Times of India
07 September 2011
By, Malathy Iyer

The nexus between a section of general practitioners and diagnostic centres is yet another instance of everyday graft that bleeds your pocket dry

When Mulund housewife Sunita R took her maidservant for an ultrasound scan to a local clinic, she expected the bill to be lower than that charged in swanky clinics or hospitals. But she was shocked to receive a bill of Rs 1,150 for the plain pelvic scan. When she asked the radiologist for an explanation, she was shocked to hear: “Go and ask your general practitioner.”

Sunita concluded that the GP obviously had a ‘tie–up’ with the radiologist. “Many hospitals charge less for simple scans,” she said, adding that she was certain the maidservant didn’t need a scan at all. “The doctor saw my anxiety and recommended a scan.” Sunita took her maid to another doctor, who prescribed a deworming course.

Consumer activist Mushtaq Parekh dubs Sunita’s experience as yet another example of the ‘cut practice’, which he insists is rampant in the medical system. A cut is literally a portion of the fee charged from the patient; it is believed that diagnostic clinics offer cuts to doctors for patients referred, consultants to general practitioners and hospitals to GPs. “There is also a cut practice of a different kind between pharmaceutical companies and doctors. The more a doctor prescribes a drug, the more favour he gets,” he said.

His reasoning is simple: “Doctors are trained to touch a patient and realize what the problem is. Yet they prescribe a Rs 10,000 CT or MRI scan that ensures they get a cut of at least 30%.”

Mentioning a series of lectures organized by a new hospital coming up in the suburbs, a doctor said: “These were supposed to be continued medical education for general practitioners (GPs). But the essence was about the cuts that the GPs could get for recommending patients to specialists attached to the hospital.”

The problem with the ‘cut practice’ is that the patient–doctor relationship suffers. Dr Arun Bal, founder, Association for Consumers Action on Safety & Health (Acash), said: “The cut practice is no doubt a big problem, but it is a function of the commercialization of medicine. Corporate hospitals are known to write out monthly cheques to general practitioners and specialists for referring patients. The hospitals show these payments as marketing costs and seek tax benefits.”

He said the cut practice is not a bribe, but more of a commission. “It is like a TV manufacturer giving a cut to his dealers. But when it comes to cut practice in medicine, ethics are at stake. Doctors would be guilty of professional misconduct if they accept a cut from a colleague, diagnostic clinic or corporate hospital.”

Parekh feels a quasi–government body or an NGO could help in curbing such practices, but many doctors believe it is a matter of personal choice. “Today, a student spends crores to become a doctor and, on stepping out, realizes that he needs a network to get patients. What can he do but collaborate with others in the business,” a doctor said.

A few doctors said there are many who do not participate in this practice. “It’s difficult but not impossible,” said an infertility specialist who does not have any referral arrangements.

How The System Works
Hospitals send marking executives to doctors in the vicinity, promising a commission for every patient referred. Hospitals make cheque payments for such referrals Diagnostic clinics also set up a similar network. Specialists who do not come in contact with patients directly, too, are known to give a cut to doctors who recommended patients to them

How it Affects Patients
Patients are unaware of the cut practice because they are treated well—be it by a gp, a specialist or hospitals. but the practice:

Inflates medical costs. Some surgeons claim they pay as much as 40% as commission to doctors referring patients

Excessive testing. Doctors put patients through a battery of unnecessary tests to earn a cut. Consumer activist Mushtaq Parekh says doctors have readymade sheets provided by labs and just tick the boxes

Unnecessary surgeries and procedures. Doctoractivist Arun Bal says this is the worst aspect of the cut practice, which is also difficult to prove in court