Anarchy rules healthcare system

The state of the country's healthcare services has come to limelight again. The citizens are still being deprived of the minimum standard of healthcare service despite mushroom growth of private hospitals and diagnostic centres.

Due largely to lax monitoring and regulation by the authorities concerned, such hospitals and clinics are being run without any proper guidelines which are posing a grave threat to public health.

Private hospitals have created options for the people to seek health services from various facilities other than the government ones only. But these hospitals are allegedly exploiting the patients due to lack of their knowledge and helplessness. The laws too are ineffective and there are also multiple problems with compliance level too.

What is surprising is that more than 40 per cent of private hospitals, clinics, blood banks and diagnostic centres are not registered with the relevant government agency. According to the Director General of Heath Services (DGHS), there are 612 government hospitals, 128 secondary and tertiary level government hospitals, 484 government hospitals at upazila and union level, 4,280 registered hospitals and clinics and 9,061 diagnostic centres in the country.

Apart from the government-owned hospitals, the situation in private clinics and diagnostic centres outside Dhaka is even worse. They do not have proper equipment, manpower, doctors, nurses, emergency, ambulances and authorised blood bank needed for a full-fledged clinic.

What is worrying is that lax government monitoring and absence of clear laws and regulations allegedly help the private hospitals and diagnostic centres charge exorbitant fees from the patients. A patient coming to private diagnostic centre for pathological tests has to pay six to ten times higher than the fees charged by public hospitals. Shortage of manpower, lack of capacity and absence of regulatory measures made it difficult for the government agencies concerned to carry out proper supervision on such practice.

A comparative analysis of such tests carried out by the public and private hospitals witness a wide-ranging gap. The test examination costs of Glucose (Random), Serum Creatinine, Serum Uric Acid, Serum Cholesterol, Serum Calcium, Serum Bilirubin (total) should range between Tk 20 and Tk 40 inclusive of all expenses.

Dhaka Medical College Hospital (DMCH) charges a patient for Glucose (Random) test Tk 80, for Serum Creatinine Tk 50, for Serum Uric Acid Tk 100, for Serum Cholesterol Tk 50, for Serum Calcium Tk 80, and for Serum Bilirubin (total) Tk 60, totalling Tk 430. The DMCH follows a rate chart provided by the Directorate General of Health Services. All government hospitals and clinics follow the same rate chart.

But major private hospitals charge much higher for similar tests. The United Hospital charges a total of Tk 3030, Apollo Hospitals Tk 2910, Square Hospitals Tk 2760, LabAid Hospital Tk 2100 and Ibn Sina Diagnostic Tk 1316, according to the reports.

It is often alleged that there is no minimum regulation in the private healthcare sector. Many private clinics and hospitals use date-expired and substandard reagents for tests. They do not maintain protocol for quality assurance and most of them even don't have qualified technicians.

On their part, owners of the private clinics and hospitals, however, defend their position, saying that they charge higher fees as they have to pay commission on each test to the doctors. A doctor who recommends a medical test gets 30 to 50 per cent commission on a test from a private hospital. This is an open secret, and everybody knows it.

A number of brand hospitals say they charge high as they add value to their services. They claim they have world-class technicians, online delivery system and lifelong report-preservation system -- all these involve higher costs.

But a spokesman of the Bangladesh Medical Association (BMA) blamed the owners of private clinics and hospitals and pharmaceutical companies for creating such unhealthy environment in the healthcare sector. The commissions are basically a form of bribe. One company starts it and another must follow suit to survive. Such unhealthy competition has made our healthcare costlier.

However, private clinic and diagnostic owners association claims the private hospitals are playing a key role in ensuring healthcare for the people as the government alone can't do it. Such clinics maintain higher quality and invest huge money.

There are allegations that doctors, private hospitals, clinics and diagnostic centres and government officials concerned has created an unholy nexus to put the country on the list of nations with the costliest private healthcare. The private healthcare services are regulated under the 'Medical Practice of Private Clinics and Laboratories (Regulation) Ordinance 1982' which is not up-to-date to regulate such a large number of private health facilities.

There are allegations that a section of dishonest public hospital staff influence patients to get admitted into private clinics citing better treatment. Private clinics offer a slice of their income to these touts. Medicare services in public hospitals beggar description. It is hard to get proper services there. Specialist physicians are mostly busy with their private practices.

There is no denying a hell of anarchy prevailing in the country's healthcare system. Affluent people have little faith in local healthcare services. Going abroad for treatment is a regular phenomenon here. A substantial amount of foreign currency is being drained as a result.

Private hospitals in the country are supposed to treat at least 10 per cent of the poor patients free of charge. It is binding on them by the government as they get duty-free facilities in importing machineries and equipment. But the fact remains no poor patients get free treatment there.

Besides, poor doctor-patient communication poses as a hindrance to reaching correct diagnosis. Many doctors are reluctant to improve such communication which is one of the key elements of treatment. Whereas Bangladeshi physicians have proved their worth in treating diseases abroad, they give little importance on the good relation to heal patients in the country.

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