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The role of private hospitals in a crumbling health sector

01 Jul 2022

  • Service, availability, and convenience against costs, quality, and fears
  BY Sumudu Chamara   The lack of resources and funds has compelled the authorities to prioritise essential services, and the health sector is one of the key essential services that the authorities have to keep afloat despite the economic crisis. Even though measures are being taken to provide essential medicines and fuel for hospital staff in order to ensure their timely attendance, whether the services provided by public hospitals remain intact is a question.  According to several people who take treatments from private hospitals at present, including those who have taken treatments from public hospitals recently, improving the quality of public hospitals, which they think is not at a satisfactory level, is not a matter that the authorities should ignore anymore. According to them, it is because there are people whose only option is public hospitals, and because it can help prevent private hospitals from continuing to charge unfairly.   From public hospitals to private hospitals   According to some who spoke with The Morning, private hospitals are becoming a more famous place among those in the middle and low income classes too. The availability of drugs and doctors and not having to waste as much time that is wasted at public hospitals, are reasons. Explaining this, 38-year-old private sector worker V. Sanath Yasaratna, said: “There was a time when I did not choose private hospitals to get treatments because they are expensive. They still are expensive. However, when looking at the way that the country has changed due to the economic crisis, I think that I get a good service for the money I pay to private hospitals, which is sometimes better than the services of public hospitals. I used to take treatments from public hospitals a lot. However, some of them do not have the necessary medicines my father needs now, and therefore, they ask us to buy medicines from an outside pharmacy. It is like the only free service that we can get from public hospitals is the doctor’s service. To get that service, we have to wait in line for many hours. The reason why I choose private hospitals now is, even though I have to pay a lot of money, I do not have to waste my time. Most of the time, the doctor comes on time, and I know what time I have to be present at the hospital. I have to pay for the medicines, but there is no long queue. However, I must admit that with the prevailing drug shortage, there were times when even the private hospital from which I get services from did not have some medicines that I needed. However, in my case, it has not happened very often. Overall, I think that I get a satisfactory service from private hospitals for the money that I pay, as opposed to the free service I get from public hospitals for the tax money I pay.” He added that Sri Lanka should talk not only about fuel queues and liquefied petroleum gas (LPG) queues, but also hospital queues. “LPG and fuel are important, and the lack of those essentials is a serious issue. However, there are queues in public hospitals too, and they should receive attention. The main reason is the hospital staff’s inability to get fuel to commute to work, and it keeps worsening. I could afford to get treatments from a private hospital, but not everyone can do that. Regardless of the seriousness of the health conditions, some people’s only option is public hospitals. We do not talk about this adequately.” Thirty-four-year-old three-wheeler driver Hashan Kumara also shared a similar opinion about people shifting to private hospitals to get better treatments. He added: “Private hospitals’ treatments are not cheap, and sometimes, I spend several days’ worth of income to get treatments for just one time. But, my mother is 59-years-old and I want to get her the best treatments, and therefore, I started taking her to private hospitals several months ago. That was when Covid-19 was prevalent. Hospitals were filled with people, and except hospital staff, none of the service seekers seemed to care about following safety precautions. The worst part is, hospital staff were becoming rude to patients. They may have been under severe stress, but, that does not warrant them to be rude to patients. That is when I thought that I should look into my options in the private healthcare sector. I realised that even though they charge a lot, their services are quite admirable, especially when it comes to the manner in which they treat patients. They treat patients with dignity, and such treatments are important to elderly people like my mother. That is something that I am willing to pay for.” In the context of the current economic crisis, he said that even though private hospital charges have increased, that is bearable. “Earlier, getting treatments from a private hospital was seen as a luxury that only a few could afford. However, during the past two months, the prices of almost every service have increased, and when compared with the other price hikes, private hospitals are no longer luxuries.”   Improving services   However, not everyone seems to think that recent price increases in private hospitals are reasonable or affordable, in a context where there is a decline in the quality of certain services which has made private hospitals more preferable than public hospitals. In this regard, 42-year-old entrepreneur Harsha Perera (name changed on request), said that the quality of services provided by private hospitals is also dropping due to the current economic crisis, and that they are now more greedy for money than they were before. He added that they sometimes even resort to unethical practices to make money. He added: “I am taking treatments from private hospitals because I am more familiar with a certain doctor who provides treatments only in private hospitals. There was a time when private hospitals provided high quality services even though it was for a lot of money. However, it has changed. They are also trying to make as much profit as possible, and they seem to be trying to do it through increasing charges and providing the bare minimum services.” He described the quality drop which he said is becoming worse: “The waiting time has increased, because some doctors are not able to come to the hospital on time due to the fuel shortage. They also do not have certain types of medicines. While some they have delivered on request, some we have to buy from a pharmacy. What is more, there is a tendency to make patients feel that their health situation is in a serious state and to thereby influence them to do more tests, stay in hospital or take more treatments than is necessary. In addition, through the experiences of a friend who stayed for a few days in a leading private hospital in Colombo, I learnt that the quality of food provided to patients has also decreased while the price has gone up by around 50%. All other charges for doctors, equipment, medicines and document related work have gone up considerably.” In this context, he said, the Government should try to make the public health sector more efficient and people-friendly, and thereby stop private hospitals from exploiting patients. “If the public health sector had developed over time, perhaps, more people would be seeking treatments from public hospitals than from private hospitals. Nobody likes to spend money like this, and the exorbitant prices that private hospitals charge keep increasing very often. It is the successive Governments fault. They have let public hospitals remain underdeveloped, and private hospitals have been continuously increasing their standards. One may point out the fact that private hospitals charge money so that they can provide better services. In a way it is true. However, providing free health services through public hospitals I think is a mistake. The Government should have charged at least a nominal amount, at least to cover the cost of utility bills or maintenance, and such would have helped public hospitals to provide better services. This is a time when public hospitals should pay more attention to how people-friendly and updated they are.” Twenty-six-year-old private sector worker Nilushi Samarasekara (name changed on request), meanwhile said that the quality of services obtained from both private and public hospitals is decreasing, and that therefore, people should be more vigilant to protect their health. “This is really not a good time to be sick. There are no essential medicines, medical equipment, or even doctors who can come on time. If you go to a public hospital, you will have to wait in several queues for hours, and then buy most of the prescribed medicines from a private pharmacy. If you go to a private hospital, they will take as much money from you as possible and provide an ordinary service which is somewhat better than the services of public hospitals. Either way, you will end up spending a lot of money, and you are likely to get disappointed at some point during this process. The best thing is to protect your health.” Responding to a question on how the inadequacies in the two sectors should be managed, she said that the private and public health sectors should work together. “They should enter into some kind of agreement, and prioritise the people’s health above all. The private sector can contribute by increasing the quality of the health service, especially by introducing competitive policies, while the public sector can use its resources and contacts to ensure the timely procurement of medicines. If these two sectors join hands with a good understanding of what each party can contribute and expect from this collaboration, the people will benefit from it.” While people have the right to choose what health service providers they want to get treatments from, according to some who spoke with The Morning, they have shifted to private hospitals because they needed better services which they said they could not get from public hospitals. It is also the very reason that they think justifies the exorbitant charges of private hospitals. While improving services provided by public hospitals may be challenging at present, it should certainly be among one of the priorities of the Government in the future.

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