Monday, August 21, 2017

Health cost decrease spurs debate

Emergency departments and maternity units at government hospitals have reduced treatment charges because of a significant health budget increase, but costs remain high, with patients forced to pay room charges, give “presents” to doctors and even give fees to cleaners and gatekeepers.

Yangon General Hospital. (Boothee/The Myanmar Times)Yangon General Hospital. (Boothee/The Myanmar Times)

The charge reductions came into effect from January 1 but medical superintendents some large government hospitals in Yangon said they still cannot afford to remove charges completely. The reduction in costs largely stems from the funding increase for medicines, which previously patients had to pay for, under the 2012-13 budget.

The budget for drug procurement has increased from K3 billion to K65.5 billion, while spending on accessories has risen from K1 billion to K95.74 billion, the Ministry of Health’s finance department confirmed.

“We can reduce delivery charges this year from K50,000 to K5000 for surgical delivery and K25,000 to K2500 for a normal delivery,” said Dr Tin Nyo Nyo Latt, the medical superintendant at Yangon Central Women’s Hospital.

However, when The Myanmar Times inquired about the cost of delivery at the hospital, it was told women should expect to pay “at least” K200,000 for delivery, room charges, medicine and food.

Patients said that there had only been minimal reductions in overall treatment costs.

Ko Thein Zin, a translator at a media company, said his mother was admitted to Insein Public Hospital with a severe stomach pain on January 25. She spent two weeks in a “cost-sharing” room and the family spent about K600,000 altogether on treatment and food. After surgery, patients or their family members are even handed an envelope in which they are supposed to put a “present” for the surgeon – K30,000 at a minimum.

“We spent a lot of money to buy medicine and pay fees for operations, hospital staff and room charges. We had to pay K6000 a day for room fees and at least K1000 for [non-medical staff fees]. You can even see cleaners and gatekeepers asking for money from patients,” he said.

Ko Thein Zin said he understood why patients had to pay for treatment at public hospitals but hoped to see service improve to the same level as private hospitals.

He said there was little alternative to paying for treatment at a public hospital.

“The other option is to spend a lot of money at a private hospital and we can’t afford to do that,” Ko Thein Zin said.

Ma Nge, who has been attending Yangon Women’s Hospital for the past three months, said she had noticed a drop in charges since January 1, with the cost of some medicines falling by half, but service charges had remained about the same.

“Three months ago when I was admitted to Yangon Women’s Hospital I had to spend a lot of money on daily room charges, and also on medicines and ‘presents’ for the doctors,” said Ma Nge. “When I was admitted the hospital staff asked me if I could afford to pay. They said if I can they would arrange a room and all the necessary things. If not, I have to stay in a common room,” she said.

Dr Than Htike, the medical superintendant at Yangon Children’s Hospital, said the increase in funding was not big enough to give everybody free medicine or treatment.

He also said it was unclear what would happen in the 2013-14 budget and whether the cost reductions would continue.

“The less funding we have [from the government], the more we have to rely on cost sharing,” he said.

The policy of cost sharing, whereby patients had to pay for medicine and anything above the most basic facilities, was introduced in 1990, following the end of socialist rule two years earlier.

Dr Tin Nyo Nyo Latt said 50 percent of income generated under the cost-sharing scheme goes to the government, while the rest stays with the hospital. This policy remains in place, although Dr Phone Yaung from the Health Department said the ministry plans to amend the policy soon to reduce costs for patients.

Dr Zaw Min, a retired anaesthetist who spent 30 years in the state system, working at Yangon General hospitals and North Okkalapa hospitals, said cost sharing was the only way for hospitals to cope with severe budget shortfalls.

“This system was started in 1990 when the government lacked money to support public health. At that time, we didn’t know how much money the government gave each public hospital or what the overall budget was. We just noticed that there was less support for medicine and other essential items,’’ he said.

Under the policy, poor patients were supposed to still be able to receive free treatment. However, in practice few patients received genuinely free healthcare – only with a letter of recommendation from a hospital’s medical superintendent could they avoid the costs, he said.

The low salaries for state doctors also prompted many to seek work in the growing private sector or ask patients directly for more money, he said.

Further budget increases are also expected in 2013-14, which should further reduce costs to patients in the state health system. However, Amyotha Hluttaw representative Dr Myat Nyarna Soe warned that rural communities were missing out on the benefits of the enlarged health budget because of the paucity of state health facilities.

“Increasing the budget for public hospitals further still will not have a significant impact on primary healthcare in Myanmar because 70pc of people live in rural areas. The government needs to put more priority on rural healthcare because currently the state health system doesn’t really reach them,” he said.