Medical treatment in private hospitals at government expense

The government has initiated a measure to provide medical services to people at private hospitals using public funds.

Concerned officials said the initiative has been taken to reduce the huge pressure of patients at Dhaka Medical College Hospital (DMCH).

However, questions remain as to why patients should be treated at private hospitals instead of increasing the facilities and capacity of DMCH.

Aiming to reduce the pressure of patients at DMCH, the government has contracted four health facilities to provide treatment in exchange for government incentives.

Three of the facilities are medical college hospitals.

Experts said previous experiences with public-private partnerships in the healthcare sector have not been positive.

Health management expert Professor Dr Abdus Sabur Khan said that if the government wants to ensure quality healthcare services, it should invite open tenders instead of selecting specific hospitals.

Because signing an agreement will not be sufficient to obtain good results. There is no strong monitoring mechanism to avoid irregularities like witnessing five patients and billing for 15.

Recalling past experiences, he said, “Due to a lack of capacity, situations like involving Regent Hospital and Dr Sabina arose during the COVID-19 pandemic. Even at the National Institute of Kidney Diseases, dialysis services were operated by a private organisation, Sandor, while government employees were kept sitting idle.”

Dhaka Medical College Hospital is the country’s largest healthcare facility which has 2,600 beds on paper. Nevertheless, in between 5,000 and 7,000 patients are regularly admitted there.

According to data from the government’s health department, a portion of patients admitted to Dhaka Medical will be referred to private hospitals under a government-managed system. They will receive all facilities including medicines and diagnostic tests at those hospitals. The government will pay the bills after settling the accounts at the end of each month. A draft policy has already been prepared. However, it has not yet been finalised which diseases will be treated, how much of the cost the government will bear and how much the patients will have to pay.

Four Hospitals on the List

As there are no large private hospitals in the vicinity of Dhaka Medical, the government has selected four hospitals in Tejgaon, Gulshan and Badda. One of them is M H Shamarita Medical College and Hospital in Tejgaon. The government has taken an initiative to purchase healthcare services from the 525-bed facility. The other three are Impulse Hospital in Tejgaon, Shahabuddin Medical College Hospital in Gulshan and United Medical College Hospital in Badda.

Shamarita authorities said a team led by Professor Dr Nazmul Hossain, Director General of the Directorate General of Medical Education, visited the hospital around three months ago. The team members inspected the hospital’s overall capacity to provide healthcare services.

Professor Dr Sirajul Islam, director of Shamarita Medical College and Hospital, told Asia Post, “In principle, it has been decided that patients will be sent to our hospital to ease the pressure on government hospitals. We will provide all kinds of treatment facilities and the government will pay the bills.”

He said, “If patients from different departments including medicine, surgery and gynaecological surgery receive this facility, people will get better access to healthcare. At the same time, the situation where patients are forced to return without receiving treatment on the floors or verandas of government hospitals will be reduced.”

Asked on what basis four hospitals had been selected, Professor Dr Nazmul Hossain, Director General of the Directorate General of Medical Education, told Asia Post, “Private medical college hospitals do not have enough patients. As a result, students are being deprived of proper practical training. On the other hand, government hospitals like Dhaka Medical are struggling to cope with more than twice their capacity. To address this crisis, the government has taken the exceptional initiative of purchasing healthcare services from private hospitals.”

He said, “According to the law, a medical college must have 500 beds for every 100 students, with an average occupancy rate of 70 percent. But many private hospitals do not have enough patients because their fees are high. Legal complications or pressure have also failed to resolve the issue. If the government sends additional patients from government hospitals to these facilities by providing a specific subsidy, it will be beneficial for everyone.”

Dr Nazmul Hossain said, “Building a new 1,000-bed government hospital would require at least Tk3,000-4,000 crore and three years. But through a contract, these beds can be added within a single day. This will reduce the pressure on Dhaka Medical. Students of both government and private institutions will have opportunities to see patients. The quality of services can be improved quickly at a lower cost.”

How the Services Will Be Provided

According to sources at Ministry of Health, once everything is finalised, private hospitals will have to sign agreements with government hospitals. A portion of patients admitted to government hospitals will be sent to the respective private hospitals under government management. They will receive the same facilities available at government hospitals, including medicines and diagnostic tests. The government will pay the bills after settling the accounts at the end of each month.

Initially, patients requiring medicine, paediatric care and minor surgery will be referred. Several rounds of meetings have already been held with the four hospitals. Another meeting is scheduled for next week.

Health and Family Welfare Minister Sardar Md Sakhawat Hossain said discussions are underway on how patient bills will be calculated and how the government will make the payments. He also said the process of finalising which types of patients will be sent to private hospitals is ongoing.

The Health Minister told Asia Post, “What types of patients we will send to private hospitals will depend on the situation. We have discussed the matter with them. We will arrange a specific amount of funding from the government. However, there are other costs as well. For example, sending a cancer patient would involve significant expenses. We are considering how much patients will be charged in such cases.”

Professor Dr Nazmul Hossain, Director General of the Directorate General of Medical Education, told Asia Post, “Under the government’s public-private partnership (PPP) policy, agreements are initially being made with four institutions in Dhaka. Following the Prime Minister’s instructions, work is underway to expand the initiative beyond Dhaka as well. In the future, there are plans to include ICU, CCU and dialysis services under the initiative.”

He said, “Private hospitals will provide services using their own personnel. The government will pay a fixed portion of the daily cost per patient as a bill. A draft memorandum of understanding (MoU) has already been prepared. The initiative will be formally launched once some legal issues related to the Public Procurement Rules (PPR) are resolved.”

Health Minister Sardar Md Sakhawat Hossain said the process would take some more time to be finalised.

“Another meeting will be held with the hospital authorities next week. If the issues are finalised there, it will be possible to implement the initiative,” he said.

Not Just Agreements, Strong Monitoring Needed

Even though the plan to purchase healthcare services from private hospitals is almost finalised, those involved believe the implementation of it will be challenging.

Professor Dr Zahid Raihan, Additional Director General (Administration) of the Directorate General of Health Services, said, “The hospitals from which services will be procured have been selected. Now, work is underway to formulate a policy on the process through which patients will be referred and the extent of medical treatment and surgical facilities that will be available. It will not be enough to settle the matter only on paper. There are many complications involved in actually referring patients and starting their treatment.”

Dr Zahid Raihan stressed that proper management and accountability must be ensured as the government is taking responsibility for the process.

He said, “This is an entirely new concept. We are considering whether a team will have to recommend the referral of a patient or whether the doctor or patient will have the freedom to choose. However, giving priority to the patient’s preference in every case may not always be consistent with the actual need.”

Dr Zahid Raihan also stressed the need to identify and address other shortcomings related to service quality in addition to the shortage of hospital beds. He said the government wants to maintain the highest level of transparency so that no questions or controversy arise over allocating resources to private hospitals while government hospitals continue to face shortages of equipment or funding.

The Health Minister also spoke about the quality and capacity of private hospitals.

The minister said, “Any hospital will provide treatment according to its own capacity. They cannot provide poor-quality treatment after receiving patients from us. Each hospital will assess that which types of treatment it can provide well and sit with us accordingly.”

Professor Dr Abdus Sabur Khan has raised questions about the quality and cost of services at the selected hospitals.

He said, “The services United will provide cannot be provided by Shamarita or Shahabuddin Medical. But the government’s problem is that it tries to impose a ‘one-size-fits-all’ policy in every situation. Just as all circuit houses or district hospitals in Dhaka are designed in the same pattern, it is impossible to put all these hospitals under the same fee structure.”

The expert believes the socioeconomic circumstances of patients also need to be taken into consideration.

He said, “The patients who go to Dhaka Medical come from a particular socioeconomic background. If they are suddenly taken to United, the strict rules and environment there may make the patients and their attendants feel psychologically uncomfortable."

"Simply transferring a patient and their attendant from one place to another does not ensure healthcare. If the government genuinely wants to provide better services, it should not select a specific group of hospitals. Instead, it should invite an open tender. This would ensure transparency and give qualified institutions an opportunity to come forward.”