Renting Ambulance at Govt Hospitals: Patients forced to pay double

Patients across the country are forced to pay almost double the usual fares for ambulances because of a cartel of ambulance owners at public hospitals.    

It means more misery for those who have just taken a financial hit for their treatment or are about to.

Members of two ambulance owners' associations form a syndicate in every public hospital. That syndicate does not let any ambulance from other districts take patients away. For this, the ambulances charge patients double since they have to make the return trip empty.

If an ambulance from outside the district wants to carry a patient out of a hospital, the syndicate takes half the fare as its cut.

The Daily Star learnt this after talking to ambulance owners, drivers and relatives of patients.

For instance, Belal Hossain, 45, of Noakhali, admitted his son to Dhaka Medical College Hospital on February 20. He spent Tk 5,000 to hire an ambulance.

After a few days, when he went to hire an ambulance from DMCH to return to Noakhali, members of a syndicate there asked for Tk 6,000.

As Belal wanted to hire an ambulance from Noakhali, the members told him that "ambulances from outside" could only drop off patients. They cannot pick up patients from there.

Over phone, Belal then spoke to an ambulance driver who came to Dhaka from Noakhali with a patient. Its driver asked for Tk 3,000, which is half of what the syndicate at the DMCH asked, but gave Belal the condition that they would have to get into the vehicle outside the Dhaka University campus.

Asked, the driver said the syndicate members would not allow him to take any patient from the DMCH without paying them their cut.

"If you want to hire any ambulance near the hospital area, you will need their nod. They will keep half the fare as commission and thus I will have to charge you double the actual fare," Belal quoted him as saying.

"We came to Dhaka borrowing money from my relatives. If there were no syndicates, we would have had more money for treatment."

THE SYNDICATE

There are two ambulance owners' associations -- Bangladesh Ambulance Owners' Welfare Association and Dhaka Metropolitan Ambulance Owners' Cooperative Association.

Dhaka Metropolitan Ambulance Owners' Cooperative Association, the largest one, has about 2,700 members.

Both keep all ambulances across the country in their grip and their syndicates in the districts also do not let ambulances of other districts take patients away.

They have a set of unwritten rules regarding who can take which patients and it is mandatory for every hospital unit of the associations to follow.

For instance, if an ambulance from Dhaka takes a patient from the DMCH to Rajshahi, that ambulance has to return empty or pay the syndicate there half the fare for the vehicle's return journey.

When asked about syndicates ripping off patients, Badal Matbar, general secretary of Bangladesh Ambulance Owners' Welfare Association, tried to justify the syndicate's activities. 

"Members of our organisation have to pay Tk 1,500 monthly parking fees and membership fees of Tk 200 a month. It takes Tk 20-22 lakh to buy an ambulance. If ambulances outside the DMCH are hired, the owners will lose money."

Asked about the syndicate, Alamgir Hossain, president of Dhaka Metropolitan Ambulance Owners' Cooperative Association, said this was done to protect ambulance owners from incurring losses.

The syndicate members at the DMCH reasoned that if they allowed "outside ambulances" to pick patients from DMCH, the number of ambulances available there would shrink.

Wishing anonymity, an ambulance owner of Kushtia told this paper, "As soon as patients are taken inside Dhaka Medical College Hospital from ambulances, we are driven out of the hospital premises by the syndicate members there."

While visiting the capital's two other major public healthcare facilities, this correspondent found syndicates controlling ambulances there.

At Shaheed Suhrawardy Medical College Hospital, ambulance driver Mizan said except the members of their organisation, Bangladesh Ambulance Owners' Welfare Association, no one can take patients from this hospital. If others want to carry patients from there, they have to negotiate with them.

Al Amin, president of Dhaka Metropolitan Ambulance Owners' Cooperative Association's National Institute of Cardiovascular Diseases unit, said, "Outside ambulances are not permitted to take patients from here because we cannot do it from other places."

This correspondent in the three locations found most of the ambulances of the syndicates to be bare-bones. They had a gurney and an oxygen cylinder and hardly any other equipment.

NO GOVT POLICY

Alamgir Hossain, president of Dhaka Metropolitan Ambulance Owners' Cooperative Association, told The Daily Star, "How will an ambulance run? How much will the fare be? No government policy has been made in this regard."

Talking to this correspondent, DMCH Director Brig Gen Nazmul Haque admitted that an ambulance syndicate is active here. "Whenever I asked the syndicate members to leave the place, they go away but return again."

The DMCH authorities have introduced a mobile app so that patients can get ambulances easily, but people are less interested in using it, he added.

The government has cut the import duty on ambulances. The import duty is about 31 percent for the run-off-the-mill ambulances people import. The same vehicle in the microbus configuration has an import duty of about 90 percent.