Private hospital bills are an invitation for bankruptcy

On Nov 23, 2018, the former director of Medical Services in the Health Ministry, Dr Dorothy Gwajima (pictured), spoke eloquently about the need of regulating the charges of private hospitals. My friends back home were excited that at last something positive would emanate from her statements.

I was not as excited because I know some of this is just rhetoric since the private medical sector is very powerful. Perhaps with the new permanent secretary who is a medic there may be some hope however it is the responsibility of the Chief Medical Officer to advice the Minister on this issue. The notion why private medical practice has complete freedom and is super-exploitive has long been a riddle in Tanzania.

I have written extensively in the past regarding this topic and fortunately President Magufuli has also spoken about the high cost of private hospitals but apparently there is intentional lethargy and inertia about this in the ministry.

Medicines sold to patients in these private hospital pharmacies have a profit margin of 600 to 1000 per cent while some laboratory tests have a profit margin of 1500 per cent.

Imagine a private healthcare system so unaffordable that a cancer patient must mortgage his or her home in order to pay for the drugs necessary to combat the disease, in an instant the cherished dream of owing a home disappears. Imagine also that every routine checkup or mild fever requires a long list of laboratory tests and expensive poly-pharmacy prescription that evaporates lifetime savings of a family.

All this happens day in day out under the eyes of the Ministry and there is total lack of any regulation to protect the exploited common person. Why? Paradoxically private medical practice is held in high esteem and is seen as divine.

There is no debate and evidence indicates that the private health sector plays a substantial role, especially in developing countries, and that the poor, in an unregulated environment, heavily use the private health sector. The regulation pertaining to registration and licensing of professionals and medical facilities are necessary but inadequate to reorient the private sector’s contribution toward achieving the goals of efficiency, affordability, and equity of health care.

There are three objectives in relation to the private provision of health care for conditions of public health importance: widening access, improving quality, and ensuring non-exploitative prices. A regulatory structure is needed for each of these objectives albeit it is difficult but service users (patients) are key stakeholders but unfortunately and at times intentionally patients are totally marginalised in the regulatory framework.

In this pertinent issue where are the professional associations like the Medical Association of Tanganyika (MAT), where are the so-called civil societies that should be in the forefront to protect the poor from this legitimatised exploitation.

Civil society plays a crucial role in enabling consumer voices to be heard and in serving as a watchdog. The private medical practice is so powerful that it has managed to neutralize the government, professional associations as well as civil societies.

In my discussions with colleagues in the private practice two defences’ are put forward, if you are poor go to a public hospital or get yourself a health insurance. Many private hospitals do not accept NHIF members and after all health insurance coverage is fairly low. If private hospital is only for the rich than why are they tax exempted? Can the businessman hike food prices and say if you are poor go on starvation.

It is pathetic that this is happening in the fifth phase government, which wants to have a priority agenda to help the poor. Strangely something is grossly wrong in the Ministry of Health. Patients often seek health care from private providers, including for conditions of public health importance such as malaria, tuberculosis, and sexually transmitted infections. The reasons cited by users include better and more flexible access, shorter waiting time, greater confidentiality, and greater sensitivity to user needs.

International policymakers are currently recommending greater use of private providers on the grounds that they offer consumers greater choice; increase competition in the healthcare market; and remove state responsibility for service provision, thereby encouraging its role as regulator and guarantor.

However, there is a concerned especially when unregulated the quality of care offered by many private providers is poor. If it is unregulated than there is no accreditation and this is worrying. What is happening in the private practice is unknown and there is total lack of transparency. Why is there opacity and secrecy in the private medical practice?

The growth of private health sector has with purpose been unplanned, unregulated and unaccountable. This has been primarily due to the state’s reluctance in not taking the responsibility of regulating, monitoring and making the private health sector accountable.

The legal framework related to medical care delivery is such that it provides some avenues to consumers to fight cases for compensations but provides no say in deciding the minimum quality of care.

This being the case, it is a big myth that the quality of care in private health facilities is the best. This is being spread mainly to discredit the public sector and to keep away all efforts at introducing some minimum and useful regulations over the quality of care and pricing in the private sect. It is time to stop lip service and do something concrete to stop this chronic super exploitation.

Zulfiqarali Premji is a retired MUHAS professor. His career spans over 40 years in academia, research and public health. He has authored over 100 publications. He resides in Canada. He can be reached via [email protected]>