Is COVID Killing Hospitals Too?

Dr Kapil Kochhar, Additional Director, Department of Bariatric, Minimal Access & General Surgery, Fortis Hospital, Noida talks about how hospitals are not able to generate enough revenue to pay their staff and are running into huge losses due to the COVID-19 pandemic

Yes you read it right. Besides causing such mortality and morbidity for humans, COVID is killing hospitals too, albeit slowly. And why only hospitals it’s killing the entire economy and almost every industry has been affected. But why it’s important to discuss hospitals at this stage. It’s important because the pandemic has yet to peak in India. And if hospitals die before the peak then the casualties are going to be manifold.

Most people are thinking that COVID has become a milking cow for the healthcare industry. The sole aim of this article is to clear such myths ad rather tell everyone that it has come as jolt out of the blue for the healthcare industry. People give examples of certain pharma companies’ shares jumping the bandwagon because they are into manufacturing of paracetamol or Hydroxyquininie. People are citing the full order books of the companies all over the world that are into manufacture of ventilators. The reality is far, far away from this.

India has a unique healthcare structure all over the world. It has an enormous government set up which at times fails to deliver for the shear load it carries.There is no dearth of talent or resources there. The major burden of healthcare is shouldered by the private sector which has always been accused of fleecing the public and making humongous amounts of money. This brought in various controls by successive governments. The most recent being in the form of Ayushman Bharat scheme. This along with certain panels like CGHS / ECHS etc. are absolutely unviable in terms of cost. The hospitals all over the country were already suffering from recession and then comes COVID, the giant killer. In most developed nations healthcare is government owned (say NHS of the UK) or heavily aided by the government (say healthcare in the US).Totally private healthcare is very minuscule in developed countries and obscenely expensive. Its availed by the super-rich in those countries. India has a very wide variety of hospitals ranging from individual doctor owned set-ups of around 30-50 beds to big chains of hospitals owned by corporates. A few of the latter are also owned by international healthcare chains too.

How are the hospitals dying?

The moment COVID struck India; governments (both state and central) announced a slew of measures to contain the disease. In some cases there were clear orders in others it was a hard worded warning. Pan India lockdown was announced for nearly three weeks and now almost a similar extension has been announced. To make the matters still worse we can’t even see the light at the end of the tunnel. As the lockdown has been extended further.

1. All big hospitals were asked to stop non-essential OPDS. This was done to avoid crowds in hospitals to curtail the spread of the disease. This meant that all the revenue arising from the OPD dried up. No patients meant no laboratory tests, no radiological investigations and no sale of medicines and other equipment like physiotherapy stuff from hospital pharmacies.
2. All non-essential surgeries were put on hold for similar reasons. To avoid cross infections from diseased patients or asymptomatic carriers. The backbone of any hospital is on the revenue generated from operating rooms. We are not saying that there were un-indicated procedures going on but they have been postponed for the time being.
3. All preventive health checks have been stopped. This was an important revenue source in many hospitals.
4. With closure of international flights no international patients are coming for treatment. Although no patients are also coming from smaller towns but they must be getting treated there only.
5. The movement restrictions along with the COVID phobia people are scared to even enter a non-COVID facility now. Due to lack of transport hospitals are sending chartered buses and ambulances to ferry their staff for duties thereby increasing the costs.

To sum up the entire scenario there’s been a 70-80 per cent drop in revenue for all hospitals. The worst affected have been the smaller units who are not even admitting minor cases which were there mainstay earlier. Most of them have not been able to even pay salaries to their nurses and grade 4 staff. Paying rents for the premises is a distant dream.

Talking about bigger units they can be broadly divided into two types. The COVID and non-COVID facilities. Non-COVID hospitals have been ordered to stack up with PPEs just in case the situation goes out of hand. So they have been forced to buy all protective gears worth lakhs of rupees.There is hardly 20-30 per cent occupancy and to make matters worse occasional detection of COVID patient leads to closure of the unit along with quarantine of staff.

Facilities that are treating COVID patients are in a bigger soup. Treating COVID is an expensive exercise. Patients are being kept for weeks together. And rough cost of treating each COVID patient is around Rs 40000-50000 a day. Lots of PPEs are used. All tests done and barrier nursing. And this cost increases to nearly Rs 1 lakh per day if patient is shifted to ICU. On an average five PPEs are used per ICU patient per day. The COVID staff has fixed duty hours and then they are quarantined. Any of them are not even allowed or have been advised not to go home and are staying in hotels or premises. All this cost is being borne by the hospitals. The cost of treating a COVID patient is around Rs 5 lakh for 12 days. Here comes the catch. No one wants to pay that. Neither the patient nor the insurance companies. Plus other patients are even more scared to enter a COVID facility for fear of infection. And on expected lines a lot of doctors, nurses and other workers are also falling prey to the disease while treating COVID patients.

In fact the situation has become so bad that many large hospital owners are willing that their units be taken over by the government. They are willing to run the place as per their orders provided they take care of the salaries and fixed tariffs like electricity, water, rent etc. They are willing to work on no profit no loss basis.

One doesn’t need rocket science to understand why it’s necessary to keep all the hospitals alive and healthy. If we look at the situations in countries which have peaked before us we know how people have been dying on hospital verandahs. The number of casualties was so high in so called developed countries with the best possible healthcare delivery systems in the world.