Sunday, August 6, 2017

When doctors turn money minded-an example of Dr X

Yesterday, I experienced a 'catch' in my back muscles due to which my body tilted. While analgesics did alleviate the pain, it was not better on Sunday too. After a referral by our family doctor (whom we trust blindly), I visited his clinic on Sunday. This doctor will stay unnamed on public forums, to avoid

This particular doctor has a very high rating on Practo(though I did not use that platform), and has a website/clinic seemingly focused on patient care and welfare. The notice boards emphasizes on the continuing professional education(CPE) and certifications attained by him, as also the 'sacrifices' made by doctors and the need to respect them. So far, good. It is however the aftermath of the visit which left me poorer by ~Rs 4,000 and shocked

  1. A cursory 10min examination asking me to do some exercises in front of a haggled looking doctor, which concluded in his "Diagnosis" that I had come just in time to avoid slip disc. The bedside manner was not seeming ok
  2. The team interested in starting treatment instead of asking how do i feel or validate issues. 
  3. X-Ray not feasible since his entire team busy in operations. However, he felt confident to start lumbar traction(that too instructing the medical support staff without explicitly pointing it out). This procedure btw is not medical current practice, as per 2nd opinion. 
  4. Extreme and undue hurry to admit me into bed rest even before X-Ray/MRI, in a 'premium room' with billing of Rs 6000/day(albeit including price of nursing, doctor) and no medicines
  5. Starting IV drip(for which Rs 950 charged finally)
  6. Drawing blood without prior explicit consent, for a battery of tests with desired billing Rs 6,500
  7. Charging Rs 800 for X-Ray(Whereas the clinic standard pricing Rs 400). 
  8. Finally, consultation in #1 and #6 charged Rs 2000 instead of his standard billing price on Practo of hardly 1/3rd of this. 
This doctor is successful commercially having 3 clinics in/around Mulund(E), and yet I lost all respect today for him. To protect yourself from such doctors, one should ensure that
  1. Discuss the cost of treatment UPFRONT and do not mention your mediclaim coverage(Btw this doctor prominently displays insurance TPA tieups)
  2. Ensure that PROS/CONS of treatment are mentioned by  him
  3. Never get yourself hospitalized BEFORE diagnosis is complete and a written opinion(this can nail him for overmedication)
  4. Refuse procedures like I.V/Bloodtests if not necessary 

Sunday, February 19, 2017

Judiciary-Heal thyself while reforming all and sundry

As someone who has earlier studied law(during professional courses in accountancy and company secretaryship), I've been avidly following the practice of law. While judicial activism is a welcome trend to fill the institutional void in the executive and legislative branches, it should now extend to fill the judiciary and legal professional itself. For example, below points

  1. Refusal of Supreme Court to disclose information on judges's financial status etc under the Right to Information Act-do note this decision cannot be litigated as the Supreme Court is itself the final legal arbiter in India
  2. Hearing celebrity/high profile cases out of turn while allowing other cases to languish for a long time. There needs a transparent mechanism to decide out of turn vs regular cases, else the spectre of speedy justice for some will exist.
  3. Judicial Appointments-The existing collegium mechanism has its documented faults in preventing nepotism etc. The Modi government should be lauded for sticking to its guns in this regard
  4. Blatantly favouring the legal professional: Whether it is about levy of service tax on advocates, restricting tax tribunal hearings only to legal professionals, entry of foreign law firms in India, asking censorship cuts in already approved Movie Jolly LLB 2 which lampoons the legal profession, these decisions favour the legal profession in India, at the cost of other stakeholders
  5. Non transparent court ordered appointments: In the case of BCCI Committee of Affairs, the Supreme Court ordered appointments of 4 professionals who would be remunerated and not on a honorary basis. This appointment was not competitive or application based, unlike say a normal UPSC appointment. 
  6. Caustic remarks during proceedings/inability to tolerate critiques: While judges routinely pass strictures during hearings like Sahara case, BCCI, if there is critiques by even retired judges,like M Katju the courts take offence and initiate contempt proceedings. Is this fair?
  7. Revision of allowances/pensions: The Courts award merit increases to themselves-to be fair this is done by the legislature also. But is this fair?
The following points if fixed, would go a long way for judges to be perceived truly as neutral arbiter

Politicians and bureaucrats should be subject to the risks public face

  1. Minimum qualification/guidelines for bureaucrats should be applied to their political bosses. For example, codes on conflict of interest, corruption proceedings for accumulating assets disrportionate to known sources of income
  2. Fit and Proper Norm for political party leadership-NOT just elected representatives
  3. Democracy within the party-Regular inner party elections under independent observer
  4. Performance linked pay and redundancies/exits without golden parrachutes-Pay Commission hikes to be accompanied by exits, to avoid life long employment promise. After all, pay commission salaries are good compared to private sector entry norms
  5. Piercing the corporate veil to avoid remote control from jails: Be it Lalu Yadav controlling the RJD from jail, or Sasikala now ruling the AIDMK from jail, prisons do not end the rot. So extending the ban on political party 

Saturday, February 18, 2017

ICAI 67% member fee increase in 2017-Is this fair?

As a member of the ICAI(Institute of Chartered Accountants of India), I visit their website to keep updated with events. During that time, I noticed an announcement of fee hike The numbers were quite high so I decided to analyze the impact on ICAI finances. For this, I looked at the annual report  With total income of 66624 lakhs, the operating surplus of 6820 lakhs represents a surplus of nearly ~10%. Interestingly, nearly 50% of this surplus is generated from classroom training programs(excess of receipts over costs) of 3729 lakhs.

The member fee income for 2015-16 was Rs 5636 lakhs. The approximate breakup of this is analyzed in the 5th column which assumes all members to be below 60, and charged the statutory slabs-this is almost the reported fee. If we replace the tariffs with the proposed one, the institute's income increases by nearly 3800lakhs to 9339 lakhs, which represents nearly 50% of the operating surplus

The question is that for a revenue source accounting for just under 10% of the overall receipts, is it fair to increase member fees without a public consultation, justification and updates on efforts to do cost management? Otherwise, we risk a bulging bureaucracy with Pay Commission Indexed salaries.

Friday, February 17, 2017

The tale of 2 young Presidents & dynasties-ICAI vs ICSI

Recently, the ICAI elected Mr Nilesh Vikamsey as its President and Mr ND Gupta(Jr) as its Vice President. Mr Vikamsey's brother was the ICAI President around a decade ago, while his father was on the ICAI Central Council decades ago. While for Mr Gupta, his father was the ICAI President in 2001. While Nilesh has come up the hard way of WIRC-Central Council-President, Mr Gupta was directly elected to the Central Council in 2010 without even contesting his regional council elections(NIRC), and is now catapulted to the Vice President post, which all know is a stepping stone to the Presidency post in a year. I cannot think of any other ICAI President in recent history, who has been able to achieve this milestone of direct elections to the Central Council without any 'great' individual achievements.

In sharp contrast is the election of Mr Sham Lal Agarwal as the ICSI President. While Mr Agarwal is quite young and with just 12yrs practice, he came up the pyramid of chapter-Regional Council-Central council, and won support by his work, without any visible family heritage or godfathers.

Saturday, January 14, 2017

Uber/Ola value proposition fast eroding

Over the last year, both Ola and Uber have began to increase prices and/or make consumer experience worse for those. Some observations are below. At this rate, both often charge for share bookings the same tariff as black/yellow auto and taxi, while not being much faster. Also, this is without offering a clear differentiation like passenger insurance, impartial dispute redressal etc. Guess this is the start of the end

When Introduced
Fare calculation
Transparent distance and time
‘Upfront fares’
Surge pricing display
‘x’ surge’ displayed transparently
Inferred from the upfront fares multiple-you need to calculate
Ride time fare
Rs 1/km
Rs 1.5/km
Pool/Share rides
Usually 50% of Uber Go/Ola Micro
Even 70%-100% of the fares
Pool/Share rides routing
Detours usually not much
Sometimes 30min detour to worsen the experience
Pool/Share rides
‘Express’ rides where you hop on/hop off routes like highway-now its like hailing cabs
Short distance rides
Perception that where regular cabs refuse/Ola uber will agree
With high min fares >=Rs 60, Uber/Ola will be costlier anyways
Payment via Wallets
Usually useful to avoid cash payments
Wallets like PAYTM side with Uber/Ola, so its better to use credit cards only