Private healthcare booms at poor's expense
Private healthcare has boomed over the last decade as commercially-run hospitals, clinics and pathological laboratories mushroomed in urban centers on soaring treatment costs in the name of better care.(The Financial Express)
Catering exclusively to cash rich upper and mid income people, these privately run health institutions are ripping off public pockets while narrowing the access of good healthcare to country's mainstream population.
A wide-ranging survey by the Bangladesh Bureau of Statistics, studies by private insurance companies who sell health coverages and anecdotal evidences have revealed the extent of this "disturbing trend".
The BBS survey released last month found that annual turnover of the country's privately-run healthcare operators have shot by seven times to Tk 20 billion in 2005-06 from Tk 3.2 billion in 1997-8.
It also shows that the annual expenditure of these establishments have soared by a staggering 15 times to Tk. 74.7 billion in 2005-06 from Tk. 12,065 million in 1997-8.
Their unbridled and unregulated expansion means private health care institutions now make up 81.17 percent of the Tk 91 billion value added to the country's Gross Domestic Product by the health sector in 2005-6.
The contribution of the government's health care system, which was more than 50 percent in early 1990s, has diminished to a meagre 18.83 percent.
Experts said the BBS survey confirms the fear that the country's healthcare is becoming increasingly privatised at the expense of tens 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 (BSMMU), said.
"This is also a question of ethics and social conscience because at the end of the day, providing health care is not a business, it is above all a social duty," he added.
The BBS survey says there were a total of 4015 private health care firms active in the country in 2005-06, which includes privately run hospitals, clinics, nursing homes and pathological laboratories. This number was only at 2003 in 1997-98.
"These are ominous signs. It depicts a sorry state of affairs in the country's public health care system," Dutta said.
These institutions employed 56,184 health workers including doctors and medical practitioners in 2005-6, up form 14,742 in 97-98. Most of these establishments are run in single ownership or partnership.
The number of beds in these 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.
Former health department officials said lack of accountability and services by public hospitals, poor compensations for government doctors and nurses and fund crunch led to this situation.
"Every year, new hospitals are popping up in major cities and towns in the country. They thrived on a systematic failure on the part of state-owned health case establishments," an ex-health ministry top official said.
Apart from their high cost, these private health care institutes are overwhelmingly urban centric spawning in and around posh urban locations while ignoring the need of the large rural or suburban mass.
"In the past three decades, at least five health policies were formulated by the governments to fix the chronic inefficiency problem in the public health care system," the former official said.
"But each has failed to improve public sector healthcare system in the country, allowing the space to be filled up by profit-hungry private hospitals and labs," he said.
Government figures show that although public expenditure in health has steadily risen over the years, accounting for nearly 10 percent of the budgetary expenditure, services by state-owned hospitals remained as poor as ever.
"There was no accountability, no major changes in the way government hospital serves people and no significant hike in doctors or nurses' compensation. As a result, government hospitals are now nobody's baby, despite huge annual cash injection," he added
According to the BBS, the government's budgetary allocation for health sector, which was 16,959 million in 1997-98, increased to Tk 42, 141 million in the year 2005/06.
Data by insurance companies also depict sky-rocketing costs in the private hospitals and labs.
"While a typical surgical operation would cost Tk 5,000 in a public hospital., the same surgical operation may cost Tk. 20,000-25,000 in a privately run medium quality clinic," said a senior insurance official.
A basic urine test in a government hospital typically costs Tk. 20, but the same test costs Tk 75-100 in a private pathological lab.
The official said while daily charge of an ICU bed in a public hospital ranges between Tk 1500 and Tk 2000, the rate would go as high as Tk 25,000 in a well established privately-run hospital.
"Since 2000 when our company started selling health insurance coverages, we have seen that health care cost is rising between 15-20 percent a year in private hospitals and clinics."
Private sector operators pointed that the rise in health cost in the private sector has, at least in part, been helped by the increase in price of medical equipment in the world market.
"Although the amount of profit made by these private clinics or hospitals has increased manifold lately, so is their expenditure," said an owner of a top private hospital in the city.
He said the price of a typical MRI scanning machine for example, which was Tk. 50 million five to six years back, has gone up to Tk 100 to 120 million.
The Bureau of Statistics survey also supports his view to an extent, as it found that lion's share in private healthcare operators' expenditure is made up of the cost of medical equipment.
"How I can cope with the rising cost of medical equipment as well as cost of land, construction, furniture, transport and the ever ballooning cost of specialist doctors," the owner asked.
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