Private ICU institutions should be celebrated not villainised

Author: Dr B T. Rwabasonga

Last week,  Daily Monitor ran a front page story listing the daily ICU bed charges that private sector healthcare institutions were quoting . These daily ICU bed charges were in most instances about Shs3 million and as high as Shs5 million in a few cases. As expected, this story generated an uproar from the public about the exorbitant and inhumane practices of these private health sector institutions. This was unfortunate as these private sector ICU institutions should be celebrated and not villainised.  In fact, if this Daily Monitor  article had any villains, it is the nation’s abysmal specialised healthcare financing mechanism. 

ICUs and other specialised healthcare institutions are some of the most resource intensive businesses in any sector.  From hefty hospital machinery prices to expensive infrastructure costs, the cost of establishing ICUs and specialised services are exorbitantly high. Furthermore, with less than one per cent of the Ugandan population having any sort of prepaid health insurance plan, guaranteeing recoupment of this high upfront investment equally remains elusive. In any country, the bad debt write-off rates of specialised healthcare services rendered in most cases remain much higher than the fraction of the payments received. 

A 2017 survey showed that up to 37 per cent of Americans couldn’t afford to pay an unexpected $100 medical bill. These factors combined have made investment in specialized healthcare by the private sector in Uganda a costly philanthropic venture, if not a fool’s errand. Therefore, the few investors that have made the leap, ought to be celebrated and not villainised.  

This issue is particularly unfortunate for Uganda as private sector productivity has been the engine behind the country’s social and economic fortunes. For example, sectors like telecommunications have made significant advancements that have enabled financial inclusion and information technology access for many. Unlike the telecommunications sector and several other sectors, Uganda’s specialised health sector remains frozen in time with a 2020 Journal of Critical Care article stating that the entire country had a total of 55 functioning ICU beds– a statistic that means that almost one functioning ICU bed exists for every one million Ugandans. So how does Uganda move forward from here?

 In 1911, the US faced a similar healthcare predicament to the one that Uganda faces today. At the time, the US was struggling to provide adequate healthcare services to meet the needs of its increasingly older population. Its counterparts like England and other European countries, had already passed laws like England’s British National Insurance Act that had transformed healthcare delivery within their borders. Faced with this realization, the USA undertook bold reform policies in the 20th Century that would later transform it to the largest producer of health services in the world. 

In 1965, the Lyndon Johnson administration, famously proposed to spend $1.2 billion over six years to establish 32 University based medical centers that would help counter the risks of heart diseases, cancer and stroke. Likewise, the Hill Burton Act of 1946, allocated funds at state level to both private and public facilities to build and modernize their facilities with the ultimate goal of attaining at least 4.6 beds per 1000 people across the country. This landmark law led to new facilities arising in up to 40 per cent of US counties that previously didn’t have any facilities at the time. Today, the healthcare sector in the USA contributes nearly a fifth of its entire economy. This achievement has been attained despite the government taking more of an oversight role while employers and private markets have taken the lead to drive the growth and investments in the sector. 

As Uganda takes stock of the lessons learned from this pandemic, that has left ruin in its path, it has an opportunity just like the US did in 1911, to answer the call of the many Ugandans seeking these specialized services by catapulting its healthcare system to the future through increased public and private funding mechanisms.  As seen with the USA, not only would this meet the healthcare needs of the country but would boost its economy greatly. 

Dr B T. Rwabasonga, MBChB, MPH, MHA is a physician, public health professional and health services consultant based in Washington, DC.