‘In no other country are hospitals and diagnostic centres separate entities’

The Bangladesh Competition Commission has found massive irregularities in the private healthcare sector after recently conducting a study. The study found that imperfect competition among the private hospitals is compelling patients to pay higher costs. Public health expert and Chairman of the Bangladesh Health Rights Movement Rashid-e-Mahbub spoke to The Business Standard to share his thoughts and insights on the issue. 

Recently, the country's Competition Commission conducted a study and found that there was imperfect competition among the private hospitals, which ultimately facilitated arbitrary increases in healthcare costs. What do you think are the reasons behind the imperfect competition and the inflated cost of healthcare in private hospitals?  

Who will set the price of treatment in a private hospital? Who is the authority? Based on what law? Till now, there has been no such law to regulate the private healthcare sector in the country. The government wanted to introduce a law to regulate the private sector hospitals, but the draft has been in the making for years. 

In the real sense of the word, there is no private healthcare service in Bangladesh. What currently exists in its place in the market are business entities. There is a global code of ethics for providing private healthcare services, although no such thing exists in our private hospitals. 

The hospital authorities set the price for medical care on their own. You will not find any country in the world where private hospitals charge such an unjustified price for healthcare facilities. 

To fix the price of healthcare in private hospitals, the government will have to sit with the stakeholders and make them abide by rules and regulations. 

The government will have to review the prices at regular intervals, with the health ministry verifying them. This way, every hospital can be held accountable for the amount they charge for their services. 

How can we get out of this situation? The foremost issue is whether we sincerely want to or not. I think our government does not have the willingness to bring the healthcare service under its control. The government has failed to pass a single law in this regard, till date. 

If it can pass such a law, the situation in private healthcare will, undoubtedly, improve. I believe the government will face resistance because there is a professional association involved. There will be a conflict of interest, but who will overlook the conflict of interest? The government will have to solve the conflict of interest. The state is all-powerful. The state will have to look after the greater interest of the people. 

What the government is doing now is playing the blame game because it does not want to take extra responsibility. 

Yes, the professional association may call a strike if the government moves to place regulations. But ultimately, a solution will come out. The owners of the private hospitals are connected to a lot of politically influential and powerful people in society. Why will the government go against them? 

Rashid-e-Mahbub. Illustration: TBS

The Competition Commission's report also suggests that we need to establish a Health Sector Commission. Why do we need a Health Commission?   

The government should form a separate Health Commission that will hear the issues raised by the patients, stakeholders and potential victims of the system. To receive proper health care services is a fundamental right, the responsibility of the commission will be to protect the rights of the people. 

This way, the government can hold the whole health sector accountable. We need the commission to draft new laws and to initiate reforms that hold the government accountable as well. 

In general, these health institutions [private hospitals] are monitored by local governments around the world while the main function of the central government is to supervise and monitor. 

In those cases, the government is itself playing the role of the commission. In our country, where the body whose task is to monitor neglects its duty, so who will hold the government responsible? 

So, there must be a separate health commission.

The study found private hospitals and diagnostic centres opt for importing costly diagnostic equipment and tend to pass the burden on to patients by raising the cost of healthcare without enhancing the quality of basic services. Do you agree with these findings?

There are some basic treatments for which we do not need high-tech diagnosis. But often, many doctors prescribe unnecessary tests to get a percentage of the revenue generated in the process. 

While medical specialists can and should prescribe more tests to make better medical decisions, they should not prescribe costly diagnostic tests to treat common diseases. Many hospitals import costly diagnostic equipment only for commercial purposes. 

The government will have to establish a regulatory mechanism to determine which hospitals can import expensive diagnostic equipment. The government should also regulate which hospitals can have the specific diagnosis equipment and whether the hospital can treat that particular disease. 

But our country is peculiar. The government gives separate licences for setting up diagnostic centres only. A diagnostic centre is always a part of a hospital and is supposed to be under the hospital. It is a backup service of the hospital. There is no other place in the world where the hospital and diagnostic centre are separate entities. 

Generally, the profit margins for diagnostic centres are more than 50 percent. On the other hand, hospitals do not make such huge profits because the cost of running a hospital is high. Most of the profit of a hospital comes from its diagnostic centres.