Pvt healthcare business booms

Rapid commercialisation to take service costs out of people’s rich, say experts
Private health care business is booming in the country on the back of people’s growing confidence in the services of private hospitals though they charge much higher than public hospitals.
A New Age investigation shows that treatment costs for heart related diseases are at least three times higher in the private medical hospitals than in the government hospitals.
The difference is also wide in treatment costs for major surgeries and ailments related to kidney and brain as well as cancer.
Private hospital executives acknowledge that their charges are higher but not unreasonable if their quality of services is compared with that in public hospitals. The recent growth in private sector health care services has prevented a lot of patients from going abroad and saved foreign currencies, they claim.
Official statistics show annual turnover of the country’s privately-run healthcare operators shot by seven times to Tk 2,040 crore in 2005-06 from Tk 302 crore in 1997-08. Health experts warn that huge growth in private health care systems indicates rapid commercialisation of public health, which means that quality treatment is going out of reach of the common people.
Limited facilities at the public hospitals force the people to choose private hospitals for expensive treatment of critical diseases like heart and kidney ailments, patients and their relatives say.
Shahidul Haq, a retired service holder, told New Age that he was admitted to the state-owned National Institute of Cardio-vascular Diseases after a massive heart attack in July 2007.
He was kept in a queue for one month for an open heart surgery, but no schedule was available, prompting the family to shift him to a private hospital.
The country’s lone specialized cardiac hospital in the public sector NICVD is swamped with patients from all over the country and getting schedule for an emergency heart surgery takes time due to queue of patients.
The institute performs at least 10 different heart related surgeries on an average everyday, said an insider of the hospital. Patients, who are unable to bear the treatment costs of private hospitals, have no choice but to wait for their turns to come, he said.
A survey by the Bangladesh Bureau of Statistics on the country’s private medical hospitals showed how the commercially-run hospitals, clinics and pathological laboratories mushroomed in urban centers despite soaring treatment costs in the backdrop of the limitations of the country’s outdated public hospitals.
Banking exclusively on cash-rich upper and mid-income people, these privately-run health institutions spend lavishly on infrastructures and logistics to ensure better treatment and comfort for the patients, taking health care costs beyond the reach of majority population.
Apollo Hospitals’ billing section official Ashiqur Rahman said heart related treatment costs under a nine-day package range between Tk 210,000 and Tk 230,000, excluding of VAT of 2.5 per cent.
Kidney transplantation costs Tk 650,000 while it charges between Tk 4,000 and Tk 5,000 for a single kidney dialysis. Neurology or brain related surgeries cost over Tk 50,000 while cancer related therapy costs around Tk 1,5000.
Compared to heart related treatment costs in Apollo, state-owned NICVD takes operation theatre charge of Tk 2,000 while a patient has to bear the costs of medicines and rings that would stand somewhere around Tk 70,000.
Labaid Cardiac Hospital spokesman Mejbah Azad said their average cost of heart disease treatments such as by-pass and putting rings in artery is about Tk 200,000 plus VAT.
Like Apollo and Labaid, other hospitals including United, Sidkar Medical, Mirpur Heart Foundation and Bangladesh Medical College charge more or less the same for heart surgeries.
The Labaid executive said many of these heart patients would have gone to India in the past. But nowadays 70 per cent of such patients get quality treatment at home at competitive fees.
Improvement in kidney treatment facilities in recent years have reduced foreign travels for kidney patients by 80 per cent, medical sources said. As many as 35 hospitals, both private and public, are performing more than 100 kidney transplantations every year.
Kidney Foundation Institute, a public private partnership hospital at Mirpur, charges around Tk 400,000 on an average for kidney transplantation, which is lower by 40 per cent than other private hospitals.
The daily charge for an intensive care unit bed in a public hospital ranges between Tk 1500 and Tk 2000, which goes as high as Tk 25,000 in a privately-run hospital. Though cheaper, leading public hospitals have a small number of ICU beds and people rush for ICUs at private hospitals to save critical patients. A few private clinics only offer ICU services and their men collect critical patients who are denied access to ICUs at government hospitals due to bed constraints or complicated procedures.
The BBS survey reveals 15 times increase in annual expenditures of the private health service providers in less than 10 years to 2006.
Annual expenditure of these establishments have soared to Tk 12,06.5 crore in 2005-06 from only Tk 74.7 crore in 1997-98, said the study.
The huge investments led to the rapid growth of private health care institutions, which now make up 81.17 per cent of the Tk 9100 crore value added services of the health care businesses’ contribution to the country’s GDP in 2005-06.
The contribution of the government’s health care system to GDP was more than 50 per cent in early 1990s, which diminished to a paltry 18.83 per cent in the year.
Experts said the BBS survey confirms the fear that the country’s healthcare is becoming increasingly privatized, with costs spiraling out of the reach of millions of poor.
‘Continuous increase in private sector healthcare cost means that proper access to healthcare is gradually going out of majority people’s reach,’ Prof Dr. Pran Gopal Dutta, vice-chancellor of Bangabandhu Sheikh Mujib Medical University said.
The number of privately run hospitals, clinics, nursing homes and pathological laboratories doubled to 4015 in three years to 2006, employing 56,184 doctors and health workers.
The number of beds in the private hospitals and clinics in 2005-06 were 29,056, which is 43.55 percent of the national total, up from 11,371 in 1997-98.
The last 10 years saw proliferation of private hospitals with global chains like Apollo and local pharmaceutical giant Square opening global standard hospitals in Dhaka. A lot more hospitals, clinics and diagnostic centres were established while existing ones expanded their facilities, while facilities at the public hospitals remained almost at the same levels as they were in 1971.
While private hospitals boast their success in reducing foreign tours of patients and saving foreign currency by their cost-effective services, there remains a question of ethics about the cost of services they provide.
Health officials and physicians said poor manpower and logistics against the huge rush of patients, both poor and well-off, limit the services at public hospitals, resulting in growth of private sector health care business and subsequent increase in treatment costs.
Senior medical professionals believe increasing facilities and manpower at the government hospitals is a must to ensure improved health services to the majority population. Specialist doctors’ pay must be raised to limit their private practice and lure expatriate Bangladeshi physicians into jobs back home.

Courtesy of NewAgebd