Where is the Patient in Healthcare Landscape? – Asrar Qureshi’s Blog Post 963

Where is the Patient in Healthcare Landscape?  – Asrar Qureshi’s Blog Post 963

Dear Colleagues! This is Asrar Qureshi’s Blog Post 963 for Pharma Veterans. Pharma Veterans Blogs are published by Asrar Qureshi on its dedicated site https://pharmaveterans.com. Please email to aq.pharmaveterans@gmail.com for publishing your contributions here.

Credit: Azra Tuba Demir

Credit: Jonathan Borba

Credit: LLos Muertos Crew

Credit: Max Mishin

Preamble

Health and education are important subjects for politics and therefore get new ideas whenever a new government comes in. It is however a pity that previous government initiatives are usually scraped by the new government. Some may be baptized with a new name and launched again. In the education sector, Danish school was the last major initiative in Punjab which, surprisingly, is still running well. Sehat Card was the last major initiative from the PTI government. Present incumbent government has raised questions about it and its fate is still hanging in balance.

On the subject of Sehat Card, there are reports of widespread corruption in how the hospitals charged the government. There are heaps of overuse of facilities and misreporting. It is not surprising because any project that involves millions of people and billions of rupees cannot remain clean in Pakistan.

Our focus for today is the place of patients in the overall healthcare landscape. 

Place of Patients – Revenue Generating Machine

In the entire healthcare system, the only party paying money is patient; everyone else is charging the patient and is dependent on him for their business and survival. Let us count the places where a single patient pays.

Doctor – The patient goes to the doctor. The doctor prescribes medicines and laboratory tests plus some diagnostic tests. The patient pays consultation charges to the doctor which may range from couple of hundred rupees to several thousand rupees. Despite this cost, the doctor does not make effort to diagnose the illness. He would wait for the lab results to indicate what possibly may be the problem. When the test results are inconclusive, the doctor is lost.

Laboratory – The patient goes to the lab and gives blood or other specimen and money. It will usually cost a few thousand rupees in routine. The utility of lab tests can be easily contested because mostly these are an effort to find a needle in a haystack. The list of prescribed tests may run quite long. If unfortunately, the first battery of tests does not reveal anything, the patient shall be subjected to a second, third battery of more expensive and maybe invasive investigations. The cost multiplies with every new battery.

Radiology – The patient goes to radiology and pays money for X-ray, CT scan, or MRI as per prescription. X-ray is now too ordinary; therefore, it has to be CT scan or MRI or MRI with DWI or PET scan. Several angiograms are also available for specific illnesses. The cost runs in multiples of thousands. The availability of sophisticated and advanced diagnostic tools is certainly helpful in diagnosing better, but the tools do not diagnose, the clinician does. 

Pharmacy – The patient goes and buys prescribed long list of medicines which may cost another few thousand rupees. This list is prior to test results; there may be a revised list after the test results arrive. It is fashionable now to prescribe more expensive drugs to everyone who looks able to buy it. In addition to pharmaceutical products, the market is now flooded with supplements/healthcare products/ natural products, which come in flashy packs. They are a great burden on patients because their effects are dubious while their costs are exorbitant. In fact, some time back DRAP prohibited doctors from prescribing these products, but their rejoinder met the same fate which rules meet in Pakistan. Our public has become immune to commands because the legitimacy of commanding hierarchy has been severely compromised. The patient pays for all deficiencies.

If unfortunately, the patient does not get well and becomes serious, or is afflicted by a sudden serious illness, or has a trauma due to any accident, he would end up in a hospital. 

Hospitals – Generally, hospitals are providing low-quality service at exaggerated rates. Once inside, the patient pays for every minute of stay on one or the other pretext. There are room charges, nursing charges, consultant visit charges, and a host of other things. For surgery, it would be surgeon charges, anesthetist charges, theater charges, and another long list. Lab tests and diagnostics continue unabated and keep adding to the cost. In more upscale private hospitals, more charges are added in innovative ways. Putting patients on ventilator is good business because it adds several thousand rupees per day. There have been instances where patients were put on ventilator when they did not need it; in even worse cases, dead patients were apparently kept on ventilator for days to make more money. C-section operation for delivery is routine because the gynecologist does not want to waste her time in waiting for the baby to deliver, and she/he can charge much more for C-section.

The hospital cleanliness and sterilization are highly variable even in private hospitals; government hospitals are another heartbreaking story. From car park to wheelchair attendant to guard to ward boy, everyone asks for tip. Fortunately, the nurses are still not involved in this evil nexus. 

In private hospitals, the patient pays for everything, no exception. In government hospitals, the patient may get some medicines from the hospital, but has to pay for all other services, investigations etc. 

Medical Insurance – It has become somewhat popular during the last few years, but it is still developing. Medical insurance is mostly institutionalized as companies offer it to their employees on sharing basis. The basic packages include hospitalization only and do not cover daycare treatment. The more you pay, the more you get, is the basic principle. 

Medical insurance is a good facility and should be promoted. However, like car insurance, the charges are trumped up by hospitals in connivance with the insurance company staff. The result is that the limit of the patient is exhausted quickly without receiving full benefits.

Pharmaceutical Industry – Although they are not directly connected with the patients, but they affect the patient by promoting their drugs to treating physicians, who in turn issue prescriptions in their favor. The industry is business, and it tries to keep growing big which it can only do by getting more drugs prescribed by the same doctors. There is a cost to it, after which the doctor obliges because he does not have to pay for the medicines. 

Sum Up

It is evident from the above that all players in the healthcare are on one side and the patient is on the other side. It is also clear that no service provider tries to provide good service but want to charge whatever it can think of.

The reality of the situation is that a whole bunch of hyenas is preying upon one prey. And the irony is that they all keep singing the chorus of ‘Pay More, Pay More’. 

Pakistan is among those countries where healthcare is at the lowest in all respects. The norms of healthcare are flouted shamelessly in every which way. There is no relief for patients from any quarter, government, health authorities, public utilities, and even courts. The only way to stay alive is to stay healthy.

Concluded.

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For most blogs, I research from several sources which are open to public. Their links are mentioned under references. There is no intention to infringe upon anyone’s copyrights. If, however, it happens unintentionally, I offer my sincere regrets.