SynopsisFamilies are going to extraordinary lengths to fund treatment of their loved ones, including selling their houses. The question is, will they ever be able to recover from the financial stress?
Covid-19 treatment has saddled several middle-class families with hospital bills way beyond their means, pushing them into financial ruin that could take them years to come out of. In most cases, their insurance plans could cover only a small part of the cost, forcing them to sell houses, pawn jewellery and go for expensive personal loans.
We spoke to four such families that paid bills up to Rs 1 crore. All three patients required Ecmo (extracorporeal membrane oxygenation), a very expensive procedure to re-oxygenate blood. Ecmo is used in those patients who can’t even be sustained on ventilators.
There are many other families where the patients required a transplant and had to be flown to another city in an air ambulance. The bills in such cases were between Rs 3 crore and Rs 5 crore.
In all four cases we have, the patients were forced to seek treatment in private hospitals because Ecmo is not available in government hospitals or civic-run covid centres. All four spent a long time in ICUs, which is not unusual for covid cases.
Despite the stressed finances, the families thanked the doctors for their tireless efforts and said wherever possible the hospitals had made concessions.
On 23 August, when Mumbai saw 224 new cases, the month’s lowest, Anuradha Mistry, who had spent a little under four months in Mumbai’s Lilavati Hospital, was finally discharged.
Anuradha Mistry 36, Ahmedabad
Diagnosed with covid 26 April
In ICU 14 May onwards
Discharged 23 August
Bill Rs 86 lakh
Financial Distress: Husband Madan Mistry says he has exhausted all his savings and borrowed from relatives and friends. He mentioned distress sale of a property but refused to share details.
When Anuradha was wheeled in on 14 May in a critical condition with both her lungs severely damaged, doctors knew only Ecmo could save her. But it would cost Rs 1.5 lakh a day. “Doctors told me that even after Ecmo, Anuradha’s recovery could not be guaranteed. Also, they could not say how long she would have to be on Ecmo,” said Madan Mistry, Anuradha’s husband.
Mistry did a back-of-the-envelope calculation- his savings, Anuradha’s jewellery and some properties the family owns-and gave the doctors his go-ahead. Anuradha showed no improvement in the first 21 days of Ecmo treatment. The hospital bill at that point was Rs 30 lakh. Mistry now had a decision to make. “This is when some relatives and friends stepped in with financial assistance. Anuradha’s condition began to improve on the 25th day of Ecmo. I decided to continue the treatment,” he said.
Doctors don’t recommend Ecmo beyond 40 days, but Anuradha was on Ecmo for 51 days. “If a patient, after being on Ecmo for a month, does not show signs of improvement, it is assumed to be a lost case.” said a doctor who did not wish to be identified.
Jatin Mishra’s wife, Sonakshi, 31, is seven months pregnant. She has not left the lobby outside the Covid-19 ICU at Lilavati Hospital in suburban Mumbai even once after her husband was admitted on 14 May. Both of them tested positive for covid on 25 April. While Sonakshi recovered quickly, Jatin’ s oxygen saturation levels kept dropping. At Lilavati, he was first put on oxygen and then on a ventilator. But because his saturation level kept dropping, the doctors advised Ecmo.
Jatin Mishra 40, Mumbai
Diagnosed with covid 22 April
In ICU 14 May onwards
Bill Rs 1 crore
Financial Distress: Family has sold 3-bedroom house and moved into one-bedroom apartment.
“On 12 June, I was told that Ecmo was the only option. They told me it can cost anything in the range of Rs 1.5-3 lakh a day. I told them only one thing-my husband will see his child,” Sonakshi said.
The family had exhausted all its savings by the time the bill touched Rs 50 lakh. “I decided to sell our 3-BHK flat and
move into a 1-BHK in the same area,”
Dr Srinivasan Ramanathan, senior intensivist at Lilavati Hospital, said Jatin is aware of the expenses. “It’s his wife who is giving him strength. He is much better compared to the past two months and we are hoping he can be taken off Ecmo soon,” he said.
“In Jatin’s case we have to be more vigilant because he has also been diagnosed with miliary tuberculosis (a form of tuberculosis where a large number bacteria spread through the blood stream). That’s also one of the reason why his recovery is taking longer,” said Dr Sneha Madkaiker, senior consultant, critical care.
“It has not been easy for Sonakshi. We keep telling her that the father and the new-born will go home together,” said Dr Prakash Jiandani, criticalcare-medicine specialist at Lilavati.
High out-of-pocket expenses on healthcare in India
Even before covid hit, Indians had been spending disproportionately from their pocket on healthcare. This year’s Economic Survey had noted that of every Rs 100 spent on healthcare Rs 65 came from the pockets of Indians (called out-of-pocket or OOP spending). For China the figure is 35% and for Thailand it’s 10%. This happens because government spending on healthcare adds up to just 1% of the country’s national income, which is abysmally lower than even the official target of 3%.
When the pandemic hit, the bottom fell out of many household budgets because of three additional reasons highlighted by the SBI report:
1. Sudden rise in prices of medical services and medicines
The cost of health-related services and goods has gone up. This has also increased the contribution of health inflation in India’s overall inflation. By using the 5% share of health expenditure in the overall expenses as the benchmark and adjusting it for such an increase in retail inflation, economists at SBI estimate that Indian households will spend an additional Rs 15,000 crore because of the increase in prices.
2. Higher need for healthcare and medicines
For those who had to be hospitalised because of covid, it is not just the price of healthcare related goods and services but also the increase in the quantity they have to pay for (medicines, hospitalisation charges, PPE kits etc) that has added to the burden. Let’s assume, based on the current trend, that 30% of all those infected with Covid-19 get hospitalised and of these 30% opt for private hospitals. Even if we take a conservative estimate of Rs 1.5 lakh as the cost of the entire treatment, the amount that Indian households will spend just on account of hospitalisation works out to around Rs 35,000 crore. That’s the expenditure due to the increase in consumption of health services.
3. Reduced family income
According to government estimates, per capita income has declined by Rs 8,637 in 2020-21 compared to 2019-20. Assuming, on a conservative basis, that the income of all private and unorganised sector employees has been impacted, economists at SBI calculate the cumulative loss in income to be Rs 16,000 crore. This loss in income would be an additional burden on families forcing them to cut down on other discretionary spending. The three components add up to Rs 66,000 crore in additional health expenditure, which is 11% of what we spent in 2019-20. Indians spent around Rs 6 lakh crore on health in 2019-20, which was about 5% of their expenditure on all goods and services that they bought for private consumption (private final consumption expenditure).
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