Many cannot afford medicare amid rising cost of living

Multitudes of people now overlook medical treatments, unless in utmost emergency, as higher cost of living fired up by inflation is squeezing overall consumer spending, including healthcare bills.

It evidently cuts both ways, like a double-edged sword: economic growth is curtailed and public health is affected, ultimately to the detriment of productivity in the economy.

Health-service providers have found a fall in out-patients in the private hospitals for regular check-ups, pathological tests and other diagnostics.

According to government data, inflation climbed up to 7.48 per cent in July against 5.36 per cent in the corresponding month last year. And food inflation peaked at 8.19 per cent.

In case of emergencies, people in middle-and lower-income groups are rushing to public hospitals or unauthorized heath- service providers to get low-cost healthcare services.

There is no official survey or data yet on how many people skipped regular checkups or compromised medical care to manage higher household expenditures.

In a spot survey through visiting several public and private hospitals in Dhaka, this correspondent found the proof of many of the middle-and lower- income people being compelled to compromise on health expenditures in recent times.

Public hospitals and institutes, including BSMMU on the highest rung, are awfully occupied with in-and out-patients and have scarcity of equipment and manpower.

At the National Institute of Cancer Research and Hospital (NICRH), located in the city's Mokhakhali area, five radiation machines out of six are out of order. Cancer patients who cannot afford treatment in private hospital are getting appointments after 12 or 15 months in the lone government institute for cancer patients.

However, the radiation treatment after such a long interval would be of no use for them, according to oncologists.

Poor services, logistics, equipment and insufficient doctors in government hospitals prompt the patients either to go to the private hospitals or abroad for treatment. Those who cannot afford these options, choose unauthorized low-cost clinics and diagnostics.

Health experts expressed their concern over such trend on skipping regular check-up and obtaining services from the undesirables in the lifesaving sector -- often risking life, as reports have it. It may leave long-term negative impact on wellbeing of people, thus denting productivity.

And, the recent price hike of essential commodities heightened the tendency among people in low-and middle-income brackets.

Morzina Begum's is a case in study. The middle-aged woman came from Pabna to the capital city's Mohakhali Cancer Hospital. She was leaving the hospital premises heartbroken, as her grave disease worsened owing to, as doctors said, skipping three routine follow-ups during the last one year.

"I was supposed to come here every three months for checkup. But, It becomes hard to manage treatment costs as living cost is surging beyond the limit," she laments.

She said all of her family members prefer to cut spending either by compromising healthcare cost or trimming regular household expenses.

Shaiful Hassan Shameem, a radiation oncologist of NICRH, said he was noticing such trend of skipping regular follow-up that may prove life-threatening for the cancer patients.

"Many of the patients, mainly of low-income group, are coming for follow-up after skipping two-three schedules," he said.

Globally, cancer treatment is comparatively expensive, though cheaper in government hospitals, compared to that of other types of treatments.

Dr Shameem says some patients like Ms Begum were scheduled to visit for follow-up after surgery but they are skipping the schedules in recent times, making their heath conditions worse.

The situation is no different in other hospitals, too. However, private hospitals have noticed a decline in regular follow-up patient arrivals.

Hospitals providing quality and world-class treatment facilities, including Square, Labaid, and Evercare officials, have also noticed people skipping regular treatments, except for emergency, in the hospitals.

Md Esam Ebne Yousuf Siddique, Chief Operating Officer (COO) of Square Hospital Ltd, says there is rush of emergency patients in hospital but outpatients are fewer in recent times.

"We have noticed a downturn in pathology, radiology and other diagnostic tests, too," he adds.

However, he mentions, the hospital has kept its charges unchanged during the last three years despite hike in prices of all commodities in local and international markets.

Hossain Shikder, a computer operator working in a private firm in Motijheel, came to BIRDEM hospital's dental unit with acute pain. He was suffering from mild pain with sensitivity in his teeth during the last three months.

"I tried home remedy first, later tried to bear the pain as it became difficult to manage treatment cost from my handful amount of monthly income," he says.

"Already school fees of my child are due for two months -- how can I spend money for myself?" he posed the question.

Director-General of Heath Care Service Professor ABM Khurshid Alam, says rush of patients has increased in the government hospitals across the country.

"I am not sure whether the patients are switching from private hospitals for higher cost, but many patients are now coming for treatment who were panicked earlier to come to hospital fearing Covid infection," he adds.

Health economics researcher at Bangladesh Institute of Development Studies (BIDS) Dr Abdur Razaque Sarker raises another flip side of healthcare system in the country. In Bangladesh, he says, people spend 64 per cent of their household costs for purchasing medicine that are available at doorstep pharmacy without prescriptions of doctors.

"Prices of medicines for non-communicable diseases (NCDs) are higher in Bangladesh, and consumption of such medicine increased alarmingly," the researcher says, as reports say there have been spikes in medicines prices without tangible deterrence.

During the last 12 month, it has been found around 52 per cent of the cancer patients going to the public hospitals while 48 per cent to private hospitals, he mentions.

"Lower-income people are struggling to pay the catastrophic medical bills amid surging cost of living," he says on a grave note of concern about public health.

Several recent studies reveal that inflation has started taking a toll on healthcare services globally, even in developed countries like America, too, in the wake of disruptions by the pandemic and the Ukraine war close on its heels.

A recent study by West Health and Gallup has found one in four Americans having skipped treatment for rising cost of healthcare services.

Overall, 26 per cent of adults report delaying or avoiding medical care or purchasing prescription drugs in the prior six months due to higher healthcare costs.

The survey found that those who are cutting spending on non-healthcare-related expenses -- including food, gas and electricity -- are substantially more likely to be cutting spending on healthcare as well.

According to a study by the Ministry of Health, Bangladesh's out-of-pocket (OOP) healthcare expenditure, borne directly by patients, is 68.5 percent -- the highest among SAARC nations.

About 64 percent of the OOP expenditure goes for medicine, whereas it is 28 per cent in India.

It says as much as 60 per cent of the patients take medicines by self-medication.

Bangladesh has set target for Universal Health Coverage (UHC) by 2032. As per Health Financing Strategy 2012-2032, it has also a target to halve the OOP expenditure to 32 per cent by 2032.

[email protected]