The need to regulate the prices and standards at private health institutions has once again come to the forefront as complaints regarding the private healthcare sector continue to increase.
Speaking to The Sunday Morning, Government Medical Officers’ Association (GMOA) Spokesperson Dr. Chamil Wijesinghe said that the main issue in regulating the private healthcare sector arose from the non-implementation of the laws governed by the Private Health Services Regulatory Council (PHSRC).
“There is an act with the council but there are many issues in it, which means it cannot be implemented properly. We have given our own proposals to amend it to implement it properly, including on the composition of the council itself. There are 28 members in the council, and of them, nine are the directors of private hospitals. Surprisingly, the quorum of the committee is seven,” said Dr. Wijesinghe.
He went on to say that since private sector healthcare services bore a bulk of the healthcare needs in the country (outpatient treatment – 40%, in ward – 10%), the sector needed regulation as patients deserved quality at a reasonable price.
“With the economic crisis, private healthcare charges surged significantly and we have doubts whether some were justifiable or reasonable. We have many complaints about this. This happened during Covid also and in some instances we had to bring strict price controls; it was the same during the dengue season too. The bulk of the complaints are about unreasonable prices. There is an increase in complaints after the economic crisis and now almost 90% is about prices.
“The quality of care is another factor. Although consultants and doctors may be unquestionable as they work for the State sector too, the qualifications of nursing staff and supportive staff get questioned. We need mechanisms to fill this gap and that’s what the commission is there for, but it is not functioning properly.”
Meanwhile, Sri Lanka Medical Association (SLMA) President Dr. Vinya Ariyaratne said that two of the main types of complaints were regarding the charges and the delays by consultants.
“Some of these patients come from far away places and we can’t assume that only well-to-do people go to private hospitals, so when consultants get late to come to their appointments, they are heavily inconvenienced,” said Dr. Ariyaratne.
Need for accreditation
University of Colombo Department of Economics Prof. Amala de Silva, who specialises in health economics, told The Sunday Morning that there was no attempt to check the quality of the private healthcare sector and urged the accreditation of private institutions.
“They talk about controlling the prices, but in my opinion it is more important to check who is providing the services and whether they are being provided properly. We see private hospitals everywhere, but there’s no overview into how they function. Many people fuss about controlling the cost, but the quality, skill, and training are even more important. Normally, you have to get an accreditation and at least update every couple of years, then people know not to go somewhere that is not accredited. As far as I know, there is no process of accreditation.”
She said that although medicine costs were high, the private sector may not be able to lower prices due to scarcity and the exchange rate. Commenting on the current crisis in the healthcare sector, she urged “rational prescription” so that patients were not overprescribed with medicines that they could not afford or that were not available.
Furthermore, she said that patients were likely moving away from the private sector due to the increased costs from the economic crisis and the increased transport costs.
“This is anecdotal evidence, but we’ve also heard that people are getting their prescriptions from pharmacies and depending on pharmacies, not going to either private or State healthcare. They either self-prescribe or ask a pharmacist to prescribe for them. If true, this is a worrying trend,” said Prof. de Silva.
Overcharged at a private hospital
Earlier this year, The Sunday Morning reported that Sanath Athukorala had been charged over Rs. 1 million for a 12-day hospital stay for his mother.
He claimed that in one instance, the hospital had issued a bill of Rs. 17,000 for a medicine which was priced at Rs. 6,300 at the hospital’s own pharmacy. He further claimed that he had been billed Rs. 33,000 for one injection which costs Rs. 12,000, and Rs. 19.05 for one panadol tablet.
He had complained to the PHSRC and the Health Ministry following the incident.
In a letter to the National Medicines Regulatory Authority (NMRA) in September, as seen by The Sunday Morning, the Health Ministry’s Emergency Raids Unit had instructed the authority to take legal action against the private institution for selling drugs over the MRP stipulated by it and to take action to ensure that the victim was compensated accordingly.
“The NMRA assured me that they would take legal action against the private hospital at the end of this month, but earlier in the year they were reluctant to do so,” said Athukorala, speaking to The Sunday Morning.
“This is an issue which affects patients around the country every day and this cannot continue because this is people’s money,” said Athukorala.
In a letter addressed to Athukorala in October by the NMRA, as seen by The Sunday Morning, the authority had said it would legally intervene regarding the matter in the future.
However, an official at the NMRA told The Sunday Morning that the NMRA had to complete investigations from its end in order to proceed to legal action, although he acknowledged that the hospital had violated pricing regulations.