Corruption in Medical Practice

The recent BMJ article by David Berger (BMJ 2014; 348:g3169) has raised the ugly issue of medical corruption in India. We have many conscientious doctors lamenting the fading ethics in medicine. Some have raised the issue in journals, press and medical councils, the latest case being the complaint to the Maharashtra Medical Council (MMC) by Himmatrao Bawaskar against “cuts”. The recent face off between the MMC and the Kokilaben Dhirubhai Ambani Hospital is symptomatic. That the Ambanis, the richest Indian business house, can do no pure charity through their hospital (bearing their mother’s name) and stoop to kickbacks speaks volumes about the erosion of values.

Medical corruption has come a long way from ballpoint pens and small bribes in cash or kind. We now see substantial kickbacks. Among the examples are pharmaceutical companies’ hospitality to doctors on junkets, cuts by consultants to referring doctors, and demands by government medical officers that patients pay for services. The disease has other forms too: kickbacks from diagnostic centres, sharing money from sales of medical devices, or as significant non-returnable deposits, sharing lab fees, etc. Some general physicians (GP) “stalk” the highways for road mishaps and whisk the victim to “favoured” hospitals. Many private hospitals admit all emergency cases to the intensive care unit (ICU) as a matter of routine. Costly medicines and implants, cuts from doctors out of insurance and third party payments are business as usual – initiated by third party administrators or patients and often built into the insurance scheme. Private hospitals inflate bills for cashless cover or reimbursements of various types of health insurance. Diagnostic centres share 20% to 40% of their bills with referring doctors. Many government doctors routinely ask for cuts to authorise reimbursements. Many medical posts are sold at a price – not to mention admissions in private medical colleges bought with obscene “donations”.