Dr. Zafrullah Chowdhury :
Expensive medical treatment, wrong treatment and poverty in Bangladesh
Bangladesh has the highest OOP (Out of Pocket Expenses) in Asia. Extremely high prize of medicine fixed in collusion with the government, high charges in diagnosis and surgery, and wrong treatment mainly cause medical services more expensive in Bangladesh.
Let me cite examples of high charge in surgical operations. Whereas IOL costs not more than TK. 2000 and Feko (?) its double, clinics often charge TK.50,000 or more for IOL and TK. 1,00,000 to TK.1,50,000 for Feko. Sometimes eye specialists, by illegal exchange with drug companies, cheat at selling a pain killing injection at TK.50,000. Aren’t these high charges a day light robbery? The educated and the media workers rarely call these charges into question .Orthopedists and cardiac and neurosurgeons charge TK.1,00,000 to 5,00,000 for operation.
In 1994, the BIDS researcher Hossain Zillur Rahman, in an extensive study, showed that the second important cause of poverty in Bangladesh was wrong, improper, expensive and unnecessary treatment as well as the lack of timely advice of doctors. The two other causes, as he mentioned, were natural disasters and the government’s inhumane behavior. Also the BIDS Director General Dr Binayok Sen found the lack of timely treatment, and high charge in medical services responsible for increasing poverty.
The World Bank ex-president Doctor Zim Young King, in his revolutionary book Dying for Growth: Global Inequality and Health for the Poor, identified global inequality and inconsistency, and unavailability of treatment for the poor as the main reasons of poverty. It is also worth mentioning that Sir Edwin Chadwick, Engineer, London West Minister Municipal Corporation, reported more or less the same reasons in a report in 1842. He reported that polluted environment, contaminated water, waste products and blockage in drains caused diseases. He added that the treatment of these diseases cost more, which ultimately caused poverty.
On 3July 2013, the then Health and Family Welfare Minister Prof A. F. M Ruhul Haque mentioned that doctors’ absence from hospitals was a great problem in health care service. Though there are good drugs in government hospitals, doctors there prescribe expensive drugs to buy from outside. Moreover, the drug-company representatives’ dealing with the doctors is known to all. So the prescription of a registered doctor and that of a fake doctor have an awful similarity in common. Because of doctors’ absence from hospitals, quacks are on the increase. In this regard, BMDC is not seen to play any effective role.
The history of social insurance
In 1871, Otto Von Bismarck united Germany into a powerful state which had been divided into many regions. German citizens introduced different types of social insurances to prevent people from leaving their country. Otto Von Bismarck introduced health insurance in the country to provide free health care for the poor.
He introduced a law in 1883 to provide medical services for the sick citizens. In the following year, he introduced the Accident Insurance Compensation Act, and in 1889, the Elderly Service Insurance Act. Otto Von Bismarck died on 30 July 1898. Social insurance began to be introduced in Austria in 1888, in Hungary in 1891, in Luxemburg in 1901, in Norway in 1909, in Switzerland in 1911 after the Bismarck social insurance. National Health Service Act got approved on November 6, 1946. Through the National Health Insurance, despite opposition from all classes of physicians, Health Minister Enuril Vivan launched National Health Service for all classes of British citizens.
Rabindranath Tagore took the initiative to introduce limited health insurance at the local level in Santiniketan.
Medicaid, a health insurance for the poor, was introduced in the United States in 1965. U.S. doctors vehemently opposed Medicaid, calling it a communist conspiracy.
Premiums are very high in the United States because health insurance is primarily regulated by private insurance companies. On the other hand, in Canada, in the United Kingdom and in almost all European countries, National health insurance is regulated by the government in the form of low-cost health care management. Generally, 1 to 2% of the salary of all government and private employees is deducted for health insurance. Norway, Finland, Sweden and Denmark deduct 5% for health insurance and add the same amount of premium from the government. The scope of national health insurance is much wider there. In developed countries, housing and unemployment benefits and services for the elderly include social health insurance.
In 1973, Gonoshasthaya Kendra introduced local health insurance at the rate of 2 taka per family per month locally in the village of Savar. The same amount of premium for both the rich and the poor families was not well received. The rich demanded higher benefits for higher premiums, and the poor considered lower premiums reasonable. Later on, Gonoshasthaya Kendra introduced social class based health insurance: 1. Very poor, 2. Poor, 3. Lower middle class, 4. Middle class, 5. Upper middle class and 6. Rich.
The success of local level health insurance in Gonoshasthaya Kendra is limited. Poor families get 60% health insurance, the middle class less than 15% and the rich the least. As a result, the insurance system could not be self-sufficient. Poor families give little premium. Those who have health insurance in Gonoshasthaya Kendra immediately rush to the Kendra when any one of their family members becomes sick. As a result, their health is relatively better. They have low infant mortality, maternal mortality, and elderly mortality.
(Dr. Zafrullah Chowdhury is founder and Trustee of Ganoswasthya Kendra).
