Big Covid-19 medical bills making many people paupers  

When Hasan Chowdhury, a small trader, died at a private hospital in the capital after taking treatment for five days with Covid symptoms, his family found it next to impossible to get his body released by paying a hefty bill of over Tk 400,000.

The family received the second blow within a year as they had to take a loan last year after spending all the savings to bear the treatment cost of Chowdhury's wife who had been suffering from kidney problems before she died fighting for life at a hospital for over a month.

As Chowdhury's body was lying on a trolley of the hospital for a long time, the close relatives and all family members contributed and got it released and buried him, one of the brothers of the deceased told UNB narrating the ordeals their family went through to bear the treatment expenses.

"My brother was in his mid-70s and unwell. After his wife's death last year, his health declined. As his condition worsened further with Covid-like symptoms, his son got an ambulance and tried to get him admitted to a public hospital. However, he failed to manage a bed in any such hospitals, wasting several hours. Finally, he was taken to a private-bank-run hospital in Panthapath. He was immediately taken to the ICU," he said.

He said Chowdhury was on a regular ICU regime but no major check-up was done. "After three days, when we insisted, a team of doctors saw him and recommended shifting him to a cabin from the ICU. A day later he was again taken to the ICU as his condition was stated to be critical and he eventually died in the ICU after two days."

"We're given a bill of over 400,000 for five days' treatment. The body was refused to be released by the hospital as his family couldn't raise the money immediately in a day. So, we all family members contributed and got his body discharged," Chowdhury's brother added.

Maksudur Rahman, a private company employee in the city's Nakhalpara area, also became almost bankrupt after his wife and daughter received treatment for Covid in another private hospital.

"I was infected with Covid last year. Probably, I got it from my office. My wife and daughter got it from me. As their condition became serious, they were admitted to a private hospital. My sister-in-law who was taking care of them also became ill and was admitted to the same hospital," said Maksud.

When they were finally discharged, he said, the bill was beyond his capacity to pay. "I went to my office to take a loan, but to my utter disappointment, I got a termination letter with an extra month's salary. I took my entire life's savings and paid part of the bill. I was lucky to have a friend abroad who sent me money to pay the rest of the amount."

Later, he moved back to his village home with an uncertain future as he could not afford to stay in Dhaka after losing the job. "I also had to suspend my daughter's marriage as I've no money left."

Like Chowdhury and Maksud, many poor, lower-middle-class and middle-class families of Covid-19 patients were overwhelmed by staggering medical bills after receiving treatment at private hospitals.

Talking to UNB, family members of many other Covid patients described their painful stories of how they were crushed by hospital bills as they had to sell their valuables and even homestead to bear their treatment expenses at private hospitals.

According to a study conducted by the International Centre for Diarrhoeal Disease Research, Bangladesh, out-of-pocket health expenditures have been pushing nearly five million people into poverty every year.

Another survey of the Health Economics Unit (HEU) under the Health Ministry, says the average daily treatment cost of a Covid patient in private hospitals is Tk 37,128 for a general bed and Tk 68,885 for an ICU bed.

Health experts said Bangladesh has the highest level of Out-of-Pocket Expenditures (OOPE) in South Asia contributing directly to the high incidence of catastrophic expenditures and poverty.

They think the government should take immediate steps to significantly reduce OOPE and increase per capita health expenditure to check the growing rate of poverty and achieve universal health coverage.

Talking to UNB, infectious disease expert Dr Be-Nazir Ahmed, a former director (Disease Control) at the DGHS, said OOPE on health in Bangladesh has long been the highest in South Asia and it has increased further due to the Covid pandemic, pushing many people into poverty.

He said there is a common practice in Bangladesh to prescribe a lot of drugs and suggest a lot of tests.

"Many drugs are being used in our country for Covid treatment that the World Health Organisation doesn't recommend. There're basically two things --oxygen and dexamethasone-- needed for the management of Covid patients. The price of dexamethasone is also very low. But if you look at the list of medicines of Covid patients here, you'll find many of those being given going beyond the WHO advice," the expert said.

He said these medicines are not available in many government hospitals. "I went to Gaibandha Government Hospital a few days back and saw patients have to buy 20 per cent of the medicines that are very expensive. Besides, patients have to go to private hospitals for many expensive tests like the CT scan of lungs. "So, these catastrophic health expenditures are making people bankrupt and the poor even poorer."

Dr Be-Nazir said the government should increase the per capita health expenditure to protect people from falling into such trouble and the vicious circle of poverty.

Besides, he said, the government should focus on improving the capacity and the efficiency of the Health Ministry to utilise the budgetary allocation for the improvement of health services.

Public health expert MH Chowdhury (Lenin), chairman of the medicine department at the Health and Hope Hospital, said the Covid treatment is very expensive and difficult for the poor to bear.

"The government should have increased the capacity of the public hospitals and set up adequate field hospitals to ensure the free treatment of the Covid patients. But it has failed to do so. People wouldn't have to sell their land and homesteads for Covid treatment had the government strengthened its healthcare capacity," he said.

Lenin said there are irregularities and mismanagement when it comes to medical bills in private hospitals for lack of proper monitoring by the government. "The government should look into these seriously."