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Healthcare stands on three pillars: Healthcare related policies; Public and private health infrastructure; and availability of diagnostic and treatment tools, the last one also includes easy access to drugs. We shall review each of these in some detail to understand the entire healthcare landscape. The information is gathered from several sources, and references are given at the bottom.
Private Health Infrastructure – Issues and Opportunities
According to some statistics, private healthcare system provides health cover to over 70% patients. These patients opt to use private healthcare whenever they need it. A rather significant number of patients start treatment at the public healthcare but later switch to private sector after getting dissatisfied with the quality of care at public hospitals.
Private healthcare may be further divided into three segments: paid private healthcare; institutional private healthcare; and charity-based free/subsidized healthcare.
Charity based healthcare is a large segment in Pakistan. Communities, families, private businesses, foundations, trusts, NGOs, and small associations collect zakat and donations to run free dispensaries for outpatients. At a bigger scale, they also run proper hospitals. Many individuals have connected themselves to some hospital ward or arrange drugs for deserving patients. Charity support runs major hospitals in a major way, such as SIUT – Sindh Institute of Urology & Transplant, Indus Hospital Network, and Shaukat Khanum Cancer Hospital. Prominent welfare organizations such as Sundus Foundation, Fatimid Foundation, and Akhuwat are run entirely on donations. Thanks to charity-based healthcare, and the public hospitals, poor population gets the required treatment, which otherwise would never be possible.
Institutional healthcare is where a particular institution provides healthcare to its employees and their families. Armed forces run the largest network of primary care, secondary care and tertiary care hospitals independently for all arms of forces; army, air force, and navy. Armed forces have started their own medical colleges also. Besides their own staff, these hospitals also cater to civilian patients at cost. A network of Social Security hospitals and dispensaries was established in 1970s for industrial workers and has been running since. All major corporations, run primary healthcare facilities for their employees and families. Institutional healthcare relieves burden on the public healthcare system to some extent.
Paid private healthcare is the largest network of clinics, polyclinics, secondary and tertiary care hospitals which is estimated to cater to over 70% population. General Practitioners practicing in every village, town, and city are the first point of healthcare, and the last in most of the cases. They are also a referral point for secondary and tertiary care hospitals, although this referral is informal. More affluent people go directly to consultants and specialists who are more abundantly available in cities and towns. Chains of diagnostic laboratories have also grown because every consultant prescribes a battery of tests. In every mega city, very large private hospitals have established themselves and most of these have now established medical colleges to go with the hospital, Aga Khan Hospital Karachi is probably the biggest private hospital in the country. The hospital was built on an 83-acre site in the heart of Karachi. It consists of a 721-bed hospital, a medical university for 500 students, a school of nursing, and housing for staff and students. Aga Khan Development Network – AKDN health network includes the Aga Khan Hospital Karachi, four woman and child hospitals with a total of 213 beds, 290 outreach medical centers in more than 100 cities across Pakistan.
Paid private healthcare is a welcome oasis in the rough landscape of diseases and illnesses. Some of the best-in-class treatments are available only in private sector. In Pakistan, the entire healthcare system would collapse without paid private healthcare.
Paid Private Healthcare Issues
The biggest issue with paid private healthcare is the high cost of treatment. Every service is costly to begin with, and the cost is further escalated by doing unnecessary diagnostic tests, undue hospital stays, and lots of dubious charges. COVID19 period was a godsend for private hospitals who made billions from inpatients and outpatients.
Cesarian-section deliveries are a regular feature in women who would otherwise deliver normally. The procedure is done to pump up the charges. Stenting in heart patients is another huge scam which brings in millions of rupees every month to an established hospital. Lots of people are now carrying stents in their chests and are candidates for replacement stents in few years. As mentioned in an earlier post, ventilators became a huge business thanks again to COVID19. It is said that in some instances, patients who passed away while on ventilator were kept on it to continue charging.
Cost of private healthcare is a worldwide issue. Misdemeanors like above are also seen even in the most developed countries. The common theme behind this is GREED, not profitability. A decent private hospital with regular inflow of patients become profitable more quickly than many other businesses, but then greed drives it to keep pushing the boundaries.
Quality of Care
Quality of care in private healthcare system is highly variable, between various hospitals, and within the same hospital. Part of it comes from negligence of treating physicians, and part from errors by the paramedical staff. Mistakes are covered up by more expensive treatment citing disease progression; deaths are justified by Allah’s Will.
The legal action against doctors and hospitals has never been carried out because brothers do not give evidence against brothers; it will come back to them next time. In this matter, the entire private healthcare system is united against patients. Some people have sued their treating physicians and hospitals, but nothing could be done because no doctor came forward to give technical advice. Those who came, protected their own ilk.
All private healthcare has always remained unregulated. In the past, some half-hearted efforts were made to bring in some kind of regulation, which were met by strong resistance from the entire community. After devolution of healthcare through 18th amendment, the provinces have reluctantly established health commissions whose current effort is to register the healthcare providing outlets to begin with. What happens inside the outlets is still entirely uncontrolled.
Government has also never been able to control the unqualified medical practitioners despite repeated efforts. Their numbers, audacity, and the number of patients they treat has increased so much that it is impossible to track them and stop them. And in any case, they are providing basic treatment to a large number of patients at a rather nominal cost.
This is the overall state of private healthcare. Next, we shall take up the third pillar of healthcare.
To be Concluded……
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