How families are grappling with high Covid hospital bills

Ms Sarah Mirembe, a mother of two, told this newspaper that her grandmother, Ms Robina Matovu, aged 70, was diagnosed with Covid-19 and admitted to Ntinda Hospital, in the suburbs of Kampala, on June 13.

“We were told to deposit Shs2.5m before the medics could act, but once the money was paid, the patient was immediately wheeled to an emergency room for that night,” she says.

The Uganda Dental and Medical Practitioners Council (UDMPC) says it is unethical for healthcare providers to ask for any down payment when emergency care should be provided first to save life.

Ms Mirembe adds: “However, the next day, grandma was transferred to a room which (I think) a patient had just left because its bathroom was dirty. We weren’t sure whether the previous occupant was also a Covid-19 patient, but when we asked someone to clean it up, nothing was done, so one of us bought disinfectants and cleaned up the room.”

“I also noticed there was no nutritionist to guide us on what to feed the patient, so the caretaker had to look for food from outside and bring to the patient,” she adds.

Ms Mirembe says on June 15, her grandmother’s oxygen was allegedly given to ‘a more critical emergency’, meaning that night, she was not on oxygen until the next day.

Ms Mirembe’s family has since not known the alleged critically ill patient, who necessitated the removal of their own patient’s oxygen.

A general receipt shared by Ms Mirembe shows oxygen therapy was the most expensive item at the hospital, going for Shs3m per day, between June 13 and 16, while physiotherapy went for Shs200,000 per day and was only given from June 13 to 16.

A critically ill Covid-19 patient uses around 10 oxygen cylinders per day, according to information from the umbrella body of private health facilities.

Each cylinder is refilled at around Shs40,000, meaning the hospital spends around Shs400,000, excluding delivery costs, which may not exceed Shs100,000. 

A family member, who is also a health professional but declined to be named, says they reportedly mooted the idea of sourcing the oxygen from outside in order to minimise costs, but their idea was rejected outright by the hospital.

Dr Misaki Wayengera, the head of the Ministerial Scientific Advisory Committee on Covid-19, says chest physiotherapy is very good depending on the situation the patient is in.

“There is a way we measure the amount of oxygen in blood using a pulse oximeter,” he says.

The family says their request to have the Shs2.5m per day bill reduced was also rejected, prompting them to suggest relocating their patient to a Bugolobi-based health facility, which was charging Shs1m per day.

“It was then that the bill was reduced to Shs600,000 per day. For a bill to be reduced from Shs2.5m to just Shs600,000 per day means the original charge was very high in the first place,” the family member said.

He says the family ended up paying about Shs14m between June 13 and 25 when the patient was admitted to the time she was discharged.

Ms Mirembe says much as her grandmother pulled through, private hospitals should not exploit the crisis and look at patients as cash cows.

“Why charge families for services which haven’t been fully offered?” she wonders.

Col Edith Nakalema, the head of the State House Anti-Corruption Unit, last week convened an emergency meeting with some owners of private hospitals after this newspaper highlighted the plight of struggling families and several complaints about “ridiculous daily charges” to treat a critically ill patient, which go as high as Shs5 million per day.

In response, some owners of private hospitals complained of the cost of personal protective equipment (PPEs) and asked the government to help them set up oxygen plants in health facilities and waive some of the taxes they incur. They also requested for ventilators and a special fund to borrow from at low interest rates.

Ms Mirembe’s family is not the only one struggling as the second wave of the pandemic sweeps through the country.

Another businessman, who deals in buying and selling land, who preferred to identify himself only as Musa, says it was frustrating to raise Shs120 million for his father’s treatment even after his patient died.

“My father passed away last Friday and was buried the following day, Saturday. This was after battling Covid-19 for about a month,” he says.

Musa remembers his father as a 90-year-old man who had the energy of a 70-year-old man because of his active lifestyle.

“I think he might have contracted the virus during an interaction with someone who had it. At the beginning of June, when he began showing symptoms of Covid-19, we rushed him to a private facility in Bbunga on the outskirts of Kamala City,” he recalls.

“But instead of confirming our worst fears that he had Covid-19, the medical team did not mention anything for a week until one night when he could hardly breathe. When this happened, different family members began making frantic calls for an ambulance that would help transfer daddy to a better hospital,” he adds.

Musa had to face the hurdle of looking for an ambulance when his father was dying.

“Can you imagine making emergency calls to hospitals and they tell you they don’t have ambulances and beds! I even called a cousin who works at Case Hospital for help, but he told me there were no beds,” he laments.

“But, somehow, at about midnight, we managed to get an ambulance. Our plan was to rush him to the private wing of Mulago hospital, but the ambulance driver told us he had been instructed not to take any more patients there,” Musa says.

Musa says they then opted to rush his father to Platinum Hospital, but while on their way there, they were told the only available bed had been taken.

“Afterwards, we spent almost three hours on the road looking for alternative hospitals. Meanwhile, as we were running around, they were telling us the oxygen in the ambulance was running out. Uganda!” he sighs.

“Someone eventually advised us to go to Medipal International Hospital in Kololo.  Upon arrival, we were asked to make a deposit of Shs10 million. Since we did not have that much money at our disposal, we pleaded without success,” he adds.

“Different family members opted to make calls during the night and we managed to raise Shs5 million, an amount which was deposited in the morning. After promising to clear off the remaining balance in the evening, the hospital agreed to admit my father,” he says.

Musa says during the two weeks-and-half his father spent at the facility, the money for his treatment was secured mainly from his savings, “which is all gone.”

He says they also got loans and contributions from different people.

“By last Friday, the overall bill had shot up to about Shs120 million. As we speak, my current bank account is at 0 (zero),” he says. This newspaper saw a provisional bill as of June 24, indicating that the total bill amounted to Shs92.2 million.

The issue of exorbitant charges in private hospitals has largely not been resolved, although Dr Diana Atwine, the Ministry of Health permanent secretary, says engagements are ongoing.

She says the ministry has no powers to command private facilities to pull down prices.

But Musa says there are inconsistencies in the hospital billing.

“These hospitals also need to be careful with the kind of accountants they employ. I remember one time, as we were going through the payments in the receipts, the sums were not adding up. Almost Shs20 million had not been billed, something we protested. The hospital later admitted the mistake. But you can imagine, if this error was not discovered, we would have paid more money,” he says.

“And what is more depressing is that after paying all the money, the doctors say you can’t see or touch the patient. It is something that traumatises families,” he adds.

Musa says although they did everything in order to keep their dad alive, he did not pull through.

“His body was handed over to us after the family had cleared the pending bills. He died on Friday and was buried on Saturday,” he says.

“Away from the bills, what hurts me most is that we did not have the chance to give our father a decent send-off because of the strict directives guiding burials of persons who have succumbed to the virus. May his soul rest in eternal peace,” he adds.

Dr Mukuzi Muhereza, a medical worker in western Uganda, says a private hospital in Kampala withheld the body of his colleague, Dr Alex Mulindwa, over pending medical bills. Dr Mulindwa, who had Covid-19, was brought to Kampala from Mbarara when his condition started worsening and died three weeks ago.

“We retrieved the body after clearing a bill of Shs18 million and he was buried in Mubende. He (Dr Mulindwa] had spent six days in the hospital. The deceased was a young man who had just started working,” he says.

Dr Joel Okullo, the head of UDMC, says it goes against medical ethics for hospitals to withhold the body of a dead person over medical bills.

“We have told the private hospitals that it is unethical for them to retain patients or bodies because of non-payment. They should work out a way one can use to pay without necessarily having to detain any patient or dead body,” Dr Okullo told this newspaper.

“Asking for deposit before care goes against ethics. But they [private hospitals] argued that it is a requirement because they are going to put a lot of resources into treating a patient and that it would be unfair if they did that and someone decides to walk away on them,” he added.

He said they have agreed with private hospitals to make payment plans for families whose patients have recovered or died without having to withhold the body.

Ms Theopista Ntale, a Covid-19 survivor, says even tests to assess whether one has fully recovered or having long-term effects are very expensive, going as high as Shs320,000.

This newspaper saw a copy of the costs of the tests. Many Ugandans cannot even raise the Shs200,000 for tests to determine whether or not they have Covid-19.

Hospitals, lawyer speak out

Dr Edrin Jjuuko, the head of medical services at UMC Victoria Hospital, says they always make agreements with the family on payment plans if they cannot raise the bill at once.

“We always give people a payment plan if they fail to pay at once. We work together with them to understand where the issues are and why we are charging them that way,” he says.

Ms Grace Ssali, the executive director of Uganda Healthcare Federation, says hospitals are meeting high costs to buy medicines, pay health specialists, provide personal protective equipment and oxygen, among others.

Regarding the issue of hospitals retaining bodies after family members have failed to clear the hospital bills, Julius Selwambala, a lawyer with Kasumba, Kugonza and Co. Advocates, says: “There is a law called the Contract Act, which provides channels for recovery of money in case a party breaches a contract. The family entered the contract with the hospital that it provides services to the patient and in return it will pay them. It is a fact. Now, when you fail to pay, the hospital is supposed to sue these relatives for the debt the hospital has incurred in giving the service, but not to retain the dead body. So, the hospital is expected to write notices of intention to sue families, take them to court and then file cases against them but not to say that we shall not give you your dead person for burial.”

Mr Paul Gurindwa, the managing director of Ntinda Hospital, says: “We used to extent credit services to patients, but people took advantage of this deed. People would come pleading with us to treat their patients and we would, but upon presenting the bill, they would not even want to release a penny. So, we soon learnt that families were taking advantage of us. So, when we insist that patients deposit Shs2.5 million on arrival, we would have what to start with even if family members eventually find difficulties completing the rest of the bill. Because we are in the Covid-19 era, prices of medical equipment have skyrocketed. Yes, we want to save lives, but, how are we going to do that without equipment, which is being sold costly on the market and there is also medical personnel doing the job who need to be paid salaries too.”

Dr Richard Lukandwa, a consultant physician and medical director at Medipal International Hospital in Kampala, says: “There are a number of factors we (hospitals) look at when admitting a patient in the Intense Care Unit (ICU), especially in this Covid-19 era.  There are overhead costs per patient, staff costs per patient, pharmaceutical costs per patient, laboratory tests, oxygen therapy, which is central in this particular disease, among other things. And so, when you add all this things, you find we are also overstretched. My colleagues in the private sector have highlighted that most facilities in Uganda have been bought by foreign investors simply because the cost of running a hospital is unbelievably high. The cost of treatment in ICU is very expensive all over the world but because our country is poor, everything is seen as disproportionate. Prices are obviously high because of Covid-19 and the requirements for crucial things such as increased oxygen, personal protection equipment (PPEs), staff allowances, among other things. But, what we (private sector) are doing is working together with government to see how we can resolve the issue of high pricing.”

What some stakeholders say...

This Covid-19 story is one that I will continue sharing for years to come. The people supposed to be helping us are swimming in the cash boom, taking advantage of the situation. This country! If there was an option for human beings to choose which country to be born in, I would not choose Uganda,” Musa, lost father to Covid-19.

This discussion [on the issue of exorbitant charges in private hospitals] is still ongoing, we think these people can cut their costs to a reasonable rate. I know Covid-19 is a very expensive disease to treat because those PPEs and the other things they use are very expensive,” Dr Diana Atwine, Ministry of Health permanent secretary.

Asking for deposit before care goes against ethics. But they [private hospitals] argued that it is a requirement because they are going to put a lot of resources into treating a patient and that it would be unfair if they did that and someone decides to walk away on them,” Dr Joel Okullo, head of Uganda Dental and Medical Practitioners Council.

When we insist that patients deposit Shs2.5 million on arrival, we would have what to start with even if the family eventually finds difficulties completing the rest of the bill. ...prices of medical equipment have skyrocketed. Yes, we want to save lives, but, how are we going to do that without equipment?”  Paul Gurindwa, managing director, Ntinda Hospital.

Compiled by Esther Oluka, Philip Wafula & Tonny Abet