the big story

The high price of getting Covid

First, the numbers: Number of cases in India: 165,348 The tally of deaths: 4,711. The caseload is rising with speed. As Times of India notes, it took us 109 days to hit 100,000, but just nine days to add another 50K. 

The TLDR: Private hospitals are the latest battleground in the war against the virus. As the number of cases escalate, so do patient bills. The biggest reason: the operational costs of safety protocols. Also: stingy insurance companies. We explain why a Covid-19 infection can quickly become a financial nightmare.

Starting with the good news…

As of last week, less than 15% of cases required hospitalisation. Of those in hospital, just 2.25% needed to be put in the Intensive Care Unit (ICU). Only 1.91% required oxygen, and just 0.004% required ventilators. But if you are one of the unlucky minority...

First, you gotta get a bed…

There are 105,000 isolation beds across 600 hospitals in the country. And private hospitals are popular. They account for 55% of in-patient care cases in India, while government hospitals only account for 42%. 

Key point to note: Our government policy is to isolate even patients with mild symptoms in hospitals or Covid care centres. According to an expert:

“The isolation of every patient is absolutely required. The countries that sent patients with mild symptoms home are now facing the consequences – their numbers have exploded.”

So you will need to be hospitalised even if you are not critically ill.

But where are the beds?

The states facing the sharpest spikes—e.g. Maharashtra and Delhi—have ordered private hospitals to step up. Maharashtra took control of 80% of such beds, while Delhi ordered that 20% be reserved. But a lot of these hospitals are not Covid-ready—and lack proper isolation wards, ICUs with ventilators, quarantine wards with oxygen supply and normal quarantine wards. 

Add to that our preference for private hospitals. The result: an acute shortage of beds. This week, 74 of the 82 ICU beds for Covid-19 patients in Delhi were occupied. In comparison, only 111 of 348 such beds were taken in government hospitals. And 80% of even non-ICU beds are occupied in private hospitals. In Mumbai, there is now a waiting list at the best hospitals—leading to dangerous delays in care.

Then you gotta get medical attention…

As a nation, we have a shortage of 600,000 doctors and 2 million nurses—and that doesn’t help in a pandemic. In Covid-19 cases, according to experts, “The ideal bed-to-nurse ratio is one-to-one and for five beds, we need one resident doctor and a senior intensive care consultant.” Not only are hospitals understaffed, but many have been forced to shut down due to infections. Mumbai is now scrambling to import medical staff from Kerala to cope with its caseload.

Then you get the bill...

Once admitted, patients typically are required to stay in the hospital until they test negative. 

• The cost per day for someone without ICU requirements can range from 14,000  to 32,000. And your bills are higher if you have underlying conditions—since doctors take a more aggressive approach. 
• As with any disease, the more ill you are, the more you pay—especially if you slap on expensive ICU and ventilator charges. Indian Express estimates daily ventilator charges as between Rs 1000 to Rs 2,500. Hindustan Times claims private hospitals charge between Rs 25,000 to Rs 50,000 per day. Make of that what you will.
• An average of three to five PPE kits are used per day, and the cost per kit ranges from Rs 700 to Rs 1100. Doctors and nurses will have to change their kits every four hours. The daily cost of PPE alone ranges from Rs 6,000 to Rs 10,000.
• You have to be tested repeatedly to track whether you are infection-free. Usually, patients are discharged after three to five consecutive tests turn negative. In some cases, eight to ten tests are required to get a definite result. The cost of a test: Rs 4,500.
• But you will typically have to undergo other tests for immuno-deficiency etc.—and these are far more expensive.

Indian Express estimates that Covid hospitalisations can cost anywhere from Rs 3-16 lakh—based on the treatment required. Hindustan Times estimates a total cost of Rs 2.8-3.5 lakh for a two-week stay for a “normal” case.

Finally, you gotta fight with insurance…

Hospitals pass on the charges of being Covid-safe to their patients. According to an insurance expert, “These charges include the cost of PPE billed at as high as Rs 5,000-9,000 a day; care and hygiene, and waste management charges, which are otherwise part of the room rates.” And insurance companies will not cover that part of the bill. Also excluded: oxygen masks which can account for almost 20-25% of hospital bills.

Point to note: You have to pay these safety-related costs even if you are not a Covid patient. PPE charges apply to all patients in the hospitals now. And no, insurers will definitely not cover that part of your bill.

The reading list

• Hindustan Times and Indian Express have the most detailed analysis of the costs.
• Mint and Moneycontrol cover the insurance angle.
• The Hindu looks at allegations of price-gouging at private hospitals.
• The Print looks at the Supreme Court’s recent push for free or subsidised care at private hospitals.
• The Telegraph has the most details on the bed shortage.

Image: Kelly Sikkema / Unsplash