Can private practice in government hospitals benefit doctors and patients?

There is no precedent in developed countries where doctors of government hospitals do private practice or institutional practice outside their workplace. They are rather encouraged to provide good treatment in exchange for generous salaries. But, from 01 March 2023, doctors of government hospitals in Bangladesh will be allowed to open private chambers in government hospitals to provide medical services to patients for a fee after office hours. This service will be known as 'Institutional Practice.' 

According to the Medical Practice and Private Clinics and Laboratories (Regulation) Ordinance 1982, government-employed doctors cannot practise privately during their office hours. In India, doctors are also required to work in the hospital during working hours but are allowed to do consultations outside of hospital hours. 

Initially, the government of Bangladesh is going to start implementing this initiative in 20 districts, 50 upazila hospitals and five medical colleges. Doctors in all government hospitals in Bangladesh are required to provide services to patients from 8 am to 2 pm. Most doctors then provide services to patients in private hospitals, clinics or private chambers. 

Initially, the doctors can try out this institutional practice from 4 pm to 6 pm. The government has taken this initiative primarily to keep doctors in their workplaces, to create opportunities for young doctors to practise and to ensure treatment from specialist doctors at a low cost.

As fees would be fixed for institutional practice, the initiative can benefit both patients and younger doctors. This may provide some comfort for patients, especially the underprivileged ones. The opportunity for younger doctors to observe and study more patients will increase their expertise. 

In Bangladesh, patients are dying almost every day because there are not enough specialist doctors in various hospitals. Mistreatment and negligence are other reasons why many patients are dying. 

A report in Daily Sun shows that over 550 patients died from 'wrong medical treatment' and 'negligence of doctors' across the country in the last six years. According to data compiled by the Bangladesh Society for Enforcement of Human Rights (BSEHR), 141 people died from wrong treatment in 2012 alone. The number of such deaths was 69 in 2017, 65 in 2016, 104 in 2015, 122 in 2014 and 53 in 2013. 

A large number of doctors and hospitals have been sued over patients' deaths due to the mistreatment and negligence of physicians. During the novel coronavirus pandemic, there were widespread allegations of maltreatment of patients at various hospitals across the country. Despite repeated warnings from the government, patients were still being denied treatment in hospitals. 

One of the reasons Bangladesh's healthcare quality is inadequate in comparison to many other Asian countries is a shortage of physicians, specialists and clinical equipment in government hospitals. According to the World Bank, Bangladesh has 0.6 doctors per 1,000 patients, although the WHO recommendation is one doctor for every 1,000 patients. Additionally, there should be at least three nurses for every doctor in Bangladesh. But currently, the ratio is less than one for every doctor, which is highly imbalanced. 

According to government data, there are around 1.5 lakh hospital beds in Bangladesh. Among these, the number of private hospital beds is almost twice as high as that of government hospitals. Compared to the World Health Organization's (WHO) recommendation of a minimum of three beds per 1,000 patients to ensure access to healthcare, we do not even have one bed allocated for every 1000 patients; the number is only 0.87. So, along with this initiative, the government must ensure adequate medical equipment and recruit sufficient doctors, nurses and medical staff.

Moreover, the high cost of treatment in private hospitals makes it difficult for middle-class families, especially those with low incomes, to afford the treatment. Due to this, their only hope is government hospitals. And if private practice starts in government hospitals, patients will easily get medical services from expert doctors at a lower cost. 

To address these concerns, the government of Bangladesh has implemented several regulations and guidelines for doctors. Private and public services provided by doctors should be separated so that private patients do not receive preferential treatment over public patients. Financial transactions of private chambers should be monitored and audited to ensure compliance with regulations and to prevent corruption. 

Guidelines for how doctors should balance their responsibilities as government employees and private practitioners should be established. Training and education for government doctors should be provided to help them understand the ethical and legal implications of opening private chambers. Private chambers should be encouraged to provide services at affordable fees and to support the public health system.

This practice can be common in many government-run hospitals in Bangladesh. They can help to supplement the income of doctors and provide additional medical services to patients. However, it can have some drawbacks as well. 

The potential for conflicts of interest and the possibility that private patients will receive preferential treatment over public patients is one of the biggest concerns. Besides, it may become difficult for everyone to get the services of government hospitals due to the enormous demand. Very few senior physicians provide services to patients on hospital grounds nowadays since they usually charge at least Tk 1,000 for each patient in their private practice. But in this system of institutional practice, they cannot charge so much fee.

It is important to note that allowing doctors to open private chambers within government hospitals can be a complex issue. The government must continue to monitor and evaluate the impact of this practice on both patients and the healthcare system as a whole. 

Md Moin Uddin Erfan is a Graduate Associate at The Business Standard and a member of the Social Research Group.

Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the opinions and views of The Business Standard.