Tuesday, March 12, 2013

Healthcare in developed nations ‘prices sans health insurance

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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