India is ranked second to last in a survey of 32 countries by KPMG International investigating healthcare transparency. The survey does not analyse healthcare infrastructure; it specifically analyses the availability of healthcare data and reporting of health related parameters.
The only country to score lower than India on the list is China – a country famous for its censored, government-run internet. Countries such as South Africa and Saudi Arabia outdo India in the list, albeit narrowly, scoring 1 and 2 percentage points above India respectively.
The ranking is based on a final percentage score calculated from 27 indicators across six different categories of transparency. Among these are patient experience, governance (rights and responsibilities) and personal healthcare data (access and safeguarding of patient data).
One important issue is the amount of information provided to the patient. Health Issues India has raised this issue in the past relating to cardiac stents. We noted that doctors would discuss pricing options with patients regarding their choice of stents, without providing sufficient information about the stent’s function and effectiveness – “seemingly using contrast bias to push for the patient to select the more expensive stents.”
This notable example has consistently been in the headlines over the last few months as the government stepped in to cap the prices of stents, along with forcing stent producers to disclose pricing data. This was due to hospitals marking up the cost of the stents by many times the original purchasing cost, moving the cost onto the patients, many of which will be unaware of the comparatively low cost the stent was bought from the manufacturer.
Other indicators include information such as whether the hospital provides the success rates of a given operation, as well as the ratio of babies born naturally or via c-section. Factors such as these allow for patients to make an informed choice on whether they wish to use a particular hospital for any given procedure.
The intention of the study is to showcase which healthcare systems are most effective, and place the patient as priority, says Nilaya Varma, Partner and Chief Operating Officer with KPMG in India. Also mentioned was the unexpected downsides that may come with a high rating on the scale.
For example, a high level of disclosure may compromise patient privacy, or if a hospital is seen to be treating a high volume of patients with a specific disease it may be viewed as a specialist hospital in that area when its facilities are no better than in any other hospital. Also in the instance where success rates are highly publicised a hospital may turn away a patient that has low odds of success in an effort to maintain a high success ratio.
While KPMG has said that India handles some matters of healthcare transparency well, to rank so low in the poll at a time when the National Healthcare Policy calls for more public-private partnership may hurt healthcare business interests.