does not pay us by the amount of money we earn for it. Health and education have to be beyond commerce. That is why this mad race of how many beds you own and what not. Excerpts from an interview: How does the private sector get to command 80 percent of India’s health market? That’s how it has always been. as shown in its programme that has lowered the rate of caesarean sections.

And a surgeon needs to give far more time to a normal delivery.com Print Email to Friend | From Tehelka Magazine. Three. doctors need to be sensitised. 2011 About Us | Advertise With Us | Print Subscriptions | Syndication | Terms of Service | Privacy Policy | Feedback | Contact Us | Bouquets & Brickbats Tehelka. is leading to higher baby weight. We use birthing balls to reduce pain perception. Ltd. Two. birthing beds to avoid shifting patients twice.asp 5/20/2011 .com is a part of Anant Media Pvt. From more than 70 percent. I really don’t think it is more profitable for the hospital overall. A C-section in a later stage of labour increases distress to the mother (more blood loss. Do hospitals have a role in this? Most private set-ups have individual doctors and not a group of doctors or units working together. This time the baby’s weight was 3. Who decided to reduce the C-sections? It came about when we started the integrated mother and child programme. One reason is richer patients with sedentary lifestyles. whereas C-section is over in an hour.Tehelka . visiting consultants will not make such an effort. it came down to 46 percent. who typically does not want to take risks regarding the mother or the baby. PHOTO: TARUN SEHRAWAT How can a hospital reduce the C-section rate? One. one-on-one sessions with pregnant women. Vol 8. more patients come to a hospital that will not do unnecessary interventions. Issue 5. injury to the bladder). But some turn away thinking our hospital forces you to have a normal delivery. we designed an integrated mother and child programme.5 kg. Caesarean gives the option of conducting deliveries at her convenience and availability.asp?filename=Ne050211coverstory.India's Independent Weekly News Magazine Page 5 of 5 ‘We brought down caesarean deliveries from 70 to 46 percent’ Dr Sonia Naik of the obstetrics unit of Delhi’s Sitaram Bhartia Institute talks about a programme that reduces caesarean deliveries. We created a protocol so all the doctors follow the same treatment. combined with a sedentary lifestyle. The surgeon’s fee for a normal delivery and C-section does not differ that much in our hospital. How do the patients respond? The patients who have a normal delivery were grateful because they feel most hospitals nowadays do a C-section. they need to work in a team. She was happy with her faster recovery. after the age of 30. she may have to wait for hours. Dated Feb 05. Another is better food availability. © 2000 . The entire responsibility is on that one doctor.2011 All rights reserved http://www. In the long term. which is more risky. One who had an elective C-section earlier with a good-sized baby (3. Yet another is that women are having babies later. sopan@tehelka. which.3 kg) had a normal delivery next time. She goes for a Csection if there are signs of distress to the baby. But don’t hospitals earn more from C-sections? C-sections involve an anaesthetist and operation theatre. trained child birth educators and physiotherapists. and more drugs. But women who have a C-section despite trying for a normal delivery feel disappointed. The hospital director was keen on it.tehelka. Individual responsibility also means the doctor is not available 24x7. And there is monthly auditing to see the C-section rate.com/story_main48. Excerpts from an interview: Why are caesarean deliveries so common in private hospitals? They are more common in private hospitals than in public hospitals. It had antenatal workshops.