Today a patient with a good policy walks out of your hospital having paid nothing. He signs the papers, the insurer settles the bill, and he goes home. If this goes through, that stops. He pays ten per cent of the bill himself.

It is ten per cent of the amount the insurer had already agreed to pay. The extras that were never covered are still his, on top of that. A ₹3 lakh bill costs him ₹30,000. A ₹10 lakh bill costs him a lakh. Cashless or reimbursement, it makes no difference. Accident cases are in too.

There is a limit. No patient pays more than ₹5 lakh on one claim. That sounds like real protection until you work out when it applies. Five lakh is ten per cent of fifty lakh. How many of your admissions run to a ₹50 lakh bill? For everyone else the limit does nothing at all. Premiums come down in exchange. Two more rules close the escape routes. He cannot pay extra to remove the ten per cent. He cannot claim it from a second policy either.

The reason given for all this is where it stops being a billing story. The argument is about behaviour. When somebody else is paying, the patient stops looking at the bill. Nobody asks why one more scan was ordered. Nobody checks whether a smaller hospital charges less. Nobody picks the cheaper room, and in most Indian hospitals a bigger room pulls the doctor's fees and the procedure charges up with it.

A note from the General Insurance Council says insured patients are less price-sensitive. That, it says, leads to two things. Hospitals over-bill, and doctors do more than the patient needs. Look at who the second one names. The industry's case for taking ten per cent off your patient rests partly on the idea that you order extra when somebody else is paying.

A colonised patient looks completely well. Only a deliberate armpit and groin swab finds them. Your automated identifier can report this organism as something harmless. Here it did so with eight of the 54 confirmed isolates. If you find it, start an echinocandin. All 54 isolates were above the fluconazole threshold. None were above the caspofungin or micafungin threshold. It concentrates. One of the six ICUs held 15 of the 20 cases, so screening a single suspect unit beats screening everywhere.

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She was at her desk, on duty, at a primary health centre in Yadadri Bhuvanagiri on 1 October. The United Doctors Front has written to the Chief Justice instead of filing a case. A letter is allowed, it costs no single doctor anything, and it moves much faster. It is not asking for a new law. It wants the Centre and every state to show what they did with the safety orders they already have.

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Same work, same registration at the end of the year, less than half the money. A senior NMC official has told ThePrint that one national stipend cannot work, because the poorer states cannot pay what the big ones can. So the states keep deciding. What the regulator says it will chase instead are the 60 colleges out of 555 that paid their interns nothing at all. And PG residents have one clause on their side that interns do not.

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In many colleges the Nodal Officer left the NMR or SMR field empty in faculty and resident profiles. The first deadline to fix it has already gone. The new memo adds one line that widens the risk, and it names two people who have to get it done. Neither of them is the person whose attendance gets rejected.

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Darya Shipilova was 28. She worked at the Irkutsk Anti-Plague Research Institute in Shelekhov, in Siberia. She was admitted with severe pneumonia on 29 September, put on a ventilator, and died two days later. The WHO puts the date at 2 October. People of Baikal, an exiled Siberian outlet, reports she told medical staff she had broken a test tube of plague bacteria on 25 September. Russian authorities have never confirmed that.

What they have confirmed is far less. Rospotrebnadzor calls it pneumonia of unknown cause. It says further testing of her samples found no organism linked to her work. It also says no accident with dangerous organisms was recorded at the institute at all. The head of the neighbouring republic said she had died of plague, then added the word maybe, and has since said the source had nothing to do with his region. Irkutsk officials will say only that it was a particularly dangerous infection. The WHO is still waiting for laboratory results.

The response is far bigger than the statements. Nearly 200 contacts are under observation. More than 60 institute staff were shut inside from 2 October. Hospitals in Irkutsk are under quarantine, a maternity unit among them. Public events were cancelled, and police have opened a criminal case over safety violations causing death. Every contact tested so far is clear of everything except two common colds and two cases of covid. Washington says it is watching and sees no reason for alarm. So does the European Commission.

Worth keeping straight while this runs. Pneumonic plague takes two to four days to show itself. It spreads by droplets, person to person. Untreated, almost everyone who gets it dies, which is why the suspicion has to come before the confirmation. Aminoglycosides, doxycycline and the fluoroquinolones all treat it. India's last confirmed outbreak was October 2004, in a village of 332 people in Uttarkashi. The one before that was pneumonic, in Hatkoti in Shimla district, in February 2002. It killed four of the 16 people it infected.

Take a final-year resident whose practicals are still going on. Her result will be out weeks before the November papers begin, and she still cannot submit a form. Her university set one calendar, NBEMS set another, and nothing she did caused it. FAIMA has written for the whole 2023 batch and asked for three things. The smallest of them changes nothing about the examination.

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