Regulating private hospitals | Sunday Observer

Regulating private hospitals

12 March, 2023

Just about one month back, I underwent a cataract operation at a leading private hospital in Colombo. The insurance took care of my costs, but that is not the issue I am really concerned about. The final bill came to almost Rs.70,000, and when I examined the bill using my other eye (they put a patch over the operated eye), I was rather surprised to learn that the hospital has charged Rs.35,000 for “eye treatments”, not counting the Intra-Ocular Lens (which I bought separately for Rs.40,000) and the Doctor’s fees.

There really was no explanation as to what really consisted of the so-called eye treatments. This did not affect me personally as the insurance settled the money directly with the hospital, but if I had to pay the charges out of pocket I would really be concerned over this total lack of transparency.

I guess it is a simple matter of breaking down the invoice into the various components. If they tally and add up to Rs.35,000 (or whatever other amount), the patients would have no qualms about paying the money, either with their own funds or through a health/life insurance policy. But right now, this situation creates a lot of doubts and confusion, as we have to guess what the costly “treatments” might be.

No proper regulations

It has been highlighted in the media many times that the charges levied by private hospitals are not transparent and moreover, they are exorbitant in many cases. There has been plenty of talk about regulating private hospitals and putting a lid on their prices for hospital stays and diagnostic tests. However, the latter action was seen only on a few recent occasions.

One instance was when the private hospitals initially made a killing on the Rapid Antigen Tests (RAT) and Polymerase Chain Reaction (PCR) Tests for Covid-19. Then the Government stepped in and slapped maximum possible prices on both tests – Rs.2,000 per RAT and Rs.6,500 per PCR. This was a great relief for the patients, as Sri Lanka, unlike many other countries, did not have on-demand free walk-in testing.

A few random checks were done, but those who required a PCR or RAT test for leave or overseas travel had to get one from a private hospital. The only silver lining was that the Covid-19 vaccines were given free by the Government, with no private sector involvement. There is no doubt that they would have priced the vaccines to earn huge profits if given a chance to do so.

Another instance was when, during a calamitous dengue outbreak in the Western Province and some other areas a few years ago, the Government declared a maximum price for the NS1 Dengue Virus Antigen Test – Rs.1,500, as opposed to the RS.6,000 that some hospitals were charging. This was hugely beneficial to the patients who were at the end of their tether as a result of mounting expenses. Since dengue has reared its head again, the Government should again declare a mandatory maximum price for the NS1 test. Understandably, this would cost more than Rs.1,500 due to higher forex exchange rates, but it could still be given at a reasonable rate.

Unfair charges

Similarly, hospitals charge various amounts for tests, surgeries, and even medicines. A recent report highlighted that one leading private hospital has charged Rs.33,000 for a pill that costs only Rs.6,000 to import, even at the higher forex rates. These claims, which have apparently not been denied by the hospital concerned, must be investigated thoroughly. If true, this amounts to fleecing the patients on a massive scale.

The prices for even a simple test can vary greatly from hospital to hospital. An Electrocardiogram (ECG) that costs Rs.700 at one hospital can be priced at Rs.900 at another. A Caesarian surgery that costs Rs.150,000 at one hospital could run well over Rs.200,000 at the hospital next door. Worse, hospital charges for channelling a doctor can go over Rs.1,000. This is apparently for the chairs, the toilets and the air-conditioning. But at this price, they might as well throw in a cup of tea as well. Remember, the hospitals earn a good sum from the doctors as well, as they hire the consulting booths at a substantial cost.

Even the parking rates at hospitals are very expensive. The patient has to pay the hospital twice this way – for whatever services obtained inside and for parking. In some countries, it is not even legal for hospitals to charge parking from patients and their families.

All these factors should be considered by a Private Hospital Regulatory Authority which has been proposed many times, but is yet to see the light of day in a proper manner. In lieu, Governments bring in piecemeal laws to regulate various aspects of private hospitals. Some of these are conveniently forgotten by the private hospital authorities with the passage of time. Such an Authority could regulate the pricing structures for medicines, surgeries, rooms, diagnostic (blood and fluids) and imaging (MRI, X-Ray etc.) tests.

A prudent move

President Ranil Wickremesinghe recently proposed the establishment of non-paying wards in private hospitals, a move that will help the less affluent to avail themselves of various services from private hospitals, especially in instances where certain advanced tests and treatments are still not available at the State hospitals. This is a sound idea, but it should be tightly regulated lest the hospitals cut corners with the patients who will not pay the hospitals anything upfront. In other words, they should get the same attention that the paying patients get. Perhaps the health insurance scheme proposed by the President for the underprivileged communities will help in this regard.

Our health authorities should study how countries such as Singapore regulate the private healthcare industry to provide a win-win situation for patients across the board. Talking of Singapore, the tiny City State attracts thousands of medical tourists from around the world each year. Some of our private hospitals are equally advanced as the ones in Singapore and if enough publicity is given, may be able to attract similar numbers of medical tourists. The Government must work on this and other new vistas for our Government and private healthcare service to make it second to none in the world.