We planned to halve out-of-pocket expenditure in healthcare and then went the other way

A recent report by the Health Economics Unit of the Ministry of Health and Family Welfare revealed that around 16.4 percent of the population do not seek healthcare services at all in a year. Looking at this statistic, the first question that comes to our minds is, "Why?" 

Healthcare is a basic fundamental right, so technically, the government should provide us with healthcare services. Then, why are they overlooking it? 

Our healthcare costs are rising every day and we end up paying large hospital bills out of our pockets. 

These expenses carried out by the public to avail healthcare services are referred to as out-of-pocket expenditures (OOP) or expenses.

Over time, our annual out-of-pocket expenses as a percentage of total health expenditure have continued to rise. If this continues, these expenses will likely balloon to an astronomical amount that will become hard to afford. 

If you look at the data of Bhutan, you will see that out-of-pocket expenditure is only 13.16 percent of total healthcare expenditure. The rest is carried out by the government. 

Among other South Asian countries, Bangladesh has been ranked second highest in out-of-pocket expenditures where it accounts for 68.5 percent of the total healthcare cost. In 2012, this figure was 64 percent. 

Back then, we took up a strategy to bring down that figure to 32 percent by the year 2032. But instead of decreasing, the percentage kept rising.

What could be the reason behind this? Is it because though we have a fixed target (reduce OOP by 32 percent), we have not taken any practical steps to attain it? If that is the case, then what steps should we take? 

The aforementioned report said that patients spend a huge amount of money on medicines as the price of medicines has increased as well.

Be-Nazir Ahmed, Former Director of Disease Control at Directorate General of Health Services. Illustration: TBS

In that regard, we could give free medicines to our patients and for that, we need a larger budget allocation for healthcare services. Every fiscal year, we allocate five percent of our national budget for healthcare, but according to the World Health Organisation, a country should allocate a minimum of 17 percent of its budget to health. 

Clearly, we should consider incrementally increasing our budget allocation towards healthcare services. 

But only allocating a budget would not solve our problem as the crux of the problem is the lack of monitoring. In our budget for healthcare, every year, a considerable amount of money remains unspent.

Distributing medicine is just an example, but we will need a solid plan to face the upcoming OOP catastrophe. To do that, we can enact a three-step plan – short, mid and long-term.

The three-step plan

A short-term plan could span over a two or three-year timeline and aim to decrease the out-of-pocket expenditure by 50 percent. We could allocate money for those areas where our patients usually spend more on healthcare.It will automatically decrease the cost burden on an individual. But again, I am re-emphasising the need for strict monitoring throughout this whole process.

In my observation, doctors usually suggest more than one medicine to combat a particular disease. So, we can aim to promote a "avoid unnecessary drugs" type of campaign. 

To make this campaign successful, we can start by holding doctors accountable for the number of medicines they prescribe. 

In 1982, we had a policy for this - The Drugs (Control) Ordinance - and we successfully stuck to it. I do not see why in 2021 we cannot follow that again.

There might be some influence of private medicine companies in this regard. Hence, we need better policies to supervise the doctors. If required, we can ban the pharmaceutical companies' representatives from lobbying their brands.  

We could have avoided this situation if Bangladesh Medical Association had played an active role here as well. But in the past few years, pharmaceutical companies have become so powerful that we have just surrendered ourselves to their will. This same scenario can be found in our general hospitals, which would explain why we have so many diagnostic centres.

Our hospitals were supposed to be self-sufficient to conduct these diagnoses and tests. 

To conduct the necessary diagnosis for different patients, we would need more manpower. Unfortunately, in many government and general hospitals, we lack pathologists and medical technologists. Until we have skilled manpower, we have no choice but to outsource our diagnoses to diagnostic centres. 

Also, we do not have enough medical machinery and equipment in our public hospitals to become self-sufficient. So, we need to fill up these gaps in our short-term plan and move towards the mid-term plan.

As a part of the mid-term plan, we could provide free medicine to patients for the most common diseases like diabetes and hypertension. When we talk about providing free medicine for patients, it should be ensured that no patient is excluded, from the ER to the OT.

For the long-term plan, we could aim to provide free medicine for acute diseases like cancer which are usually expensive. Once these sectors are covered, we can set a target to provide free treatment, step by step, and work on making progress. 

While enacting the whole plan, we should avoid the involvement of the private sector so that the government is not dependent on it to provide free healthcare services.