Letters to the Editor

Government should seriously address issues in trauma care

This is with reference to the report titled ‘Experts recommend national standards to improve trauma care’ by Falaknaaz Syed in the 1-15 June, 2005 issue of your paper. I congratulate her for highlighting the issues in trauma care and covering the consultation report for improvement of trauma care.

I have lost my only son, Supratim, in March, 2003. He, at that time, was a final year student of computer Science and Engineering. He was doing final year project at Mahindra British Telecommunication in Mumbai.

On 7th March, while going to office, somehow he slipped from a train at Andheri station and his left hand was detached. He was first taken to Cooper hospital by the railway police where no facility for trauma care was available and from there to KEM Hospital’s plastic and reconstructive surgery department instead of trauma care. Doctors in that department showed much interest in reconstruction of that hand, which was separated without going for a CT scan. Before the operation, my distant relations present there were told about the stories of the successful operations of similar cases they had performed. Consent from distant relatives was taken without waiting for we parents to reach from Kolkata. The ultimate result was that he died the next day at the age of 22.

It appears either KEM hospital did not have the expertise or the equipment to take care of such patients, or the plastic surgery department did an experiment on my son, which cost him his life. The lady team leader was very reluctant and unhappy to talk to me and advised to take rest for my air journey. Its good that the government has woken up and is looking into trauma care and laying guidelines for people like us.

Ranjana Bose,
Librarian, Chittaranjan National Cancer Institute, Kolkata

Diabetic foot requires internationally acceptable expertise

This is with reference to the article ‘Neglect of diabetic foot treatment may lead to leg amputation’ by Shardul Nautiyal in your publication dated 16 – 31st July, 2005.

I am encouraged to see the interest and awareness that is being generated among the people and medical fraternity regarding the vascular complications of diabetes mellitus. The article is lucid and informative. I would like to emphasise that a vascular surgeon’s opinion is mandatory regarding the symptoms and treatment of diabetic foot. A thorough knowledge in this regard, is what is internationally acceptable today.

Dr Ashok Gupta
Consultant vascular surgeon,
Escorts Heart Institute and Research Centre, New Delhi

Package Deal Pricing will not help insurance companies

This is with reference to the story ‘Insurers to introduce Package Deal Pricing to prevent inflated bills’ by Falaknaaz Syed in the 1-15 July, 2005 issue of your publication. We need to understand that medical insurance is a contract between the insurance company and the insured person seeking to cover unforeseen eventualities, which implies that hospital is not a party to the contract. It also means that the hospital or the network service provider as a courtesy provides service of sending the insurance documents and details to the insurance company after obtaining it from the patient. This entails a capital intensive infrastructure, for which a dedicated staff, phone lines, fax services are required but is not being paid for by the TPAs/insurance companies.

In the above milieu, will it be possible to bring down the costs of medical treatment when all the fixed costs enumerated above are showing an upward hike. I feel that IRDA and other agencies need to have a relook at the insurance premium and work from within rather than to attack the service providers and create an Ayn Rand like situation.

The insurance companies cannot force their rates and packages on the network service providers as the promise of providing service was settled on the rates given to them at the outset and a bilateral agreement signed.

The TPAs do not seem to be transparent in their job. A nexus seems to exist between them, their clients and the unscrupulous service providers. TPAs never visit and verify the cases. They do not have the expertise to evaluate the patients and the plan of treatment as put up by the treating doctors. They want the shortest time between authorisation and surgery. Another point is that a lot of doctors so not have a dual pricing system for the insurance patients and the paying patients. The idea is to separate the wheat from the chaff and not penalise the transparent workers along with their errant cousins.

A comprehensive software uniting all the TPAs, insurance companies at one end, and the TPAs and network service providers at the other end will smoothen out the process to a great extent. The TPAs compete amongst themselves and cannot come to a consensus. Therefore, IRDA needs to step in and resolve these issues. Making a comprehensive package pricing has in no way helped CGHS so how will it help the Insurance companies?

We must take it for granted that a definite case load of diseased persons exists in the population which increases by the day hence the premium projections should keep pace with the increasing patients and their needs and their expectations from the medical service providers. The government authorities should accredit the hospitals. We are moving towards becoming a Medical tourism hub, hence this will further raise the bar, as investment in life saving equipment will rise.

All expenses are rising today-taxes, indemnity insurance, water, electricity, captive power and fuel, customs duty, cost of life saving drugs and equipment etc. An additive to all this is the accelerated obsolescence of medical equipment, which makes it mandatory for the service providers to keep up with the technology and competition.

The insurance companies should not foist their rates on the service providers unless it is a bilateral agreement with them. Keep the reverse example in mind also - If I have an insurance of Rs 100, can I a year later increase it to 140? No Way, because it is in the contract that for one time payment, I have been insured for Rs 100. So I have to cancel my old contract and re-do the policy. Then why are the insurance companies insensitive to the medical service providers?

Dr Sharad Kochhar,
Medical Superintendent, Shroff Eye Centre, New Delhi

Interesting article on stent manufacturers

This is with reference to the article “Uncertainity looms on stent manufacturers and importers” by Rita Dutta in July 1-15 issue of your paper. It made for very interesting read.

Sushil Bagga,
Managing Director, S B Medicare (P) Ltd, Defence Colony, NewDelhi