Healthcare Landscape in Pakistan – Private Sector – Asrar Qureshi’s Blog Post 978

Healthcare Landscape in Pakistan – Private Sector – Asrar Qureshi’s Blog Post 978

Dear Colleagues! This is Asrar Qureshi’s Blog Post 978 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.

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In a study that the Lancet conducted, healthcare in Pakistan currently ranks 154th out of 195 countries in terms of overall performance. This included both public and private healthcare. I would start with the clarification that private healthcare sector, while doing a good job, is not providing world-class treatment as is claimed by them. Private healthcare outperforms their public counterparts, as measured by the overall quality of healthcare and patient satisfaction, latter being trumpeted more.

I had quoted earlier also that the business generated by private hospitals is expected to be about 1,600 billion rupees. On the contrary, the governments of all provinces put together shall spend less than 1,200 billion rupees on public healthcare network which comprises of about 1,300 hospitals. True that the treatment at public hospitals is not entirely free, rather 80% patients being treated at public hospitals pay from their own pocket, which is in addition to 1,200 billion rupees spent by the governments. 

The number of private hospitals is estimated to be around 700 only, with most hospitals having 100 beds or less. Private healthcare does not compete with the public healthcare in catering to the number of patients they treat; the difference is huge. For example, Mayo Hospital Lahore, probably being the oldest in the country, has 2,500 beds and over 150,000 patients visit the hospital every day. The same is true for Civil Hospital Karachi. 

Private healthcare in Pakistan is expensive. Let us look at various components to understand the cost structure.

When I started visiting doctors from pharma industry, Professors were few and their prescribed fee was 200 for first visit; second visit fee was usually half for couple of visits. Lab tests were not prescribed often, but if it was done, the patient could show the reports for free. Associate Professor cadre did not exist. Assistant Professor could charge 100 rupees for consultation. As the governments diverted their attention from people to power, the consultants kept increasing fees. Presently, 4,000 to 5,000 per visit is the norm. Some more narcissist consultants charge 7,000 to 10,000 per visit on the pretext that they want to discourage patient influx toward them in larger number. 

Ordinary hospital room charges are at par with a four-star hotel; deluxe rooms are at par with five-star hotel room. In addition, there is a list of additional charges under various made-up heads. The average cost per day for a COVID19 patient during the pandemic was 100,000 to 150,000 per day; this did not include medicines. Ventilator was the most favorite tool for making money which cost 25-30,000 per day. Maternity hospitals are doing deliveries through Cesarean Section, which is completely unwarranted, but it brings a lot of money. 

The consultant who admits the patient comes for 3-minutes in the morning and evening and charges full consultation. The consultant prescribes a long list of lab tests, particularly the most expensive ones in the hospital. Few years ago, my wife was admitted in a very well known (infamously) hospital in Lahore. Next morning, I went out for a while, and when I came back, I was told they were doing her echocardiography. Why? I asked. The consultant had prescribed. It was completely unrelated, but it was done. I asked them to show me what other tests were prescribed. Beside many others, there was full body color doppler (scan), which was completely irrelevant. I had a rather noisy argument with them and got it written on the file that no further test would be done without my permission. They threatened me that the consultant would not agree but I insisted and had my way. Majority of the patients do not know what they are being prescribed and why, so they keep paying. I mentioned above that private hospitals are expected to rake in 1,600 billion rupees in this year. Statista forecasts that this revenue shall increase to almost 2,000 billion by year 2029. Cost of private care is simply prohibitive; their quality may be discussed separately. 

Diagnostic labs swelled like rivers in floods during COVID19 pandemic. They made fortunes like never before. One test cost 7,900 rupees and there were long queues of people wanting to get tested. You can do the math yourself. Except maybe (if at all) the biggest names, every diagnostic lab offers kickback to doctors who send patients with a battery of tests. The rate of kickback varies based on who has more power. Diagnostic labs have installed various kinds of scans because each test brings many thousand rupees. These equipments are quite expensive also, but these are installed somehow to maximize revenues.

Hospital pharmacies are another story. There are two pharmacies in every private hospital: one for supplying drugs for use by the hospital, and the other for patients. Mostly patient pharmacies are busy because admitted patients buy all drugs from them, and even outdoor patients who come only for consultation are coerced to get the medicines from there. These pharmacies are either given to highest bidder or is run by the hospital to earn maximum profit. Both ways, the patient does not get any relief which he/she usually get from a street pharmacy. In addition, disposable/consumable items like syringes, cannulas are sold at excessive prices because these do not have a fixed price. 

How a private hospital makes money from every avenue can be seen from two, small things which you may ignore ordinarily. Hospital canteen is given out on contract at a hefty sum and in return the canteen is allowed to sell everything on inflated price. Car parking contract is also given at a good price. 

Sum Up

People opt for private healthcare because they believe they will get better consultation and care. They receive better care in most cases, but better consultation is not guaranteed because it depends on the competence of the physician. The sum up is that the patients are getting value for money even in good cases, and they are simply losing money in the name of private healthcare.

There are regulatory agencies to regulate private healthcare. However, their performance so far has not impacted the quality and cost of treatment for better.

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.

Reference:

 https://borgenproject.org/facts-about-healthcare-in-pakistan/

https://www.statista.com/outlook/hmo/hospitals/pakistan

https://onlinelibrary.wiley.com/doi/full/10.1111/1744-7941.12360