Bangladesh government hospital doctors will be able to see patients in their institutions from March 1. That is, the doctors will get private practice facility in the hospital after their duty in the government hospital and can see patients with money.
For this, they no longer have to go outside private chambers, clinics, pharmacies or private hospitals to see patients. BBC news.
Health Minister Zahid Malek said these things after an emergency meeting of the Ministry of Health and Family Welfare on Sunday. This activity is called Institutional Practice by the Department of Health. However, many public health experts say this decision may disrupt the services of patients who come for treatment in government hospitals.
How Institutional Practice Works
Doctors in all government hospitals in Bangladesh see patients from eight in the morning to two in the afternoon. Most doctors then see patients in private hospitals, clinics or private chambers.
Initially, after seeing the patients in the government hospital, it is being thought to provide the opportunity for this private practice from four in the afternoon to six in the evening. The health minister said that better services will be available at a lower cost than the cost of seeing a doctor outside a patient. He said, whatever fee the doctors charge outside, they will surely reduce the cost while practicing in their own institution. Moreover, the fee for all patients will not be the same. In this, patients can see specialist doctors at low cost. Those who are admitted will also get treatment. Many doctors will be available at the same time in government hospitals.
This will make it easy to find a doctor in the government hospital in case of urgent need. Also, the government hopes that government doctors will gradually be discouraged from private practice outside. Initially, 20 district and 50 upazila hospitals as well as five medical colleges will start the pilot program. The minister also said that the work of making policies is going on. This decision has been taken in consultation with the leaders of doctors, professional associations of doctors and the higher authorities of the ministry.
The minister also said that the policies will be finalized with the opinions of all concerned parties regarding the advantages and disadvantages of doctors in seeing patients at work, where the doctors will sit, how long they will see patients, how much will be their fees and who will see which patients. He mentioned that a high-level team and committee will be formed for the quick implementation of the plan and the said committee will inform the ministry.
Decisions without evaluation
Although this is the first time that the issue of institutional practice has been brought forward, the government has been providing palliative care to patients at Bangabandhu Sheikh Mujib Medical College (BSMMU) Hospital in Dhaka since 2011. After the working hours of the hospital, the specialist doctors of 26 departments are seeing patients for 200 taka per visit for the remaining five days except Friday and Saturday. This practice lasts till afternoon. For this, the sale of tickets for the special services of the external department started from 2:30 pm.
Public health expert Abu Jamil Faisal said that the decision to start a private practice in the government hospital was not correct without any evaluation on how fruitful the consultation was.
He also said that when this service was started, there was enthusiasm from specialist doctors, senior professors, associate professors and also patients. In the next it is seen that no senior is sitting anymore. They replaced the former private practice by placing junior medical officers. In other words, this service has not been implemented in practical terms. A decision had to be taken after evaluating these issues.
Will the quality of service increase?
It is alleged that a doctor in private practice outside a government hospital is not as sincere as he is in his own hospital. Many times the complaint of seeing patients in private chambers instead of going to the hospital is also a long-standing one.
In such a situation, if private practice is started in government hospitals, many doctors may take advantage of it and if that happens, the health care of government hospitals will come under more question, Faisal fears. He said, if the patient comes during the government service, the doctor can ask them to come during the private practice saying ‘I am busy now’. Then he went to the private chamber after seeing the patient for an hour. After that, if you want to see him, you have to go to the private chamber.
This will disrupt the range and quality of medical services in government hospitals, patients will be deprived of government services. As a result, he thinks there will be no benefit in this decision. The Ministry of Health said that even after institutional practice, doctors can do private practice outside.
Who will benefit: the patient or the doctor?
Although the scope of health care in Bangladesh has increased, the quality of service remains questionable in practical terms. According to public health expert Lenin Chowdhury, the government is emphasizing on facilitating the private practice of doctors instead of providing quality medical services to the population as a whole.
He said that the aim of the government should be to provide necessary medical services to all the people of the country. If this is not possible through the government’s own manpower, it needs to be done in combination with government and private manpower. Then development of healthcare sector is possible. Government should not aim to promote private practice.
According to him, it is necessary to first decide how many people the government can treat with its own manpower. If it is 40 percent, then attention should be paid to provide quality treatment to those 40 percent people. On the other hand, if the remaining 60 percent of patients have to receive services in private medical centers, then the government should ensure its quality and control the service prices. When the service is provided in the public sector, besides the doctor’s visit fee, health check-ups, medicines etc. must be arranged at the government expense.
He said, it is necessary to ensure free services for at least the poor to the very poor and also for the 6.4 lakh people who fall below the poverty line every year while seeking medical treatment.
He questioned whether there will be any fundamental change in the health care sector by expanding private practice in government hospitals without such planning. Public health experts say that there is no precedent in developed countries where doctors from government hospitals do private practice or institutional practice outside their workplace. However, they are encouraged to provide good treatment with generous salaries.
In that case, if it comes to serving more serious patients in government hospitals, then Chowdhury thinks that the doctors there should be paid like private hospitals instead of private practices.
According to Abu Jamil Faisal, it is necessary to provide adequate financial support to a government doctor so that they can spend their whole time on research and government medical services without allowing them to do any work outside of government healthcare.
On the other hand, he said, doctors of private hospitals are not getting the opportunity to develop because doctors of government hospitals are not allowed to see patients in private hospitals after seeing patients at their workplaces. Usually three nurses, five technologists are required against one doctor in providing good care. Bangladesh does not have this ratio.
Government hospitals do not have enough manpower. In this situation, the new decision does not say anything about how much help doctors will get from others while seeing patients in private practice in government hospitals. According to the Ministry of Health, the rate of receiving treatment abroad will be reduced by implementing more welfare-oriented plans. According to the Bangladesh Private Medical College Association, there are 6,000 public and private medical centers in Bangladesh. Still, every year at least five lakh people seek medical treatment abroad. Due to the lack of quality medical care in government hospitals as well as the exorbitant cost in private hospitals, the trend of going abroad for treatment, especially in India, is increasing day by day.