Fixation of doctors’ consultation fees: A step towards universal health coverage

Universal health coverage (UHC) means the availability of quality health care for people, without costing an arm and a leg. 

Being one of the targets of the Sustainable Development Goals (SDGs) of the UN, UHC received fresh momentum in the healthcare systems of many countries throughout the world. However, Bangladesh is still lagging behind to a great extent in the case of ensuring UHC for its people.

Though Bangladesh has adopted its plan of giving 80% health coverage by 2032, poor governance, increased corruption, inadequate healthcare facilities, weak public health communication, coupled with elongated Covid-19 Pandemic have made the realisation of the plan even more difficult. 

The out-of-pocket medical expenditure rate is still significantly high (63%) and doctors' consultation fees amount to a significant portion (17.5%) of the expenditure.

Given the almost non-existent medical health insurance, Bangladeshis have to spend their total income's 15% as medical expenditure, and in case of consulting a public doctor at private facilities, the cost is even higher (16.1%). 

Doctors in private practice charge consultation fees in an unregulated way. Some of the Doctors' fees even range from Tk 1000 to 1500, which is way beyond the reach of the working-class people.

The Medical Practice and Private Clinics and Laboratories (Regulation) Ordinance, 1982, which was promulgated during the martial law regime, fixed the consultation fees of the doctors. 

However, a subsequent amendment to the Ordinance in 1984 gave liberty to the doctors to fix consultation fees on their discretion. Doctors were given this liberty to charge patients according to their expertise and the quality of the consultation they provide, and the doctors are expected to do so.

The term "medical consultation" is defined nowhere in the Ordinance of 1982, and it gives rise to obscurity as to the essentials of medical consultation. Eventually, questions remain as to the parameters of expertise and quality of consultation of the doctors and to the justifiability of the fees they charge for their consultation.

The 1982 ordinance and the Code of Ethics of the Bangladesh Medical and Dental Council make it mandatory for the doctors "to prominently display in the chamber a list of fees that may be demanded by him". Unfortunately, such charts are barely seen in the doctors' chambers.

Even though the consultation fees are made known to a patient, what if the patient cannot afford the fees mentioned in the chart and is unable to get the medical consultation of the doctor s/he visited? 

This inability to pay consultation fees due to poor financial condition apparently results in denial of the right to healthcare which is assured by the Constitution of the People's Republic of Bangladesh under Article 18.

There might be a contention that one should see the doctors that s/he can afford. This contention leaves questions as to the quality of consultation one can afford with one's poor income. 

This contention is also reflected in the healthcare system of Bangladesh, as a result, the poor people do not bother going to the specialised doctors for their health problems, rather they have to choose the pharmacy stores and quacks for treatment.

Because of the doctors' consultation fees and other medical fees being overly high, a lot of people become poor having to bear the healthcare expenditure. In Bangladesh, out-of-pocket expenditure for healthcare services pushes almost 5.7 million people into poverty every year.

To end the plight of the poor people who are seeking healthcare through the private chambers of the doctors, the consultation fees must be fixed at an affordable rate by the government through passing new laws or regulations or by amending the existing ones. Displaying of the charts of the consultation fees for the patients must strictly be ensured through proper monitoring.

The government may entertain the credit points system to fix the maximum and minimum consultation fees and the credit points will be designed on the basis of seniority, experience, and success rate in treatment. 

Besides, the introduction of receipt of consultation fees will enable the patients to prove their claim in case they are aggrieved by any negligent consultation of the doctors.

In order to further the realisation of UHC by 2032, the establishment of a national health care insurance scheme and increase of budget allocation in the health sector are crying needs. 

Ultimately, Bangladesh needs to mobilise its resources to raise sufficient funds, reduce heavy reliance on direct out-of-pocket money, and reduce and eliminate inefficient and inequitable use of resources to ensure affordable, equitable, and high-quality healthcare services for people from all walks of life.

Md. Reaz Karim is a law student at the University of Chittagong. He can be reached at m.reazkarimcu@gmail.com. 

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