- There are at least 5,000 hospital brokers in Savar
- Most of them pharmacy owners
- Besides, many physicians and low-income people also work as middlemen
Ayesha Akhter (not her real name), a resident of the Savar municipality area, recently went to the Savar Prime Hospital for treatment after the place was recommended to her by a pharmacy owner. There, Ayesha spent a large sum of money on different tests that she underwent.
Unknown to her, a good portion of the money she spent on the tests went to the pharmacy owner, who made a commission for nudging Ayesha towards Savar Prime Hospital. Turns out, the pharmacy owner was also a middleman.
Md Foysal Ahmed, owner of the pharmacy in Namabazar area of Savar, admitted that he was a middleman. He said he did not see anything wrong in taking commissions.
"Even if I do not take any commission for sending patients to the hospital, the patients will have to bear the same costs. Rather, through me the patients get some discounts, and I can earn some money. Besides, the commission I receive is part of the profits of the hospital authorities. If I had not been given the commission, it would have been added to their profits," said Foysal.
He further said many physicians were taking commissions, so there was nothing wrong that he was doing it too.
"Physicians get commissions from hospitals and diagnostic centres, where their patients go for medical tests. Again, the physicians also receive gifts and commissions from certain pharmaceutical companies for prescribing their drugs," he added.
He, however, did not disclose the names of the physicians involved in taking such commission.
Like the Savar Prime Hospital, most of the private hospitals, clinics and diagnostic centres in Savar upazila of Dhaka are dependent on such middlemen. Owners and managers of several hospitals, who did not want to be named, said if the brokers were not paid commissions, it could lead to the closure of their institutions.
According to Md Harunur Rashid, managing director of the New Life Care Hospital in Savar Genda area, in the case of admitted patients, they pay a commission of 20% to the brokers, and for various health check-ups, the rate can be even higher.
Md Wakilur Rahman, general secretary of the Private Hospital Owners Association of Savar and also the owner of Lab Zone Private Hospital, said the average amount of commission the middlemen received from 40 hospitals and clinics affiliated to their association alone stood at Tk5 lakh per month.
"You see, this practice of giving commission to middlemen is common all over the country. If only my organisation stops this but others do not, it will not work. Then these middlemen will send patients to another hospital instead of sending them to my hospitals. To them, quality treatment is not a big issue. There is a competition of who can pay more commission. As there are many private hospitals and diagnostic centres in the upazila, there is a competition among them," said Wakilur.
Asked how the hospital owners fix the prices of different medical services, including health check-ups, Wakilur said they set the prices in line with the hospitals and diagnostic centres in Dhaka, as the government had not set any standard for it. Besides, the issue of giving commission to brokers was also taken into consideration while fixing the prices of medical services, he added.
It has been learned that the number of such brokers in Savar is at least 5,000. Most of them are pharmacy owners. Besides, many physicians and low-income earners also work as middlemen.
Wakilur Rahman said medical expenses could be greatly reduced if the commission trade was stopped. Besides, in many cases, patients were deceived by these brokers by being recommended low-quality hospitals, he added.
According to the health department's website, there are 54 licensed hospitals and clinics in Savar upazila. Besides, there are 71 licensed diagnostic centres, most of which are part of various hospitals.
On the other hand, the number of private hospitals and diagnostic centres, including licensed and illegal, is more than 150, according to the Private Hospital Owners Association of Savar.
Md Mozammel Haque, the Savar upazila sanitary inspector, said there are more than 100 private hospitals and diagnostic centres in the upazila. The information of the Upazila Health Complex is based on a survey conducted a year ago.
Meanwhile, some new hospitals and diagnostic centres have been founded while some have closed down. However, this list was not updated due to various complications during the Covid-19 pandemic period, said Md Mozammel.
Dr Md Arman, medical officer (Disease Control) of the Savar Upazila Health Complex, said apart from the 50-bed upazila health complex, there are two sub-centres of the health complex in Aminbazar and Birulia. There are also community clinics at union level.
The Upazila Health Complex on a monthly average sees around 20,000 outpatients and 5,000 admissions. The number of patients receiving treatments from community clinics and two sub-centres per month is also not less than 30,000.
The health complex, however, does not have any data on how many patients take services from the private hospitals and diagnostic centres.
According to the 2011 census, Savar has a population of 14,42,885.
Public health specialist Dr Mohammad Abdus Sabur said if this sector could be properly regulated, it was possible to reduce medical expenses 50-60%.
"If you go to Dhaka for a caesarean section, you will see that the cost varies from hospital to hospital. For example, in some hospitals, it takes only Tk10,000 for a caesarean operation whereas some others charge Tk1,50,000 in the same city. So it is a completely unregulated sector," he elaborated.
One of the reasons for not being able to control this sector was that the existing law relating to private hospitals in the country was so outdated that it was not consistent with the present times, Sabur said. Despite several initiatives, the law could not be amended for various reasons, he added.
Besides, there was also a manpower crisis in the Department of Health, he went on.
"So this sector is now in a completely uncontrolled state and there is no accountability.This is the only reason why so many people in the country are falling below the poverty line every year due to the skyrocketing medical expenses, benefiting a section of people and the middlemen," he said.
Dr Md Farid Hossain Mia, director (hospitals and clinics) of the Directorate General of Health Services, said the Health Protection Act was being drafted for regulating the country's private health sector.
He hoped that once the law was enacted, discipline would return to this important sector.
"We are focusing on some issues like categorising the organisations and services, and pricing. Hopefully, it will be implemented soon, and if it is implemented, the existing weaknesses in the law will be addressed and the whole sector will be brought under regulation," he said.