Cost is as crucial as care and cure

Dr Subash Pyakurel

  • Read Time 4 min.

Let’s explore our shopping habits once. Isn’t it true that we look at the menu along with the rate before we order food in a restaurant? Similarly, we collect and cart the stuffs in a grocery shop only after looking at the price-tag on it. Can we imagine a consumer paying the bill without asking for the price of the stuffs, even if s/he is a millionaire? Shall we be ready to pay more for the same item of the same quality? The answer should be ‘no’.

But have we ever noticed a price list display of healthcare procedures anywhere in any hospital? Again the answer should be ‘no’. While googling with the phrase ‘treatment cost in Nepal’ or similar words, there is not even a single convincing finding. It is simply because there is no officially declared cost-list of healthcare service yet in our context except for government-sponsored health plans and government owned insurance schemes that, per say, is a small fraction of total list of services in use.

Why don’t we flip this facility to the public side too? On this issue, the health policy and regulation apex body Ministry of Health and Population unduly defends and pretends as if standardization or fixation of the healthcare menu and cost is not a doable and achievable agenda. The usual and pre-cooked answer we get here is ‘treatment procedure cost can vary as this is to be customized every time separately based on various factors like effort, expertise and essentials used’. If this is the case, then how does a hair saloon or a surveyor calculate its charge? To our curiosity, college fees can be fixed. Similarly, the cost of gold is displayed in almost every newspaper in a strategic location. Fuel price is exposed distinctly. Government can fix the wages, announce basic salaries and disclose bus fares. Though varied and versatile, the cost of a table and vegetables can be calculated categorically. Then what factors are preventing the government and hospitals from publicizing the treatment cost for clear knowledge of the patients? Why should not service takers be allowed to plan their budget while undergoing gallstone surgery?

Right to know

Our constitution has secured the right to information (Article 27). Likewise, Article 35 of our constitution clearly states that basic health needs are to be provided free of cost and people have the right to know the details of their treatment. Needless to describe, details mean not only the procedure but also the cost by default. This means the issue of cost has been specifically covered by the constitution too. If we raise this issue, unfortunately there is again a readymade answer that doctors’ fee and OPD charges have been fixed, so is MRP fixed for medicines. This answer is like a puzzle game or a delusional defense of the government.

During the ongoing pandemic, healthcare services and goods have been charged irrationally. It feels like there is no rate, there is no regulation. Affordability can be addressed only by addressing the issue of cost. 

Dear government, what percentage of healthcare expenditure is under the title of OPD ticket or a doctor’s fee and what percentage of hospital bills are covered by the medicines? This defense, on one hand, is largely confusing. On the other hand, doctors’ dignity is distorted in a way as if all the healthcare expenses of the people have been solely absorbed by medical practitioners.

Covid care, costs and chaos

During the ongoing Covid pandemic, people including doctors have raised their voices loudly with raging minds. Walls of social media are revealing the proof that healthcare services and goods have been charged irrationally. It feels like there is no rate, there is no regulation.

What does this simply mean? This means nothing but an authentic green light for hospitals to read the faces of the patients, calculate strengths of the patient party and charge the bill accordingly. This reality of ‘charge-cost-as-you-want’ might be the reason for creating this ad-hoc market and havoc management moreover nurturing black market of the machine and medicine. This might be a reason for brake-fail in pandemic plan and protocol inducing ‘your stick, your buffalo’ scenario.

Connecting the same agenda with its societal perspective, it seems we consumers are also not in a mood to ask for the cost of treatment. Whereas we ask for the cost of any other service or product very enthusiastically. The psychology could be that people love to showcase as if they can take any step for the treatment of their family members and cost is never an issue. The confusion might prevail on an imaginative ground that people around will doubt them if they enquire about the cost of treatment. Seemingly, hospitals are taking this psychology for granted.

If we are following the target of sustainable development goals and the roadmap of Universal Health Coverage, we have to take care of quality, accessibility, and affordability as three sides of healthcare service in an integrated model. Affordability, being an important organ here, can be addressed only by addressing the issue of cost. It will be too late if the Ministry of Health and Population does not take any step in standardizing procedures by applying a framework of Common Procedural Terminology (CPT) thus by fixing cost scientifically. Only then insurance can take a comfortable ride of the same along with an integrated web-based platform and electronic medical record (EMR). Undoubtedly, care and cure are crucial components of the healthcare system. The cost component equally makes healthcare more welcoming.

Dr. Subash Pyakurel, Medical Editor of Swasthya Khabar, is the founder and CEO of Health Concern.