Govt hospital test cutoff at 2pm pushes patients to costlier private centres

Highlights:

• Government hospitals usually stop outpatient diagnostic services at 2pm
• Patients needing later tests often turn to costly private centres
• Government diagnostic tests cost significantly less than private alternatives
• Nearly 40% of public medical technologist posts remain vacant
• Manpower shortages leave diagnostic equipment unused in many hospitals
• Experts propose private operators provide afternoon services using government facilities

Routine diagnostic services for outpatients at most government hospitals in Bangladesh end at 2pm despite the availability of modern equipment, forcing patients who need tests later in the day to turn to private diagnostic centres at significantly higher costs.

Most government hospitals run regular diagnostic services for about six hours, from 8am to 2pm. The Directorate General of Health Services (DGHS) says a shortage of manpower prevents hospitals from operating diagnostic services in two shifts.

Experts say afternoon services could be introduced using existing infrastructure and equipment through public-private partnerships, reducing patients' medical expenses while making better use of government facilities.

Last week, Mohakhali resident Md Omar Faruk went to Shaheed Suhrawardy Medical College Hospital for hypertension treatment. A physician advised him to undergo CBC, ECG and X-ray tests.

After waiting nearly an hour, he managed to have an ECG and obtained a serial for the X-ray. But when he went for the CBC test at around 1:45pm, he was told no more tests would be conducted that day.

"If the CBC cannot be done today, I will have to come again tomorrow. Travelling from Mohakhali tomorrow again will be tough," Omar Faruk told The Business Standard.

"Tests can be done at low cost in government hospitals. But if tests close at 2pm, one is forced to go to a private diagnostic centre at higher expense," he said.

The situation is not limited to Suhrawardy Hospital. At most government hospitals, diagnostic services for outpatient department patients close after midday.

In many facilities, collection of test fees also stops after 1pm, meaning patients travelling from afar may not be able to complete necessary tests on the same day.

Hospitals with One Stop Emergency Care Centres, such as the National Institute of Cardiovascular Diseases, continue diagnostic services after midday for emergency, ICU, CCU and admitted patients. Outpatients generally do not receive these services.

At the National Institute of Laboratory Medicine and Referral Centre in Agargaon, patient pressure is heavy in the morning but falls sharply after midday.

Although there were plans to introduce afternoon laboratory services, they have not yet been fully implemented.

Government tests cost far less

Diagnostic tests at government hospitals are significantly cheaper than at private facilities. An ECG costs Tk80 at a government hospital, compared with Tk250-300 at a private centre.

Ultrasonography costs Tk150-300 at government hospitals but Tk1,000-3,500 at private centres. An HbA1c test costs Tk300 at a government hospital, compared with Tk1,100-1,400 at private facilities.

A Bangladesh Institute of Development Studies study, "Catastrophic Health Shock and Improvement in Bangladesh: Insights from HIES-2022", found that out-of-pocket healthcare expenditure accounted for 73% of total health expenditure in Bangladesh in 2021, up from 68.5% in 2020.

Diagnostic services accounted for 27.52% of household out-of-pocket healthcare spending.

Manpower shortage a major reason

According to the Power and Participation Research Centre study "Bridging Gaps in Bangladesh's Public Health System", published in July this year, 3,892 medical technologists are working against 6,406 sanctioned posts in public healthcare institutions under the Ministry of Health. Nearly 40% of the posts are vacant.

Selim Molla, senior medical technologist at the Bangladesh Medical Technologist Association, said government hospitals have modern equipment but lack sufficient manpower to operate them.

"Necessary posts remain vacant in many government hospitals, and there is insufficient manpower for testing at various upazila health complexes across the country," he told The Business Standard.

He said medical technologists are needed for blood tests, X-rays, biochemistry, microbiology and other diagnostic services, adding that machinery remains unused in many places because there is no one to operate it.

Dr Nurul Islam, director (hospitals and clinics) of the DGHS, said the government plans to introduce diagnostic services at government hospitals after midday, but manpower remains the main obstacle.

"We have the machinery and infrastructure, but the shortage of medical technologists is severe. Compared to the manpower that should exist in the organogram, far fewer technologists are currently working," he told The Business Standard.

He said there were plans to revise the organogram and recruit more medical technologists. Once implemented, hospitals would be able to introduce diagnostic services in two shifts.

The DGHS has also taken initiatives to use unused equipment.

"We have already compiled a list of which machines are lying unused at which hospitals. We have begun installing those machines in other hospitals so that patients receive services," Dr Nurul said.

Experts suggest private management

Dr Syed Abdul Hamid, a professor at the Institute of Health Economics, University of Dhaka, recommended involving private operators to provide afternoon diagnostic services using government hospital infrastructure.

He said modern diagnostic equipment remains unused for much of the day, while patients are forced to seek more expensive services at private facilities after government diagnostic services close.

"For diagnostic services after midday, government hospitals will provide space and permit utility usage, while private operators will run the service," he said.

He suggested assigning the services to experienced private diagnostic institutions, with different institutions managing different departments.

"If provided this way, people would receive the service at lower prices," Dr Hamid said.