Standardised consultation fees not solution to unaffordable healthcare

What you need to know:

  • Standardised medical consultation fees will minimally benefit the patient.
  • The Ministry of Health and the councils need to revisit the dust-gathering policy documents to fix patient detention problems, denial of proper medical care—which also shows itself in hasty referrals to avoid accumulated treatment bills.

The Uganda Medical and Dental Practitioners’ Council has come up with guidelines on consultation fees payable by patients and according to the registrar of the council, the move was prompted by the increasing cases of patient detention in hospitals or denial of services due to inability to pay.
While hospitals never pride themselves and would never wish to temporarily detain any person who has been successfully treated or clinically managed, standard consultation fees for doctors will not solve these unfortunate incidents. The move, while it’s welcome, is a bare scratch on the surface of the massive health systemic bottlenecks that need to be fixed in Uganda to reduce ‘patient detention’ or delay, and/or denial of clinical care.

A cursory review of 10 selected Catholic hospitals (30 per cent of total hospital pool) for Financial Year 2015/16 indicates an aggregate financial loss of Shs 310,492,000 due to inability to pay treatment bills and/or escapees with, for example Nyakibale Hospital in Rukungiri District having lost Shs 180,702,950 due to patients who either failed to pay their treatment bills or outrightly escaped from hospital—35.5 per cent were ‘escapees’. Bishop Asili Hospital is Luweero District in the same year lost Shs 94 million for the same reasons. These particular two hospitals are along traffic highway routes and routinely receive road accident victims.
Kamuli Mission Hospital in Kamuli district in Financial Year 2015/16 lost Shs 40,502,300 while Aber Hospital in Oyam District lost Shs 13 million in the same financial year due to the same reasons.

The financial losses due to failure to pay treatment bills and escapees for majority of catholic-accredited hospitals has increased by averagely between 60 per cent to 90 per cent in the last three years yet average medical consultation fees in most of these hospitals has remained stable and ranges from Shs 5,000 to Shs25,000 at first contact in the out-patient department—including visitation to the specialist. Patients who come direct for admission, surgery or emergencies are not charged consultation fees.

In almost all of the above cases, no patients were detained and no persons’ properties were followed up to be sold or held to recover the losses. The best these hospitals do is to record, document and reflect the financial losses in their books!
What the setting of the medical doctors’ consultation fees by council could only help these hospitals is raise their consultation charges with now valid justification but it will not sort the inability to pay for treatment. These hospitals procure medicines and supplies, pay utilities, and pay their health workers from mainly user fee charges.
Catholic Hospitals will definitely continue to pursue Christ’s healing Ministry—the foundation of their existence, and therefore will never deny any one treatment but will need serious soul searching and genuine government support to reduce these financial losses in an environment of increasingly limited external/donor fund support.

Uganda boasts of a litany of well integrated and comprehensive health and social policies and policy propositions that could potentially avert these unfortunate experiences but is only slow or unable to implement and we will therefore remain to develop and propose ad hoc and isolated part solutions which largely provide false hope to the population. Standardised medical consultation fees will minimally benefit the patient. The Ministry of Health and the councils need to revisit the dust-gathering policy documents to fix patient detention problems, denial of proper medical care—which also shows itself in hasty referrals to avoid accumulated treatment bills.
Policy makers and key stakeholders in health need to sit at a round table and genuinely discuss and fix the dysfunctional health care system of Uganda.
Dr Kasyaba works with Uganda Catholic Medical Bureau Kampala