Article by: Azeem Waqas
Working at a public hospital in Islamabad, Doctor Zeeshan felt high temperature along with severe body aches in the last week of March 2020. He suspected a COVID-19 infection but to be sure, went to a private laboratory to give a swab for the COVID-19 test.
The results came back two days later. The 40-year-old had indeed contracted COVID-19.
“As I shared news with my family, everybody was shell shocked”, he said. “Everyone was crying like it was the end of their world – it was a really difficult time for us”.
At that time, public hospitals had little or no expertise to treat COVID-19 patients. “The conditions in public hospitals were very poor”, says Dr. Zeeshan.
“People were afraid of being admitted to those hospitals. There were no ventilators, no oxygenated beds, and no medicines for the patients. Doctors were also advising patients personally to go to private hospitals”.
So he admitted himself to a privately run hospital of Islamabad. “There was only one option left to save my life and I took it”, says Dr. Zeeshan.
Doctor Zeeshan remained admitted in the hospital for 20 days and it cost him around PKR 200,000. The hospital charged him PKR 20,000 a day for a room, medicines, tests, and food. He was kept isolated during the treatment. He ended up spending all his savings on his treatment.
This is not the story of Doctor Zeeshan alone. It is the story of virtually every Pakistani who has suffered from COVID-19. They are bearing the brunt of the treatment burden on their own pockets because the government has left them to fend for themselves.
More than 300,000 patients have tested COVID-19 positive in Pakistan but federal and provincial governments have failed to provide any assistance to bear the treatment expenses.
Also, the pandemic has exposed exorbitant and inconsistent billing in private hospitals of Pakistan, a sector regulated sparsely if at all. Although the treatment expenditures vary from one patient to the other according to the age, severity, and needs, there is no doubt that private hospitals are fleecing COVID-19 patients.
Treatment in private hospitals is going to be a very costly affair for the common man. It is easier to recover from COVID-19 than from the financial blow dealt with by the hospital bill.
In Islamabad, the posh Maroof International Hospital is charging PKR 150,000 to PKR 200,000 per day and PKR 500,000 in advance from a COVID-19 patient. Shifa International hospital is charging PKR 60,000; Kulsoom International, PKR 50,000; Quaid-e-Azam International, PKR 70,000 and PAF Hospital is charging PKR 20,000 per day.
“During the first wave of COVID-19, if anyone tested COVID-19 positive, it cost them about PKR 150,000 to PKR 200,000, to be treated in private hospital”, says Dr Zeeshan.
For example he had to test himself at a private laboratory which charged him PKR 5000, for a PCR (Polymerase Chain Reaction) test.
Medicine and food expenditure would cost him PKR 10,000 and he had to get a CT Scan or X-ray test three to four times which would be PKR 20,000 in two weeks’ time. The treatment concluded with a PCR test showing the patient COVID-19 negative.
On average, treatment of a normal COVID-19 carrier, without ventilators or other life-saving equipment, costs between PKR 20,000 and 25,000 daily, a senior doctor at a private hospital says.
The 14-day treatment of patient costs between PKR 100,000 and 150,000. Usually, patients are discharged after three to five consecutive tests turn negative. In some cases, tests will go up to eight to ten to get a definite result, doctors state.
The COVID-19 virus has increased the health expenditures of a poor man, who already has no resources for better treatment.
During the peak of the pandemic, prices of COVID-19 medicines were increased. Some medicines vanished from the market and a shortage was created by the medicine companies.
According to the Drug Regulatory Authority of Pakistan (DRAP), there are more than fifteen approved medicines for the treatment of COVID-19 in Pakistan.
These are, ACTEMRA 80 mg concentrate solution, and its retail prices are PKR 15,874.73/vial, ACTEMRA 200 mg at PKR 39,689.47, ACTEMRA 400 mg is available at PKR 79,378.94 a vial and REMDESIVIR injection price is PKR 10,873 a vial.
Railways Minister Sheikh Rasheed once said even he could not find Actemra injection in the market and had to seek help from Lieutenant General Muhammad Afzal, Chairman NDMA.
Junnaid Ansari, another patient of COVID-19 said: “An injection namely dexamethasone – synthetic steroid which has shown to be effective in the treatment of critically ill COVID-19 patients requiring oxygen therapy or ventilation – was not available in the open market and its [black market] price was not affordable for a poor patient lying on the bed”.
It is important to note that most of the politicians who tested COVID-19 positive were either treated in military hospitals or in private corporate hospitals – which shows their lack of trust in the public run civilian hospitals.
Nevertheless, at least 80 percent of the COVID-19 patients across the country are being treated at government hospitals. However, leading private hospitals do have better treatment facilities for people who can afford to pay or are directed by the health department or government to turn to them in special cases.
In the federal capital Islamabad, there is no check on private hospitals. The Islamabad Healthcare Regulatory Authority (IHRA) is a dysfunctional and toothless entity that has no power to implement its own decisions.
Chief Executive Officer of IHRA, Mr. Syed Ahmar Naqvi said: “Discussions with private hospitals are going on through the NCOC platform. The government has very limited control over private hospitals but it has control after all. We believe that there should be no price douching – they are here to help COVID-19 patients”.
“We were expecting that during the second wave of COVID-19 private hospitals would add the numbers of beds for patients. We are checking to see what they have done, and they are regularly updating NCOC and the district magistrates”.
Syed Ahmar Naqvi said that Government does not want to press them for fear they may refuse admission to COVID-19 patients and stop treatment.
“We are deliberating on different proposals to manage the price and they will be given a chance to rationalize the prices. Consultants are being engaged to rationalize the prices”.
While talking to The Truth International (TTI), Special Assistant to the Prime Minister on health Dr Faisal Sultan said that it may be counterproductive to fix prices. “By capping the charges of private hospitals they will either cheat or refuse to take care of the patients”.
Dr. Faisal said that the fees charged have to bear some relevance to costs but capping is not practical. “What would you cap it at? There will be patients that will go well over 500,000 [e.g. if they stay four weeks on a ventilator in ICU]. It also depends on the quality of staff, training, equipment, and consumables they use.”
“The healthcare commissions need to regulate quality and then cost automatically comes to a proper level. The only real solution is very robust competition, shared risk and insurance – but that actually drives the costs up, like in the US”.