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Specifics about where private medical practice is exploitative

My recent article on this subject has stirred a debate, many are questioning why the government is doing nothing while one reader asked me to be more specific with examples how private medical practice is super exploitative. In this article I explain broadly the specifics of this super exploitation with a specific example of one important issue of caesarian sections for the purpose of delivering a baby. But first what areas within the hospital need to be regulated to curb exploitation.

First and foremost there should be a regulation regarding profit margins in pharmacy and laboratory. When a patient is given any medicine whether as an outpatient or inpatient how much profit margin can the hospital have, because the variation between hospitals is too big thus there should be a cap to this. Inpatients are mostly affected by this because inpatients are a sort of captive client who has no choice but to buy the prescribed medicines from the hospital pharmacy at the cost that is dictated by the hospital. Is there any regulation and if yes is it implemented and how and what are the findings? Can the MoH show a report about this? Importantly are the prescribed medicines really necessary or is this poly pharmacy in order to make money?

Laboratory is the next place where regulations are needed because first the cost of the tests vary a lot between different private facilities and also the profit margin is exorbitant. How is this regulated? Are the tests needed or is this money making enterprise totally immune to any regulation.

One reader was of the opinion that even public hospitals are exploitative, he sent me the price list of tests and procedures (attached) displayed in some of the public hospitals. I totally condemn any form of exploitation be it private, faith based or public hospitals but at least in public hospitals the price list is openly displayed and there is no secrecy. There is no such example of transparency in any private hospital.

The ideal rate for caesarean sections in any facility is about 10 per cent, this is the globally accepted rate. But caesarean sections have increased in both developed and developing countries to about 35 per cent and this now is purely a moneymaking procedure.

When medically justified, a caesarean section can effectively prevent maternal and perinatal mortality and morbidity. However, there is no evidence showing the benefits of caesarean delivery for women or infants who do not require the procedure. As with any surgery, caesarean sections are associated with short and long-term risk, which can extend many years beyond the current delivery and affect the health of the woman, her child, and future pregnancies. These risks are higher in women with limited access to comprehensive obstetric care. Every effort should be made to provide caesarean sections to women in need, rather than striving to achieve a specific rate or make it a moneymaking procedure. Can the Ministry of Health show the caesarian rates in private as well as in public hospitals?

Numerous recent studies have found that C-section is leading towards the birth of bigger babies and smaller birth canals in women. In the future, women may not be able to give birth without having a C-section.

Most women undergo C-section due to a condition known as cephalo-pelvic disproportion, where a baby’s head is too big to pass through maternal birth canal. C-section is also needed if the baby didn’t flip into the correct birth position.

The above are just examples of areas where private medical practice is exploitative and the need to have a regulatory framework. There are many other areas that also need regulation.

The entire issue of charitable or philanthropic hospitals as private facilities is debatable. All private medical facilities that have a label of charity is to a very large extend misleading and a disguise to exploit since they are commercial enterprises with the goal to make money. To be fair they are parasitic institutions sucking the hard earn money of poor people because those entrusted to protect the population have been neutralized through corruption.

I am not against private medical practice making profit; the problem is disguising a commercial enterprise as charity to avoid taxes and conducting cosmetic events to justify their exploitation. Another misleading issue is the development budget of private hospitals as a means to justify exploitation. It is never transparent, what fraction of the profit is reinvested?

The opacity and the super exploitation needs to be addressed by putting in place regulatory framework and if this is not done it is a matter of time that citizens will go to seek justice in the court of law as it has happened in other developing countries.

Ministry of Health is busy blowing its trumpet of how successfully it is developing the health sector by presenting raw data with misleading inferences; one area they should be concerned with is the super exploitation of the poor by the private medical practice.

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]>