Medical services in distress
Thursday, 6 November 2008
Shahiduzzaman Khan
Country's medicare services in the private sector are reported to have been doing an illegal practice. They are bringing in nearly 3,000 medical instruments allegedly by giving false declaration as duty-free imports of these equipment.
It was agreed upon earlier that nine big referral hospitals would enjoy zero import duty facility along with non-profit charitable organisations. The condition was that they would render services to the poor people at a reduced or free of cost. But in reality, such referral hospitals, that got permission for duty-free import, do not give any facilities at discounted or reduced rates to poor patients. The National Board of Revenue (NBR) is now considering withdrawal of zero-rated import facility that has been enjoyed and allegedly abused by the private hospitals since 2005.
According to a report published in the FE recently, a three-member committee will target others in the expanding hospital business gradually. The committee will examine whether the 'privileged' private hospitals maintained all the conditions while enjoying the import-duty exemption, whether the patients were benefited in quality or costs and whether any official irregularities took place in extending the facility to such hospitals.
Private hospital owners have otherwise been doing good business. They do not make payment of duties to the government on account of import of hundreds of medical equipment, but continue to charge very high for their medical services. It was expected that the people of modest and low income groups would get health services at lower costs and the poor would get some treatment free of cost from such hospitals. But that did not happen. Now the question is: Should any business, having no social commitment, get such duty benefit only to implement their for-profit or business operations?
The wider public perception has been that charges for medical services in the country's private hospitals are too high. Some such hospitals do also allegedly sell equipment, imported duty-free, out to other clinics for profit. The concerned revenue officials do also have allegations about some of the hospitals transferring funds abroad through over-invoicing of imported medical equipment. The government made medical equipment import duty-free in 2005 with a view to promoting quality health services in the private sector and putting a check on overall medical expenses, in foreign currency, by those who can otherwise foot the bill thereof. Bangladeshi people spend a very handsome amount of money in foreign currencies, ranging, according to a rough reckoning on a conservative basis, between Tk 20 billion and about Tk 30 billion for taking medical services from abroad.
The offer saw some big budget hospitals coming up in the private sector. It also attracted a few international hospital chains into the country over the years. There is no denying that this did have some good impact on availability of quality health services in the country. But the duty-free offer did not have any worthwhile effect on the costs of the services offered by the private hospitals. Such hospitals are yet to show any care about serving the poor. There are no free beds, even in a limited number, for the disadvantaged patients. The original statutory regulatory order, issued on June 2, 2005, stipulated that the duty-free import facility would apply only to medical equipment imports for non-profitable private hospitals. But it was later made open to commercial hospitals as well in 2006, following pressures from strong business lobbies.
The medicare facilities in the country for the common people, especially the poor ones, are otherwise in a shambles. There are infrastructures at the upazila and union levels. Yet there are no adequate medicines and no worthwhile services are available there. A good number of physicians posted at the upazila level still prefer to stay in the cities and towns, absenting themselves from duties, in one way or other, at their places of postings. Nor does any incentral system work for retaining the services of the doctors in publicly-run healthcare facilities in the countryside. There are also not adequate number of supporting medical assistants at the upazila level hospitals.
What really happens to the public hospitals and institutions, whether in cities or in the countryside, is known to everybody. There is no proper accountability for supplies -- medicines, equipment, accessories and other items -- that are made from the public exchequer for such healthcare-provide units.
Doctors in public hospitals or services are otherwise found to be busy with outside jobs in private hospitals and clinics. As far as the earlier move by the government to slap a ban on private practice by the public sector physician is concerned, there has been no progress yet to this effect. Admittedly, this is also a complex issues. Rational compensation packages are here relevant, besides the issues of a properly incontivised structure for doctors shunning private sector.
However, the general people are not much interested to know why the public sector medical practitioners should be doing private practice. In neighbouring India, private practice by the government physicians is otherwise prohibited. If anybody (government physician) is found to do private practice, he or she will have to quit his or her job.
The World Bank (WB) has earlier advised the government for contracting out the medical services to the non-government organisations (NGOs), private institutions of fame etc. This contracting-out does need to be based on a win-win situation. The private sector organisations must be chosen from among the lists of transparent and accountable firms and organisations.
In this context, the government may also consider transferring the management and operation of the large health sector entities to the overseas medical services groups and firms of repute. In the wake of chronic mismanagement, negligence and other alleged irregularities in these organisations, it is necessary that there should be an effective mechanism to streamline the activities of all such problem-ridden public healthcare institutions.
szkhan@thefinancialexpress-bd.com
Country's medicare services in the private sector are reported to have been doing an illegal practice. They are bringing in nearly 3,000 medical instruments allegedly by giving false declaration as duty-free imports of these equipment.
It was agreed upon earlier that nine big referral hospitals would enjoy zero import duty facility along with non-profit charitable organisations. The condition was that they would render services to the poor people at a reduced or free of cost. But in reality, such referral hospitals, that got permission for duty-free import, do not give any facilities at discounted or reduced rates to poor patients. The National Board of Revenue (NBR) is now considering withdrawal of zero-rated import facility that has been enjoyed and allegedly abused by the private hospitals since 2005.
According to a report published in the FE recently, a three-member committee will target others in the expanding hospital business gradually. The committee will examine whether the 'privileged' private hospitals maintained all the conditions while enjoying the import-duty exemption, whether the patients were benefited in quality or costs and whether any official irregularities took place in extending the facility to such hospitals.
Private hospital owners have otherwise been doing good business. They do not make payment of duties to the government on account of import of hundreds of medical equipment, but continue to charge very high for their medical services. It was expected that the people of modest and low income groups would get health services at lower costs and the poor would get some treatment free of cost from such hospitals. But that did not happen. Now the question is: Should any business, having no social commitment, get such duty benefit only to implement their for-profit or business operations?
The wider public perception has been that charges for medical services in the country's private hospitals are too high. Some such hospitals do also allegedly sell equipment, imported duty-free, out to other clinics for profit. The concerned revenue officials do also have allegations about some of the hospitals transferring funds abroad through over-invoicing of imported medical equipment. The government made medical equipment import duty-free in 2005 with a view to promoting quality health services in the private sector and putting a check on overall medical expenses, in foreign currency, by those who can otherwise foot the bill thereof. Bangladeshi people spend a very handsome amount of money in foreign currencies, ranging, according to a rough reckoning on a conservative basis, between Tk 20 billion and about Tk 30 billion for taking medical services from abroad.
The offer saw some big budget hospitals coming up in the private sector. It also attracted a few international hospital chains into the country over the years. There is no denying that this did have some good impact on availability of quality health services in the country. But the duty-free offer did not have any worthwhile effect on the costs of the services offered by the private hospitals. Such hospitals are yet to show any care about serving the poor. There are no free beds, even in a limited number, for the disadvantaged patients. The original statutory regulatory order, issued on June 2, 2005, stipulated that the duty-free import facility would apply only to medical equipment imports for non-profitable private hospitals. But it was later made open to commercial hospitals as well in 2006, following pressures from strong business lobbies.
The medicare facilities in the country for the common people, especially the poor ones, are otherwise in a shambles. There are infrastructures at the upazila and union levels. Yet there are no adequate medicines and no worthwhile services are available there. A good number of physicians posted at the upazila level still prefer to stay in the cities and towns, absenting themselves from duties, in one way or other, at their places of postings. Nor does any incentral system work for retaining the services of the doctors in publicly-run healthcare facilities in the countryside. There are also not adequate number of supporting medical assistants at the upazila level hospitals.
What really happens to the public hospitals and institutions, whether in cities or in the countryside, is known to everybody. There is no proper accountability for supplies -- medicines, equipment, accessories and other items -- that are made from the public exchequer for such healthcare-provide units.
Doctors in public hospitals or services are otherwise found to be busy with outside jobs in private hospitals and clinics. As far as the earlier move by the government to slap a ban on private practice by the public sector physician is concerned, there has been no progress yet to this effect. Admittedly, this is also a complex issues. Rational compensation packages are here relevant, besides the issues of a properly incontivised structure for doctors shunning private sector.
However, the general people are not much interested to know why the public sector medical practitioners should be doing private practice. In neighbouring India, private practice by the government physicians is otherwise prohibited. If anybody (government physician) is found to do private practice, he or she will have to quit his or her job.
The World Bank (WB) has earlier advised the government for contracting out the medical services to the non-government organisations (NGOs), private institutions of fame etc. This contracting-out does need to be based on a win-win situation. The private sector organisations must be chosen from among the lists of transparent and accountable firms and organisations.
In this context, the government may also consider transferring the management and operation of the large health sector entities to the overseas medical services groups and firms of repute. In the wake of chronic mismanagement, negligence and other alleged irregularities in these organisations, it is necessary that there should be an effective mechanism to streamline the activities of all such problem-ridden public healthcare institutions.
szkhan@thefinancialexpress-bd.com