When the COVID 19 pandemic hit India in March 2020, few were prepared for what was about to happen. Hospitals, healthcare providers and healthcare professionals, both private and public began a mammoth effort to ramp up their current infrastructure and organize themselves to manage the emerging cases, set up new clinical protocols and allocate additional resources and manpower. To enable them to do so, the Government instituted a five-phase lockdown. This helped hospitals get some time to prepare and allocate resources, draw out contingency plans and ensure that screening, sanitization, and disinfection procedures were in place.

From the very start, private hospitals in India have played an important role in tackling the COVID 19 disease burden, stepping up operations to complement and enhance the efforts of the Government. Many private sector hospitals including Fortis Healthcare allotted 1200 plus beds and additional manpower, set up isolation wards, brought in new equipment, made available the desired inventory and converted their premises into COVID care and Hybrid facilities to make sure that other patients needing emergency medical care are also not neglected. Elective surgeries and cases were put on hold and to large extent focus was solely on ensuring that COVID 19 patients were treated to the best of the hospital’s capability. Treatment protocols were drawn up as per Government guidelines to ensure that the medical staff was protected from the virus and that hospitals do not become hotspots or super-spreaders. All of this resulted in the use of a much higher number of disposables, a direct cost to the hospital. Additionally, at Fortis, several internal trainings were organized for all the medical staff, efforts were made to ensure public awareness and education were underway. The medical and nursing teams treating COVID patients were split into groups working in 7-day shifts followed by a 7-day isolation period. Each of these teams were placed in separate designated areas in the hospital. All these measures have increased the cost of care (both for COVID and Non-COVID) treatment at hospitals. 

It is satisfying to note that these measures have been very effective in ensuring proper treatment of the COVID-19 patients. So far, over 1,900 patients have been discharged from Fortis hospitals across the country after they have recovered fully. Some of these patients were extremely critical or were high risk cases. For instance, an 82-year-old lady, who had various pre-existing conditions, including hypertension, ischaemic heart ailment and thyroid, was successfully treated at Fortis Anandapur, Kolkata. A 27-day-old baby became the youngest patient at Hiranandani Hospital, Vashi - A Fortis Network Hospital to beat COVID-19.

Hospitals have also invested in additional tech support so that teams can connect with one another through tele-consultation or video-consults to minimize exposure. Fortis also began remote care facilities and e-consults in the absence of OPD facilities. On an average, 400 e-consults are conducted daily and so far more than 31,000 e-consults have been done across 28 hospitals of the Fortis network. We have also procured Video Laryngoscopes for the protection of our clinical personnel. In addition, robots have been deployed for screening and disinfection purposes. Therefore, as we see overall, input costs have gone significantly high with rigorous infection control practices, disinfectants, sanitizers, masks, and protective gear for the medical staff. Fortis has also gone a step ahead to provide enhanced medical insurance coverage to more than 5400 employees and taken life covers under various schemes for all the frontline employees. The company is also picking up all expenses for employees who are quarantined for either suspected infection or test COVID-19 positive. This not only includes Fortis employees but also covers contractual employees deputed in our hospitals.

Postponement of elective surgeries, dip in footfalls, reduction in OPD patients, complete halt on international patients due to travel ban and a significant fall in bed occupancy and inpatient treatments has brought down the revenues significantly and the increased costs due to reasons stated above, resulting in huge losses for all the hospitals including Fortis. If we take the example of Fortis, the hospital’s in-patient occupancy went down to a level of 30 percent and its OPD witnessed a fall of 80 percent. International patient inflow has completely ceased, elective surgeries have been postponed, fixed costs accounts for 60 to 70 percent of the total cost and all the hospital units are incurring additional costs in the creation of isolation wards and quarantine centers. Cost is also being incurred on improving testing protocols along with the management of staff on rotational basis, stocking up on PPE kits, streamlining disinfection procedures and arranging the lodging, boarding and transport of frontline healthcare workers. All in all, there has been a significant impact on profitability because of which senior management has taken pay cuts ranging from 10 to 50 percent.

One of the main challenges at present is that even though ‘un-lock one’ began a month back, patients are still hesitant to visit the hospital premises, fearing infection and exposure to the virus. The infectious nature of COVID-19 requires that we continue with specialized infrastructure, ring fencing and care for frontline workers. Private hospitals are also accountable for their own existence and operational viability as compared to public hospitals and end up spending more on quality of care and accreditations received. For example – the daily consumption of PPE in an isolation ward is about 40 in one day and there is no fair price shop for sourcing PPEs. Living with the current constraints so far Fortis has successfully treated around 2800 patients across its network hospitals.

Yet, despite this, there has been constant speculation with respect to the amounts being charged at private hospitals for the treatment of COVID 19 patients. So much so, that several state governments have set up price caps on the treatment. What needs to  be understood is that this is no longer a public versus private narrative, but how India as a country can leverage its capacity to serve the needs of the population as a collaborative effort. It is very important at present for the private healthcare sector, particularly hospitals, pharma and medical device companies to function at the optimum capacity, and for that reason, the Government needs to provide some relief measures. The sector requests taxation relief for a limited period of time, concessions, an extension on the renewal of various licenses which add to huge administrative cost, and the availability of credit lines from the banks at relatively lower interest rates. We need to review and reshape healthcare initiatives in India with a renewed focus on a collaborative approach between the centre, state and private players.