Bangladesh has achieved remarkable progress in the health sector, particularly in reducing maternal and infant/child mortality rates significantly. Life expectancy at birth increased significantly from 44 years in 1970 to 72 years in 2016. Interestingly, Bangladesh has made much improvement in the health sector with relatively low level of health expenditure. Since Bangladesh has made spectacular progress toward achieving millennium development goals (MDGs), the country is now looking forward to achieving sustainable development goals (SDGs) and making significant improvement in the quality of life for the people by ensuring healthy life and promoting well-being for all at all ages (SDG 3) in the coming years. There are different categories of health care in Bangladesh, such as, primary health care (e.g., community clinic, Union health centre), secondary health care (e.g. certified physicians in Upazila/District heath complexes) and tertiary health care services (e.g., specialist physicians). Health care services are being provided by both public and private health service providers.
The government adopted a liberalised business approach to develop the private sector under the industrial policy of 1986 and the country experienced establishment of hundreds of hospitals and clinics in the private sector in the decade of 1990 in line with the open market economy policy. In the 1980s, disposable income of the people of Bangladesh started increasing along with their increasing purchasing capacity leading to expansion of the medical services in the private sector and thus private hospitals and clinics started flourishing. However, it is only in the decade 1990s when quality medical service started growing with some large-scale entrepreneurships as a strategic business unit (S.B.U.)
The private healthcare industry embraces a large domain which includes medical care providers, physicians, specialist hospitals and clinics, nursing homes, hospitals, diagnostic centres, pathology laboratories and wellness centres. Bangladesh's private healthcare industry has grown to be one of the country's largest service-sector industries, both in terms of revenue and employment. This healthcare industry has been experiencing steady growth for the last few decades.
An ever-increasing population with its rising healthcare demands and a widening gap between the number of beds available and the number of patients, will give rise to increase in the number of healthcare service providers. Taking the advantage, many foreign players are also looking to enter the country.
According to recent reports, it is estimated that Bangladeshi people spend six times more at private hospitals than on public ones, contributing to the larger flow of revenue and resources in the private health care sector. The private sector started acting complementary to the public sector and in the course of time, the private sector started setting up their facilities across the country with affordable services. However, private healthcare facilities started gaining preference among the public due to the quality, efficiency, and reliability of the services.
The low-cost category private clinics in city areas, especially in Dhaka, might be clustered under the selling concept. Their main target is just to earn money by somehow operating a clinic. To promote their clinics, they usually set up their clinics either near government hospitals or close to the main road so that they can get patients even without ensuring quality and services properly by focusing on their products. The hospitals' eye-catching signboard having information about many of renowned doctors is a lucrative sales strategy for them.
On the other hand, the hospitals known as international standard hospitals like United Hospital, Square Hospital, Apollo Hospital etc. believe in the social marketing concept providing superior customer services at premium prices so that they can make money through customer satisfaction. As they focus on customer needs, they offer numerous health services under packages to serve the upper-middle class and upper class people. They follow an integrated marketing approach with a satisfactory combination of skilled doctors and nurses so that patients belonging to the upper and upper middle class can be diverted from their habit of going abroad for treatment.
Actually, our private health sector has been trying to be at par with foreign hospitals in terms of medical technology. But the service is still not up to the mark. At the same time, the accommodation cost far supersedes the treatment cost which happens because of our many reputed five-star hotel-like private hospitals in Dhaka. Many patients, satirically told, become more worried about hospital bills than their health condition. There are also complaints against many reputed private hospitals and clinics that they continue life support or keep patients in ICU/ CCU even after death of the patients to charge more bills.
Private hospitals and clinics in Bangladesh have started a competition to import costly diagnosis equipment and do advertisement to increase their customer base without increasing the basic service quality. Still our doctors advise the upper class people to go abroad for major surgical operation like brain's neurosurgery, because there is a probability of infection locally or doctors are not confident.
Post-operative care is still substandard. Most private hospitals and clinics have introduced consultancy centres inside their clinics or hospitals with specialist doctors as part of their marketing or promotional strategy. Even now most private hospitals are dominated by the doctors of government hospitals. However, few recognised hospitals have started having full-time regular doctors, not part-time.
The number of private medical colleges is increasing dramatically, because the private medical college business has become more profitable than private hospital business like a cash cow concept of marketing in many cases unfortunately.
Thus our private hospitals and clinics have not received people's full confidence yet, for which even many middle class Bangladeshi patients travel to neighbouring countries, including India, Thailand, Singapore and Malaysia for 'better treatment' which drains out our foreign exchange. According to the Export of Health Services survey conducted by the Directorate-General of Commercial Intelligence and Statistics of India, Bangladesh was the largest foreign user of India's health services exports in 2015-16. Of the 460,000 inbound patients to Indian hospitals, more than 165,000 were from Bangladesh accounting for the highest export earnings of about $0.34 billion in 2015-16. It said that the average earning per patient was $2,084 from Bangladeshi patients, the second highest next to $2,906 from Pakistani patients. In 2016, Bangladesh unseated the United States as the origin of the highest number of foreign tourists, mostly due to medical tourism, reported the New Delhi-based Business Standard.
To mitigate the mushrooming of private healthcare facilities, there were regulatory measures taken by the government. However, it did not alleviate the growth of the private sector. In today's economic scenario, private healthcare organisations are largely attracting investments from big industry players at a competitive level, since the industry offers high growth potential. The government should strictly regulate private healthcare services to maintain the quality of services. Appropriate policy guidelines with effective implementation are necessary to ensure quality outputs particularly from the private healthcare service providers. As a whole, a proper healthcare system is inevitable to have a healthy nation and we should address it with diligence.
Dalia Rahman, MDS, BRAC University
