Cry for ICU

Getting an ICU bed in a government hospital has become a matter of luck for its minimal charge.

As Covid-19 has taken a dangerous turn and hospitals are overwhelmed with serious patients requiring intensive care, the treatment cost has become a major concern, especially in private health facilities.

An ICU bed at a private hospital, though not easy to get one, means counting bills for every minute. In private hospitals, Covid-19 patients have to foot the bill, which is a large one and thus a huge burden since insurance coverage is almost nil.

Treatment of critical Covid-19 patients in private hospitals is expensive elsewhere in the world, but there is government's intervention and insurance support.

In Bangladesh, insurers are yet to work out any scheme to share the cost of treatment in private hospitals.

Demand for intensive care beds in Bangladeshi hospitals is increasing amid the alarming surge in Covid-19 infections, further laying bare the country's "insufficient" critical care capacity.

The line of critical Covid-19 patients waiting for an ICU bed in all public and private hospitals is getting longer with each passing day.

The moment a critical care bed is emptied after a patient recovers or dies, another one gets admitted to it immediately.

That is why many patients are dying in ambulances finding no beds vacant after visiting one hospital to another.

Most government hospitals shift Covid patients from wards to critical care beds when their conditions deteriorate. It is very difficult to make a room for the patients requiring critical care in an ICU bed straightaway.

Some people manage an ICU bed but in private hospitals at high costs. Families of many patients are finding it very tough to bear such expenses, leading them to financial distress.

Md Kamruzzaman, who contracted coronavirus 16 days ago, had been admitted to an ICU bed in the capital's Renaissance Hospital and Research Institute for over a week and undergone treatment there for a week. He had returned home after his health condition improved.

On Wednesday, the person aged over 50 again fell severely ill and required critical care. His family members are now moving from one hospital to another, including Dhaka Medical College Hospital, in search of an ICU bed, but yet to find any.

In government hospitals, ICU beds, oxygen and various medicines are provided free of cost. Only the essential medicines that are not available in the hospitals have to be bought.

In contrast, a one-day ICU bed cost in private hospitals ranges between Tk50,000 and Tk1 lakh alongside separate costs for buying medicines or injections.

Dr Shoman Aniruddha, an anesthesiologist at the ICU of Mugda General Hospital, told The Business Standard that ICU treatment cost in government hospitals is much lower than in private ones.

For example, if it costs Tk10,000 in a government hospital a day, it will be more than Tk50,000 in a private one. In private hospitals, bed rent, oxygen, doctor's rounds, and medicines are all billed separately, he added.

Dr Shoman said, "There is now not a single bed available in our hospital ICU.  Some 20-30 patients are on wait against one ICU bed. The situation in the first wave was not so terrible. Patients are dying at wards due to a lack of ICU beds, but we have nothing to do."

As of Wednesday, of the 602 ICU beds across the country, 169 are currently vacant, according to the health directorate. And, out of 305 beds in 19 Covid-dedicated government and private hospitals in Dhaka, only 20 beds are vacant. Only 11 beds are empty in government hospitals.

However, no ICU bed was found empty based on the health directorate's information. The directorate informs that there are four vacant beds in the United Hospital. 

But Dr Shagufta Anwar, director, (Communication & Business Development) at United Hospital Ltd, told TBS, "Our hospital does not have an ICU bed available. I am constantly getting requests from many people for general beds and ICU beds. But we have nothing to do. We are to keep everyone waiting."

The Covid treatment cost is very expensive, which is more than Tk1 lakh per patient a day, she said.

When contacted, Mubin Khan, president of the Bangladesh Private Medical College Association, told TBS that they have no plan to reduce the ICU bill or enter into an agreement with the government, given the critical situation, even though the costs of ICUs in private hospitals are very high.

"We are trying to increase ICU beds to the best of our ability following a directive from the government. But we have no plans to reduce costs," he said.

It is not possible to increase the number of ICU beds overnight because skilled manpower is required to operate an ICU. Many things are required. If the origin of the infection cannot be stopped, this situation cannot be dealt with only by increasing the number of hospital beds, he pointed out.

The number of ICU beds in hospitals in the capital has increased because of the infection spike but is not enough to deal with the situation.

Dr Farid Hossain Miah, director (Hospital & Clinics) at the health directorate, said, "We have added 100 more ICU beds to hospitals in the capital following a fresh surge in coronavirus infections in March this year.

Dhaka Medical College Hospital, Mugda General Hospital, Shaheed Suhrawardy Hospital and Kurmitola General Hospital have got 10 beds each. Besides, work is underway to install 200 ICU beds in Mohakhali DNCC Market Hospital, he added.

Addressing a World Health Day function on Wednesday, Health Minister Zahid Maleque said the government is struggling to provide treatment as infections are on the rise. Many patients are not getting services.

"General and ICU beds in hospitals have increased a lot. But we still cannot control Covid-19. If we follow the government's 18 instructions and the lockdown, we can return to normal life," the health minister added.

Health insurance

According to the insurance sector, the number of health insurance recipients in Bangladesh is very low. 

If those who have a health insurance policy catch Covid-19, they will get insurance benefits for treatment in a private hospital. 

The Insurance Development and Regulatory Authority (Idra) and the Bangladesh Insurance Association are encouraging insurance companies to launch new Covid-centric products.

Idra Chairman M Mosharraf Hossain told TBS that under the existing health insurance coverage, Covid victims will get insurance benefits if they seek treatment at a private hospital. 

 But there should be separate health insurance regarding Covid-19, he added. 

"Many people suffer from kidney, heart and neuro problems after being infected with Covid-19. That is why we are encouraging companies to launch Covid-centric insurance products," Mosharraf said.

The government formulated the "Health Care Financing Strategy 2012-2032" to ensure universal healthcare. After the successful piloting in Ghatail and Madhupur in 2017, it was supposed to expand its activities across the country in phases, but there is no initiative in that regard.

In this regard, the Idra chairman said no progress has been made in this regard yet. There was even an initiative to officially insure government employees and their family members. There have been several inter-ministerial meetings in this regard, but it now has got stuck as the decision has not been finalised yet.

Sheikh Kabir, president of Bangladesh Insurance Association, told TBS, "We are also advising insurance companies to launch new products related to Covid-19."

When asked whether a policyholder will get insurance benefits after dying from Covid-19, Zahurul Haque, managing director of Bangladesh Jiban Bima Corporation, told TBS, "We have sought an actuary's opinion on the matter. As there is a crisis of actuaries in the country, we take opinions from an Australian actuary, who formulated our guidelines. But we have not received any feedback from him yet. It will not be possible to take any decision in this regard without his opinion."

In Malaysia, Covid-19 treatment in government hospitals is free for both local and foreign patients. The Malaysian government has allocated a fund equivalent of Tk200 crore to pay for patients, who are shifted from government hospitals to ICUs in private facilities.

The Southeast Asian country has declared an emergency and passed a new law that empowers the government to co-opt private hospitals for dedicated Covid-19 treatment.

The association of private hospitals there has called upon the insurance companies to join the fight against the deadly disease and share the cost of treatment to relieve patients of burden.

Insurance companies are responding – some offering Covid-19 coverage to new policyholders, some are announcing new schemes, like Tokio Marine Insurance Covid-19 Treatment Assistance Fund.

Demands are also getting loud in India to lower the cost of Covid-19 treatment in private hospitals, capping the charge of hospital services and integrating insurance coverage as more than 80% of the population are without health insurance.

A public interest litigation has been filed with the Indian Supreme Court, seeking measures to reduce Covid-19 treatment cost in private hospitals. Some Indian cities successfully enforced a ceiling on service charges in private hospitals and helped patients get refunds from overcharging hospitals. At least one Indian state integrated 1,000 private hospitals with the government insurance company to share Covid-19 treatment cost with patients.

Critical patients admitted to general units in Chattogram

Meanwhile, Chattogram has also been facing a serious crisis of ICU beds.

Of 110 intensive care units (ICU) at public and private hospitals in the port city of Chattogram, 108 were taken as of Wednesday and hospital general admissions overwhelmed, with a flood of covid patients.

Mohammad Abdur Rob, chief specialist of Covid-19 management at Chattogram General Hospital, told The Business Standard that the spike in virus infections is worrying as they do not have any ICUs left.

"Many critical patients who need intensive care were getting admitted to general beds due to the dearth of ICUs," he noted.      

According to sources at the Chattogram Civil Surgeon's Office, 92-bed Chattogram Maa-O-Shishu Hospital had 95 patients on Wednesday, with all of its 16 ICUs occupied.

All 32 beds at The Bangladesh Institute of Tropical and Infectious Diseases in Chattogram's Faujdarhat were full on Wednesday. Al Manahil Nurture General Hospital had 33 patients against its 43 beds, while all 33 beds at Imperial Hospital were taken.      

There were 62 patients admitted to 56-bed Parkview Hospital Ltd. 

"Patients are being treated in all our nine ICUs and nine HDU [high-dependency unit] beds. Relatives of 10-15 more patients are still waiting for ICUs. All of them are lining up for an ICU, but we are helpless," said Dr Rezaul Karim, managing director of Parkview Hospital.

Chattogram General Hospital is the first specialised medical facility for the treatment of Covid-19 patients in the port city. All ten ICUs at the hospital were occupied on Wednesday and patients were also admitted to 90 out of 140 general beds there.

It is almost the same at Chattogram Medical College Hospital too.

Associate Professor of the Anesthesia department at Chattogram Medical College Hospital, Dr Harunur Rashid, said though the Covid-19 unit of the hospital has 180 beds, more than 160 patients were admitted to the unit as of Wednesday afternoon.

The physician said they have eight patients in ICUs, and two intensive care units have been left vacant for emergencies.