There is perhaps no stranger marketplace than the one entered by a person who is seriously ill. The customer does not wish to purchase the product. Its price cannot conveniently be compared. Consumption cannot be postponed. And walking away because the tariff appears excessive may simply not be an option.
Yet modern healthcare increasingly requires illness to be negotiated through the vocabulary of commerce: Packages, deposits, authorisations, exclusions, non-payable items, room eligibility, co-payments and insurance limits.
None of this should be mistaken for an indictment of the medical profession. Quite the contrary. Doctors, nurses, technicians and other healthcare professionals frequently represent the most humane part of an otherwise intimidating experience. The difficult question lies elsewhere: How much commerce should be permitted to surround the act of healing?
Private hospitals cannot be expected to operate as charities. Sophisticated diagnostic equipment costs money. Intensive care requires enormous staffing and infrastructure. Medicines, laboratories, operating theatres, specialist consultants and round-the-clock services carry legitimate costs.
But profit and profiteering must remain distinguishable.
In an ordinary commercial transaction, excessive pricing may be punished by consumer choice. A dissatisfied hotel guest may select another hotel. A family confronted with a medical emergency enjoys no comparable bargaining power.
Insured, yet still exposed
Health insurance was supposed to answer precisely this anxiety. Premiums are paid because financial risk is intended to be transferred before illness occurs. Yet serious hospitalisation can reveal an uncomfortable distinction between possessing insurance and possessing adequate protection.
The advertised sum insured may appear reassuring. The lived experience can be different.
Policy limits, exclusions, non-payable consumables, authorisation restrictions, package rates and other contractual limitations may leave substantial portions of a hospital bill outside reimbursement.
Individually, such restrictions may possess actuarial or contractual justification. Cumulatively, however, an uncomfortable question emerges.
What exactly has been insured against if surviving a serious illness can still financially destabilise the household? The hospital may maintain that the treatment and expenditure were medically necessary. The insurer may recognise only part of that expenditure. Between those two sophisticated institutions stands the family, which must somehow pay the difference.
Goa's different experiment
Goa's Deen Dayal Swasthya Seva Yojana offers an instructive alternative philosophy.
DDSSY provides cashless coverage for eligible resident families through empanelled hospitals and predetermined procedures. Presently, annual coverage extends up to Rs 2.5 lakh for a family of three or fewer members and Rs4 lakh for a family of four or more.
The scheme is certainly not limitless. Not every procedure is covered and annual ceilings remain.
Its significance lies elsewhere. When healthcare is purchased collectively through a State-backed framework, the individual patient is no longer expected to bargain alone. Package rates, empanelment and institutional negotiation allow the State to exercise purchasing power that an anxious individual standing before a hospital billing counter could never possess.
At the Union level, PM-JAY similarly reflects the recognition that catastrophic hospital expenditure cannot always be left entirely to individual financial capacity.
The troubling fact remains that even several layers of protection can leave significant out-of-pocket expenditure behind.
An older lesson
from Abu Dhabi
An instructive comparison may be remembered from the erstwhile public healthcare system of Abu Dhabi. Public institutions such as Mafraq Hospital became synonymous for generations of residents with a powerful philosophy surrounding emergency medicine. Whatever the patient's nationality or economic circumstances, an emergency was fundamentally approached first as a medical problem.
That philosophy survives in the UAE's present formulation: Hospitals accept medical emergencies for initial treatment, and treatment required to stabilise an emergency case is provided without charge before subsequent treatment becomes a matter for insurance or payment.
Its wisdom lies in the sequence.
First, preserve life. Then determine financial responsibility.
This does not make healthcare free. Neither does it deny hospitals their legitimate costs. It merely recognises that there exists a moment of human vulnerability during which the ordinary logic of commerce must temporarily retreat.
For a country celebrated for enterprise and private capital, that principle is particularly instructive. Commercial healthcare and strong protection of the patient are evidently not incompatible ideas.
India's constitutional promise
India does not lack the jurisprudential foundation for such thinking. In Parmanand Katara v. Union of India, the Supreme Court declared the preservation of human life to be of paramount importance and recognised the professional obligation of every doctor, whether attached to a government hospital or otherwise, to extend immediate assistance for protecting life.
Article 21 consequently supplies something deeper than an insurance contract. It supplies a constitutional philosophy.
But constitutional dignity cannot end at the emergency-room door while financial vulnerability begins immediately beyond it.
The question for healthcare policy must therefore evolve beyond whether treatment was technically available. It must ask whether serious illness can be treated without imposing unreasonable financial hardship upon a family that has attempted responsibly to protect itself.
The answer cannot be the demonisation of private hospitals. India needs them. Nor can insurers simply be commanded to pay every conceivable expense without actuarial discipline. Public schemes similarly operate with finite resources.
Greater transparency in hospital tariffs, meaningful disclosure of insurance limitations, stronger regulation of exclusions, rational package pricing and better coordination between public schemes and private coverage deserve serious consideration.
Healthcare may remain an industry. Hospitals may earn profits. Insurers may protect themselves against unsustainable claims. Governments may impose reasonable limits upon publicly funded schemes.
But somewhere within that complicated equation, one proposition must remain non-negotiable.
Medicine deserves its price. Human helplessness should never acquire one.
