There is no mistaking the severity of the crisis faced by our private healthcare. Private hospitals and diagnostic centres, once heralded for their cutting-edge technology and service potential with the public hospitals struggling with the flow of patients, have strayed from the sacred path of service and descended into mayhem.
A new Transparency International Bangladesh (TIB) survey on private healthcare shows how bad the situation is. It shows how private hospitals and diagnostic centres have turned into profit-driven enterprises devoid of the basic principles that govern the health service universally. It specifically talks about what it calls a “commission-based marketing mechanism,” the provision of referrals (for patients) to certain parties in exchange for commission for the referees. It's a win-win strategy that benefits the physicians, owners of private medical facilities, middlemen, and practically everyone involved in the process—except those who matter most, the patients.
Given the price that you have to pay and the sufferings you have to go through to get a medical service, you may be forgiven for forgetting the fact that access to healthcare is a basic human right, not a privilege.
Unfortunately, the greed that drives this mechanism has also become a part of how public hospitals operate today. These state-funded institutions, which mostly remain stretched to the limit, should ideally have been places where patients, especially the poorer ones, felt welcomed and got treatment at cheaper rates. Instead, scarcity of doctors, nurses, and seats as well as the institutional impediments that exemplify Bangladesh's public sector mean that medical services are not as easily accessible, with patients suffering layers of corruption and mismanagement in the service delivery process. But that's another story for another day.
With 63.3 percent of the households currently seeking services from approximately 15,698 private healthcare facilities across the country—a far cry from 1982 when there were only 33—the private sector has emerged as a major player. What happens in this sector is of vital importance not only to the vast number of patients dependent on it, but also the policymakers under pressure to handle the country's growing health needs.
The private sector is in a unique position to bring about the desired technological and service-related changes in our healthcare, unencumbered by the bureaucratic strictures that typically surround the public sector. In fact, part of the reason why private healthcare was introduced was to take the pressure off public hospitals, bring innovation, and stem the flow of patients going abroad for lack of a better service at home. However, while there has been some progress in terms of access to primary healthcare, nothing much in the way of quality and cost of service has changed.
In recent times, there has been a lot of talk about excessive fees and questionable services in the private sector, after several prominent hospitals came under scrutiny following allegations by disgruntled patients and relatives. I have no problem with a private facility having a business motive which, in my view, is integral to the nature of these institutions. A privately-funded institution can serve better with a growth vision behind it. Profit is a precondition for growth and better service. Both are affected when there is not a steady flow of cash at the end of each month, but lust for profit—the kind that makes you disregard the very basic tenets of medical ethos—is an entirely different thing. No amount of logic can justify that kind of practice. It appears that somewhere along the line, the private sector has forgotten the need to strike a balance between profit-making and the essential provision of medical care.
TIB Executive Director Dr Iftekharuzzaman also expressed a similar concern at an event unveiling the survey report, saying, “The booming private healthcare sector has helped more people have access to medical services, but those who are involved in the private healthcare services are trying to turn the facilities into business outlets,” adding that the basic standards are not being maintained. (The Daily Star, February 8)
Excessive and often unregulated fees, expensive diagnostic tests, substandard treatment, and lack of properly trained health professionals are just some of the visible manifestations of a medical facility inwardly turning into a commercial organisation. Many of these problems can be solved just by strengthening regulation and enforcing the existing laws. Greater enforcement will lead to greater compliance and performance on the part of the facilities, and will eventually lead to improved services. But to think that regulation alone will change everything that is wrong will be naïve and unrealistic.
For example, a lot of what happens in the name of referrals are a matter of ethical—not legal—consideration. A doctor is ethically bound to refer a patient to the right surgeon, the right hospital, the right diagnostic centre, the right drug and equipment supplier, and suggest the right course of action. And for that, all one needs to do is use one's best judgment, without bias. But being a doctor, you can also prescribe the medicine recommended by the pharmaceutical rep that you are on good terms with—you can even suggest as many tests as you want, or set a high price for a surgery, and it will all be “legal.” This is where the ethics part comes in. Everything in the health service that is not covered by law is covered by ethics. The Hippocratic Oath has been around for a reason.
There are then certain problems that the private sector had no part in creating—such as the lack of efficient medical and paramedical staff, or the high cost of importing medical equipment—nor is it the only one affected by them.
Which is why we need a holistic approach to solution, one that will encourage ethical practices and improve monitoring and regulation across the medical spectrum, and also remove the barriers that stand in the way of a pro-people health service. The government has a big part to play in all of this but the onus is on the private sector to prove that it is willing to lead the change from within. The question is, is it ready to do so?
Badiuzzaman Bay is a member of the editorial team at The Daily Star. Email:email@example.com