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Public vs private care

If you had to choose between a government hospital and a private one, which would you choose? Both options are daunting for many reasons

Lack of equipment and infrastructure, overcrowded wards, multiple non-functioning OTPs, a single MRI machine that is being shared by several government hospitals, unavailability of ventilators and medicines, long serpentine queues and delayed surgery dates — these have been the defining characteristics of government hospitals. However, there have been efforts by the government to improve the availability of beds and introduce better facilities but many continue to lack what private hospitals claim to provide.

But private hospitals too, have their drawbacks. The expenses are much higher and they serve a different purpose. Recently, there was a case where Government hospitals aim to provide affordable healthcare to all and free services to the poor. “Private healthcare has improved considerably because they earn a lot and invest a lot. Government hospitals are different — they are trying to provide healthcare for free,” says Dr Ranjana Kapoor.

From last year’s case where the unavailability of the anti-diphtheria serum in Maharishi Valmiki Hospital allegedly led to the death of several children, to the more recent case where three-year-old critical patient Farhan, who was struggling for his life in Lok Nayak Hospital, was put on a manual resuscitator and the HC had to intervene to direct the hospital to provide the child ventilator — there have been multiple instances where government hospitals have proved to be inefficient.

Out of the total sanctioned posts of 4,644 doctors, about 1,400 posts are vacant in Delhi government-run hospitals, which serve not only the local population but also neighbouring states. They are struggling with shortage of doctors and are hiring doctors on contract basis to tackle the crunch.

“We went to a private hospital in the beginning, thinking that we would be provided better treatment as they will have better facilities. But the medical expenditure rose to such levels that we had to shift my mother to a government hospital,” says Bharat Dubey, who came to GTB Hospital for his mother’s treatment, adding,  “Even though the medical services are advanced and the doctors well-equipped, the costs that one has to incur at private hospitals is such that it has become the prerogative of only the richer class, who can afford it. We are poor people so we cannot spend so much. I wish the same kind of specialised services were provided at government hospitals.”

Another patient, Jayashree Chaudhary, says, “Healthcare should not just be accessible to those who have money. Government hospitals should also have facilities that match the level of the private ones, so those who cannot afford they do not feel that they are compromising on their health by going to a government hospital only because of money or feel pressured into going to a private hospital if they want access to better facilities.”

Rajkumar, whose wife is suffering from throat cancer, says, “After spending around Rs 2-3 lakh in her treatment, we then shifted to LNJP hospital because we could no longer afford the costs that were rising by the day. We have been staying on a pavement in the hospital for the last three months. We do not have money left and we have to borrow money to pay for her treatment. We also cannot go from here because she needs to visit the hospital every day.”

There are a few who are satisfied with the kind of treatment they were provided at government hospitals. “They charge what is suitable and do not function like a branded showroom. Had I gone to a private clinic or hospital, I am sure he would have charged nothing less than Rs 1,000 for consultation. But there are government hospitals that provide adequate facilities and are improving,” says Himanshi Khatri, a Delhi University student who recently went to GB Pant hospital for a medical check-up.

Rameshwar Prasad, who had come to GB Pant Hospital for his daughter’s treatment, says, “I don’t know about private ones, but here at least we get medicines and treatment without having to spend large amounts of money. I would not mind standing in a queue for that.”

Private healthcare in India costs four times more than the public sector hospitals, yet majority of the cases are treated by private hospitals. Cases of medical negligence and overcharging have been rampant in case of private hospitals. Despite that, those who can afford look up to the private ones for treatment.  Irregularities and cases of medical negligence also mar private hospitals. Recently, Delhi Assembly’s Petitions Committee carried out an inspection of Max Hospital in Shalimar and found that some patients belonging to the Economically Weaker Sections (EWS) were allegedly admitted for longer than needed. According to reports, a woman was made to stay for a month in the hospital for stomach ache.

But the problems that are being faced by government hospitals continue to make people prefer the private ones. In April 2018, a status report submitted by the health department on Delhi CM Arvind Kejriwal’s orders, stated that out of the 183 operation theatres in government hospitals in Delhi, only 31 are functional owing to the lack of equipment or pending civil work. Due to the shortage of ventilators, many critically ill patients had been put on ambu bags — a manual, handheld resuscitation device that has to be pressed continuously to move air into and out of lungs of a patient. Even though the Delhi government has operationalised 125 new ventilators at most of its hospitals, lack of trained professionals to operate these have put the hospital authorities in a fix at a time when there is a huge demand from needy patients.

A pharmacy at the GB Pant Hospital lacks at least 60% of life-saving medicines and injections, as per reports. Delhi government hospitals see a huge rush in their Out-Patient Departments (OPD), where thousands of patients line-up to be treated. The systems at these overcrowded hospitals are breaking due to constant rush of people; doctors are either too exhausted or patients have to wait for months to get the simplest of tests done for free.

Delhi has 34 hospitals run by the state government, with over 11,000 beds and a daily influx of 50,000 patients, 40% of whom come from outside the capital. Of these, LNJP, has 1,847 beds and remains the only Delhi government hospital with a functional MRI machine. Doctors estimate that more than 10,000 people avail its services annually. The hospital had acquired the machine in 2015 for Rs 15.35 crore.

An MRI scan — short for magnetic resonance imaging — is required to detect cysts, injuries and abnormalities across the body. The absence of an MRI machine is, perhaps, the most glaring example in a long list of equipment lacking in government hospitals. A similar problem exists when it comes anaesthesia workstations and, occasionally, providing oxygen. At GB Pant Hospital, the MRI machine has not been functional since late 2015, and a new one is yet to be procured. In such a scenario, Delhi’s five multi-speciality hospitals — GB Pant, LNJP, Guru Teg Bahadur, Deen Dayal Upadhyay and Baba Saheb Ambedkar — either share the single MRI machine or refer patients to Safdarjung Hospital and private labs. It isn’t just the absence of high-end diagnostic equipment that is hampering the Delhi government’s ambitious healthcare plans.

According to media reports, of the 183 operation theatres (OTs) in government-run hospitals, 31 are non-functional due to the absence of equipment ranging from anaesthesiology workstations to non-installation of ACs and OT lights. In Deep Chand Bandhu Hospital, all six OTs are non-functional. As per government records, reasons range from the fact that PWD hasn’t finished work in two OTs, anaesthesia workstations and vital signs monitors need to be procured, and there is a shortage of specialists. Dr Sunil Gupta, a cardiologist, says, “This is how a government hospital works. Procurement is always a lengthy process. Even for installing an AC, the health department has to pass tenders and that can take long. There are numerous checks and balances to ensure it works well — but not necessarily quickly.”

Many Delhi government hospitals and clinics are running short of essential medicines and are forced to purchase them from outside, causing a loss to the government. Many essential drugs like amoxycillin (for bacterial infections), glibenclamide (antibiotic drug), ibrufen (painkiller), hydrochlorothiazide (to treat heart failure, kidney diseases) are not available in the hospitals, as stated by the Health Department in its status report.

In a latest push, 120 beds have been added to the existing 60, and facilities such as a School of Pulmonology, CT scan, digital radiography and a respiratory endoscopy unit, to what is touted as Delhi’s second-best super-speciality hospital by Health Minister Satyendar Jain — Rajiv Gandhi Super Speciality Hospital. But a lot needs to be improved in both government and private hospitals to uplift the healthcare scenario in India.