HEALTHCARE SECTOR
BEYOND THE ‘WALLET BIOPSY’!
Janaka Perera highlights the challenges facing Sri Lanka’s healthcare services
Sri Lanka is one of few countries that has free healthcare. In recent years, both the state and private sectors have improved their healthcare infrastructure and service quality, and built a healthy human capital base.
But a key question today is how to address the growing challenges facing the health-care system.
Changing lifestyles, increasing fast food consumption and living in polluted environments are among the causes of aggravated health risks – including the rise of noncommunicable diseases (NCDs).
Consequently, more financial resources will be needed to meet the rising demand for easily accessible and affordable quality healthcare.
The depreciating rupee has also led to undermining spending power; the spend today is inadequate to meet the island’s healthcare needs.
Though state hospitals perform a commendable service despite shortcomings, less affluent patients are sometimes compelled to seek treatment from private hospitals in emergencies to avoid long waiting periods. This is why the ailing and their families may find themselves in serious financial difficulty when it comes to settling bills, depending on the nature of their illnesses and treatment.
In January, the Sunday Times reported that government hospitals were facing a crisis due to delays in appointing chairpersons and directors to state institutions. According to the report, these hospitals do not have sufficient drugs to treat cancer patients. This was attributed to the vetting process by a committee appointed by President Maithripala Sirisena.
Some patients needed medicine to start their treatment to stop the spread of cancer. Others had commenced treatment and needed to continue uninterrupted. And at the time of writing, one of the most effective drugs used for chemotherapy had been in short supply for more than two months.
The mismanagement of already inadequate resources leads to poor patient care, according to patients’ rights groups and healthcare unions. Substandard and expired medicines are also flooding the market. Indubitably, drug companies are doing what is expected of them to maximise financial returns for their shareholders.
It is no secret that many doctors are beholden to the pharmaceuticals industry since they’re paid for advising companies or delivering speeches on their behalf.
Former editor of the British Medical Journal (BMJ) Richard Smith likens the activities of the industry to organised crime in his foreword: ‘Is the pharmaceutical industry like the mafia?’
We often see media reports on patients in need of expensive surgery seeking financial contributions from the public and charities to undergo treatment either locally or abroad. In 2012, it was claimed that a majority of the population used private hospitals merely for outpatient care while approximately 30 percent used inpatient facilities.
Since government hospitals generally do not stock expensive drugs, there’s a dire need for the establishment of a system where the family of a patient warded at a state run healthcare institution can purchase expensive drugs and hand them over to the doctors. This approach would cost less than admitting patients to leading private hospitals.
As a wag said sometime back, the first test that a private hospital would conduct when a patient was admitted is a ‘wallet biopsy.’
What we need are more private hospitals that middle income groups can afford to seek medical services in or from. Private hospitals must now establish a system through which the public will know where they stand when patients are admitted. If this is done, only those who are confident they can settle their medical bills will admit family members to private hospitals.
When it comes to malpractices in hospitals, former Sri Lanka Medical Council (SLMC) Chairman Professor Colvin Gooneratne has called for sweeping legal reforms to protect patients from doctors.
He stresses the need for a system whereby the SLMC Court of Inquiry that looks into patients’ complaints includes laypersons (as in the UK) since the present process prevents independent evaluations of complaints. Addressing a media conference recently, he noted that SLMC had not found a single doctor guilty of malpractice.
The WHO Regional Health Financing Strategy for the Asia Pacific Region for 2010 to 2015 and the World Health Report (2010) highlights areas for reforms that would enable all people to have access to healthcare – i.e. promotion, prevention, curative and rehabilitative – without suffering financial hardships.
Societies, governments and international organisations must decide whether healthcare is primarily a service and secondarily a business… or whether it is primarily big business and a service secondarily. If it is the latter, then the majority of us may as well be prepared to face what former US Congressman Alan Grayson said in 2009 in response to a Republican attempt to stop affordable health care: “If you do get sick, die quickly.”
This sheds light on issues and concerns that rational people do not tend to realise: the cost of reasonable quality healthcare (after all, irrespective of what you spend or how you are treated, the final aim is for a full cure), ability for a speedy recovery (save health costs, resume to normalcy soon), safety, money factor and rights, all combined.
The mass scale importation of medicine by government healthcare services may compel people to seek low cost sources. Hence, the quality of drugs may at times be compromised. This may be somewhat all right as long as the patient doesn’t suffer from adverse conditions or allergies – as long as their lives are not at risk of a life and death situation.
Semi-government healthcare is a recommended and viable option. But given the attitude of our people that certain things should be given as they have been over the generations, this may perhaps lead to protest against violations of rights. Even the poorest can afford to consume illegal liquor and be sick but get free treatment from local hospitals.
Surely, a minimum can be charged from those who can pay. This will cultivate thoughts in their minds that medicine is not free (it is borne by public money and taxes), although they may not pay a price at government hospitals. Receiving an estimate of the probable cost of the private hospital treatment sounds ideal. But when doctors and healthcare staff manipulate, whether even an automated system is capable of providing such an estimate is questionable.
Finally, whether we have a watchdog behind healthcare misconduct at hospitals or by doctors remains a question. Many regularities seem to give doctors higher bargaining power, thus making things weak and worse for patients and the public.
Agree.
First we understood the economic situation of the country – where the low rate of economy made purchasing difficult. But when you look at the purchasing record of government authorities, they tend to ignore the above economic situation. The mismatch between money availability and purchasing decision is a major problem. Politicians and top government officials do not consider the real needs and actual beneficiaries. This shows absolutely no management practise on the government’s side, especially in the health care system.
Ignoring proper management and medical knowledge, and considering personal desire creates this problem. Giving higher authority and decision making powers for both, doctors and engineers, are a major drawback for the economy as well as the overall development of both sectors of the country. It is apprehensible that private health care organizations are business-driven, but what about government officials working in favour of those organizations instead of for the general public? Laboratory tests and drug branding are simple examples.
Do the SLMC or Ministry of Health ban this? One can never expect from these institutions. Ultimately, the Health ministry works for the benefit of the doctors; the electricity and water boards – for the benefit of the engineers. A very negligible section actually works for the people of this country and they should not be discouraged by this statement.