posted on Tue, Oct 16 '18 under tag: health

This is a response to an article on health systems research calling the cost of dengue treatment in India too high

Read the post which this is a response to here: Why is the easily treatable dengue making a profit in India? (warning: clickbait)

I can’t comment on the site because their captcha system is wrongly implemented, always showing 7+2 and giving timeout error.

As a doctor let me add another perspective on how things go on a day-to-day basis when a dengue patient goes to a hospital.

I have worked in a government hospital. When patients come there with (not-so-severe) dengue, the first thing we do is to try to explain to the patient and family that they just need rest, plenty of fluids and there is no need to get admitted. This is in part due to there actually being no space, but mostly because the patient seems alright.

But the family is alarmed. It is “dengue” after all. It is always better to be in the hospital than at home. Okay, let’s get the patient admitted. After all, the intern who checks 30 patients’ BP every 2 hours throughout the night can check one more patient’s BP easily.

Day 1 of admission, things are okay. Patient is still febrile. You give them Paracetamol, but you don’t want to give too much. You may/may not give IV fluids. You get a complete blood count, monitor platelets.

Day 2 of admission, you keep doing the same things. Check BP, check for petechiae, continue same.

Night 2 of admission, patient family gets impatient. This fever is not going away. My patient looks sick. The doctors are doing NOTHING!

Day 3 of admission, a new and loud family member comes in. Knows nothing about what the doctors ARE doing, and starts shouting at them for doing NOTHING for the patient. They want to take the patient away to a “better” hospital. Meanwhile, the intern who checked BP on that patient 6 times last night without sleeping watches and moves on, handing over the charge to the doctor who is relieving them that day.

All this happens in government hospitals.

But, I’ve worked in a private hospital as well. There is something about patients and families. When a person is sick there usually is only a few close members to take care of them. You tell them how very sick they are, you tell them about all the grave things that could happen to them, they will stare blank at you. If at all something bad happens to the patient, suddenly the calm family gets new members. They are loud and they create a lot of noise as well. These are the people who have no idea what has happened to the patient, but would be happy to blame the hospital for whatever has happened.

This article makes me curious. Was this written just as a clickbait to lead people to your symposium? It very much looks like so. Because after the first two paragraphs, dengue is forgotten in this article.

Also, the leading paragraph wrongly puts the figures as “USD$ 514 and USD$1491”. Although the link doesn’t work, the actual article puts the figures at USD 186 which is an aggregate of all kinds of patients.

Here is a better article: Economic and Disease Burden of Dengue Illness in India. It says:

“We obtained cost data from all 10 medical college hospitals. The average (±SD) cost per bed day was $35.66 ± 10.62 in the three private-for-profit medical colleges and $32.11 ± 12.31 in the seven publicly owned and managed medical colleges. The cost of a hospitalized episode in the public sector averaged $197.03, consisting of $181.40 for the hospital stay, $11.61 for 1.13 hospital outpatient visits, and $4.03 for 0.49 other ambulatory visits. The mean cost of a hospitalized episode in the private sector was $248.11, consisting of $230.74 for the inpatient stay and $17.37 for ambulatory visits. The average cost of an ambulatory episode was $26.09 if treated in the private sector and $23.49 if treated in the public sector.”

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