Overcharging by Private Hospitals during the COVID Pandemic in India: A Patient-based Analysis of Rate Regulation

Introduction: Responding to raised demand for health services during the COVID-19 pandemic, many countries turned to private healthcare providers to augment public capacities. In India, to deal with price inflation by private hospitals, many state governments implemented regulation of rates for COVID-19 treatment. Materials and Methods: In Maharashtra which pioneered the hospital rate regulation among Indian states, we conducted a mixed-methods study to examine the impact of rate regulation. Using purposive sampling, we interviewed 100 previously hospitalised COVID patients or their relatives, along with 12 health sector stakeholders. Results: Analysis shows that in 82.5% of hospitalisation episodes, patients were overcharged compared to official packages The majority of private hospitals utilised diverse stratagems to circumvent rate regulations, including double charging on items included in official packages. Conclusion: With a background of commercialisation of healthcare and pre-existing regulatory hiatus in India, gaps in design and implementation of COVID-period regulatory measures and state’s inadequate regulatory capacity formed the context for the limited effectiveness of regulatory measures. India and other LMICs with large private healthcare sectors should develop comprehensive yet pragmatic frameworks for regulating private healthcare, including standardisation of rates, which can strengthen regulatory efforts, enabling equitable and affordable access to healthcare for all.