The Independent
February 23, 2013
M. Serajul Islam
The
Patient Protection an Affordable Care Act commonly called Obamacare or the
Federal Healthcare Law will become effective from 2014. In the United States, nearly
50 million people have no health insurance because they are too poor to afford
it and hence have to depend largely on medicines available across the counter
in drug stores to self-treat themselves. Obamacare is going to make health
insurance available to most Americans as it will bring down healthcare
insurance to affordable rates. Healthcare in countries such as Canada, England
and most of the developed countries is the responsibility of the government. In
fact, this was the most compulsive argument in favor of Obamacare; that in the
world’s wealthiest nation, so many millions were being deprived of healthcare
because they could not afford to buy health insurance.
In
Bangladesh, government hospitals offer healthcare at costs that are affordable
for the common people. Unfortunately, compared to the need, the number of
hospitals is grossly inadequate and the quality of treatment is also a far cry
from what is required for comprehensive healthcare in a sovereign country.
Thus, we have seen in recent times in Dhaka and the district towns a mushroom
growth of private hospitals and clinics to supplement the humungous shortfall between
supply and demand of healthcare facilities in the country. In addition, to take
advantage of the rich in society, a few five star hospitals have also been
established mainly in Dhaka that in appearance look better than most hospitals
in the developed world.
On
the surface, there is little to complain about the hospitals for the rich that
can appropriately be termed as five star hospitals. The service is excellent but
only when it comes to registering. The service to attract patients is state of
the art. The staff gracefully receives the prospective patient/attendant and
instantly produces a computerized card faster than similar institutions in the
world’s leading capitals. Then the nightmare starts. With the state of the art
card in hand, the patients find that doctor/patient relation in these state of
the art hospitals is no better no worse than at any of the country’s government
hospitals. The doctors play God with the patients who are subjected to tests
and treatment for which they have no choice and end up paying bills that except
the filthy rich, others have to pay in a manner that is tragic. The charges are
so high that the fixed income group can afford to be treated in these five star
hospitals literally by raising money through borrowing or selling off valuables
in his/her possession.
It
is on how the fixed income people end paying for their treatment is what made
me write this piece. I was talking recently with a doctor in one of the 5 star
hospitals on this issue. I asked him if he or his hospital ever bothered to
find out how the patients paid their bills. I told him the bills are
exorbitant, almost comparable to what hospitals abroad charge for comparable
treatment but with one very important exception. Patients abroad do not pay for
such costly treatment out of their savings or from their pockets. Their bills
are taken care of by government in countries where healthcare is part of the social
safety net or insurance companies in countries such as for instance the USA for
which in most of the cases, the employer of the patients pay for their health
insurance. The doctor I spoke to was blissfully unaware and unconcerned from
where the patients paid their bills.
Our
government has not taken into view this major issue in allowing in the country
state of the art hospitals as in the developed world. Clearly there is an
anti-poor bias in allowing these hospitals to function. These hospitals also
are a trap for the ones between the rich and the poor (who cannot come to these hospitals for the prohibitive
costs), the unfortunate middle class. They are lured to these hospitals where
they end up paying for treatment that they can ill afford. In a city where
everything in public life is open secret by word of mouth, the public
perception about these hospitals is to say the least a negative one. In a
country where the medical profession has been made totally free from legal
action, there are stories about fate of patients of these 5 star hospitals that
would make the hair stand in one’s body. Patients die regularly without proper
explanation of causes. Patients leave these hospitals in worse condition than
when they had entered for treatment. A friend’s elder brother died a day after
a very well known heart specialist of one of these hospitals had released him
with unequivocal assurance that he could die of any other cause but not a heart
attack. He was found dead in the toilet seat from a heart attack!
Who
are these 5 star hospitals for? It must not be mistaken that they do not have
good doctors or treatment facilities. They do and some of the doctors would do
some of the best hospitals abroad proud if they had worked there. I saw this
myself recently. Someone in my extended family is one of the owners of one of
the 5 star hospitals. Someone in his immediate family had a heart attack. Given
her age and condition, she would not have survived in any other hospital. Here
she survived and now recovering because she was given attention that she could
not have bought for money anywhere else in the world! The question that
naturally arises is does one have to own a hospital to get the treatment that
is every patient’s fundamental right? The more fundamental issue here is does
the patients in Bangladesh have any rights at all?
The
five star hospitals raise quite a number of other very serious moral issues. In
the absence of health insurance, a large number of those who go to these end up
in debt to pay for treatment. For the majority of the people of the country,
these 5 star hospitals are comparable to
places where delicious eateries are spread around where the hungry are just
allowed to peep without any chance of
having a bite that makes their hunger all the more unbearable. Then there is
the issue of impunity. People who pay such high prices for treatment deserve
much better than they get at the moment because there is no enforceable law in
the country to hold these hospitals responsible when they are treated badly or
when the hospital shows the attitude that it simply does not care. Bangladesh is
a haven for doctors and hospitals. In civilized countries, doctors and
hospitals have to pay hefty sums insuring themselves against lawsuits from
patients. In Bangladesh, our “generous” society absolves the doctors and
hospitals from lawsuits and hence they don’t have to bother taking any such
insurance at all.
Then,
there is the case of double jeopardy for the patients. The doctors also have
“divine” blessings against legal prosecution for a different reason. Families
of patients often leave it to the Almighty when they have a death even when
they know for certain that the fatality was due to doctor’s negligence. They believe
that it was Almighty Allah’s wish their patient died that saves doctors and
hospitals from the wrath of those whose near and dear ones die for their negligence!
The writer is a retired career
Ambassador and Chairman, Centre for Foreign Affairs Studies, CFAS
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