Rising cost of treatment and indifference

The size of the national budget has grown over time and the one for the next financial year (2015-16) is expected to be worth nearly Tk 3.0 trillion. However, the Bangladesh's budgetary expenditure on health is still smaller compared to that of many other developing countries.
Though the size of the budget has grown bigger the per capita public expenditure on health in Bangladesh has declined in recent years. The amount the government allocates to the health sector in the national budget now stands at only 0.73 per cent of the GDP.
Such a poor allocation of resources in the national budget is forcing the citizens to spend a substantial amount out of their own pockets on health. The World Health Organisation (WHO) estimates the average per capita expenditure need at $54 a year. The spending in Bangladesh stands at $27 and the government makes available only $9 out of it.
What is more distressing is that a large part of the public expenditure on health is misused, primarily due to systemic corruption. None knows for sure how much of the government allocation is actually spent on public health. It could be half of the allocation or even less.
The government, however, may tend to claim success since the life expectancy in the country has been on the rise and it, according to the latest data of the Bangladesh Bureau of statistics (BBS),  now stands at 70 years.
The increase in average life expectancy, surely, has not come without the improvement in health services. The public sector health services have expanded up to the union level at the grassroots. Notwithstanding the questionable quality of services that the public health facilities are offering, particularly to the poor and low income people, there have been some visible yet limited efforts to improve the situation in the sector.
However, it is the privately-owned health facilities and manufacturers and importers of drugs and medicines are dominating the health sector and they are the ones which consume most part of the out-of-pocket expenditures made by the citizens.
The government in the national budget for the next financial year (2015-16) has made a few proposals that would invariably push up the medical expenses at the individual level and most part of the hike again would be eaten up by the private health facilities and pharmaceutical companies.
If anyone enjoying the fruits of free market economy to the fullest extent in this country it is the pharmaceutical companies. In the absence of any official monitoring, these companies have been raising the prices of most pharmaceutical products at will. The prices of most medicines over the last couple of years have almost doubled. Volumes have been written and said about the price hike, but the relevant government agencies have maintained their indifference. Such indifference, according to many, is deliberate.
The drug manufacturers are out to make business by any means, fair and foul. So, they do know how to manage the officials and others who are supposed to regulate the activities in the health sector. The procedures adopted by the drug manufacturers to keep a section of high profile physicians satisfied by now are known to most people. How gifts, in cash and kind, are made available to these physicians to promote their own drugs is an open secret. However, the givers and takers of unethical benefits bother least about any sort of criticism.
The private health facilities that generally cater services to the middle and affluent classes have given rise to a mixed feeling about their presence. To many they are more of a 'necessary evil' if seen in the context of limited public sector health facility and their quality of service. But most people do not hold most of these facilities in high esteem. The quality of service of most private health facilities is better than their public counterparts but it is well below the international standard.
In the budget for the next fiscal year, a few tax proposals have the necessary ingredients to prompt the owners of private health facilities and pharmaceutical companies to make their products and services costlier.
In the budget for the financial years 2015-16, the finance minister has proposed an additional 2.4 per cent value added tax (VAT) at the stage of supplying pharmaceutical products to the traders. The additional VAT would be passed on to the consumers. That is how businesses operate in this country.
Similarly, the government has already put into effect a hike in duty rates of some surgical and medical equipment such as blood transfusion set, feeding tube, scalp vein set, suction catheter and urine bag. This would lead to increase in cost of treatment at both private and public health facilities. The public health facilities are supposed to make available all the necessary equipment free of cost to their patients. But the patients are usually left with no option but to procure the same from outside at their own cost.
The increase in cost of treatment would certainly put extra pressure on the wallets of the middle class and affluent sections of society. They will, however, manage. The middleclass will grumble initially and accept the increase as a fait accompli. But what is about the poorer section of society? These people would suffer most. They would continue consuming the medicines of sub-standard quality or languish in the corridors or verandahs of public health facilities.
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