I know Tobby from St. Thomas well. Nice to know he is well placed in the think-tank business. Nice write-up.

I wrestle with following questions in India

1. How can you force private hospitals to provide covid care without reimbursement. Med care is expensive and cannot bankrupt patients and hospitals.

2. Private hospitals have a social responsibility to provide care
— has to have a legal requirement to provide COVID care.
— have to be realistic with cost. Once someone gets on a vent there is at least 50% fatality rate. To maximize benefit with limited INR could make a decision that they don’t have to provide mechanical ventilation. This is the most expensive part of the care since covid pts esp if they survive tend to spend more time on the vent than other pts with ARDS. Sound cruel but that is reality
—some tax write off (instead of substantial immediate payments by govt) for unreimbursed care but this is an area that has potential to be scammed. Have to trust someone and so consider with heavy fines if misused. They have to eat some of the costs in this exceptional circumstance
—I cannot fully agree with the statements under ‘counterpoint’ that speciality hospitals have limited domain. A cardiac hospital structured to take care of post surgical cardiac patients have more than enough capability to take care of COVID patients
— in the U.S., insurance pays per diagnosis (DRG).Not too complicated to calculate and likely Indian drug costs known in the Indian medical insurance industry. Some limits on charges in pvt hospitals based on cost structure in govt hospitals. The actual costs once controlled for doctors reimbursements should be close. (Excluding big fixed costs such as buildings). Charges have sig more variability than actual costs
Cannot compare with western systems
In US - almost all hosp are private and patients have to be treated by law irrespective of ability to pay but they get paid by insurance and write off the rest
In UK- NHS enlists all private patients but govt pays them to treat covid19 pts
In Australia also govt pays pvt hospitals to provide care for covid pts.

Have been out of India for 27 years now and not very sure of business aspects of health care in pvt sector there