Disciplining errant private hospitals, clinics

Disciplining errant private hospitals, clinics

Private hospitals, clinics and diagnostic centres are getting mushroom growth in the country due to high profiteering. People are often being cheated in the name of getting healthcare services, mainly due to the government's lack of necessary control and monitoring.

A recent Transparency International, Bangladesh (TIB) study revealed that profit-oriented private healthcare services are being operated in the country without maintaining proper rules and regulations. Unavailability of time-befitting laws, poor enforcement of the existing ones, lack of government monitoring, undue political influence in management and high profit-making attitude of the private sector hospital owners are responsible for the situation.

Amid surging needs of the people, the number of private healthcare facilities rose to 15,698 units in 2017 from only 33 units in 1982. Due to inadequacy in public healthcare establishments, the private clinics are making steady growth, as more than 63.3 per cent people receive treatment from the private sector.

The private healthcare services are regulated under the Medical Practice of Private Clinics and Laboratories (Regulation) Ordinance 1982 which has not been updated in order to regulate such a large number of private healthcare facilities. The government took a number of initiatives in the past to amend and formulate new laws and regulations for private medical services. But it could not go ahead with the plan for unknown reasons. Some say private clinics and hospitals have become so powerful that they create obstacles to amending and formulating laws. 

The private clinics very often charge the patients arbitrarily due to poor law enforcement. The irregularities in private medical centres located in zila and upazila levels are much higher than those operating in the city areas. It was observed that many hospitals start operations without registration, while the owners pay Tk 5,000 to TK 3,50,000 as bribe to get these registered.

Most of the hospitals and diagnostic centres lack required number of physicians, nurses, medical assistants and instruments. According to official statistics, the country's private hospitals require 47,056 nurses according to their number of beds. But there is a shortage of 20,281 nurses. The medical facilities often subject their patients to unnecessary treatment.

Coming under pressure from the hospital owners, the doctors concerned conduct caesarean delivery unnecessarily and even much earlier of expected date of delivery. The rate of caesarean delivery is around 80 per cent in the private sector hospitals, 38 per cent in the state-owned hospitals, and 28 per cent in the NGO-run ones, according to reports.

The private clinics and hospitals charge the patients at their whim. The costs of some tests are 20 to 50 times higher than the rational fees. For example, ultra-sonogram of whole abdomen, a type of medical test, costs Tk 220 at Dhaka Medial College Hospital (DMCH) while it is up to Tk 3800 in some private clinics and diagnostic centres. Lax monitoring and absence of clear laws and regulations compel a patient to pay six to ten times higher than the fees charged by public hospitals.

The government, however, claims that the shortage of manpower, lack of capacity and absence of regulatory measures made it difficult to carry out proper supervision on the private healthcare facilities. Many private clinics and hospitals are using date-expired and substandard reagents for tests. They do not maintain protocol for quality assurance and they even don't have qualified technicians. But nobody is there to monitor the those.

The private clinics and hospitals, however, defend themselves, saying that they charge higher fees as they have to pay commission on each test to doctors. A doctor who recommends a medical test gets 30 per cent to 50 per cent commission on a test from a private hospital, insiders say.

Many physicians admit that commission system contributes to the higher charges of private healthcare. But they blamed the owners of private clinics and hospitals and pharmaceutical companies for creating such unhealthy environment in the healthcare sector.

Authorities of brand hospitals in Dhaka say they charge high as they add value to their services. They have a whole bunch of world-class technicians, online delivery system and lifelong report-preservation system. All these involve costs. Besides, they maintain higher quality and invest huge amount of money. So, they need to earn profit from their investment.

Many pharmacists believe the private clinic owners should not be blamed for not having proper regulations and inspection and monitoring system in place. In fact, the government is yet to frame necessary updated regulations. The authorities are even failing to regulate whimsical fees being charged by some private hospitals and clinics.

The health budget for the fiscal year 2017-18 is Tk 206.79 billion, an increase by Tk 31.63 billion from last fiscal year's. It is 5.2 per cent of the total budget. The figure was 5.1 per cent in the previous fiscal. According to the World Health Organisation (WHO), the allocation for healthcare should be 15 per cent of the total budget.

Much of this allocation was supposed to be spent for establishing 392 community clinics and expansion of telemedicine services at district and upazila levels. But that was hardly done as yet.

However, between 2008 and 2015, nearly 24 'referral' private hospitals have enjoyed duty-free facility on the import of medical and hospital equipment since 2005, which has not been reflected in fixing prices for their services, according to the National Board of Revenue (NBR).

In these circumstances, necessary laws need to be put in place with a view to enhancing the government watchdog's capacity and taking stern actions against irregularities being committed by the private hospitals and clinics.

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