Healthcare in Pakistan resembles corporate culture. With the only difference that, unlike a marketplace, the healthcare functions like a casino where the physicians hold all the cards. The medical industry has experienced this behavioural change world over, but what makes Pakistan’s case worrisome is the culpability of the government in allowing the health system to deteriorate and letting it become the hub of irregular practices. While the unqualified doctors made the hay in the sun of ignorance and neglect, it was the qualified doctors who took undue advantage of the unregulated and unmonitored system. With the arrival of the Punjab Healthcare Commission (PHC), the health sector began functioning in a new direction.

The application of minimum service delivery standards to improve quality is made the baseline upon which the new medical culture is proposed to be erected. Now for Healthcare Establishments (HCEs) survival is possible only if they are registered with and licensed by the PHC; the practice that has helped sift quacks from the qualified practitioners. All these achievements, nevertheless have only proved to be a drop in the sea of change, because of the corporate mentality that has taken over the medical industry, especially the doctors and hospital owners. The nexus is complicated and nuanced. Complicated because businessmen have financial stakes in keeping the large and luxurious hospitals in service; nuanced because the pharmaceutical companies have taken to a new level the desire of the doctors to amass more wealth. Unfortunately, in Pakistan cartelisation is easy to form and continue with.

Pakistan is passing through interesting times. Institutional malpractices are increasingly becoming intolerable. There is a growing dissatisfaction over the judicial activism whereby suo motu notices have become a trend rather than an exception. Again this overuse of judicial power is because of the failure of the politicians as executives to implement rule of law. Why does it irritate the opposition and the civil society when the Supreme Court does what the executive is supposed to do? Their annoyance should have been over the rising number of petitions, concerning civil administration, reaching the higher courts. People have lost trust in institutions. Not because the system is impenetrable, but because the individuals managing the system are by and large indifferent and keep their personal interest ahead of the national interest. However, when courts intervene directly, chances rise of matters becoming somewhat straight and businesslike. So, when a petition was filed in the SC against the ever-rising cost of treatment, at the private hospitals, the apex court naturally laid the responsibility to investigate and find a solution to the matter on the PHC.

Under Clause (m) of Sub-Section 2 of Section 40 that says: “The Commission may make regulations and control prices of the healthcare services,” the Commission has had the mandate to ask the HCEs to adopt a reasonable price structure. It nevertheless refrained from taking any action, fearing the backlash that could have upset the entire apple cart-----health sector-----because of the corporate mindset. For the Commission, the medical fraternity is as respectable and important as the people of Punjab who look up to the commission for a vibrant and people-oriented regulatory framework. Now, with a fresh impetus to pursue an important part of its mandate, the Commission is working with the hospitals to revise their billing structure.

The question is whether the cost of treatment charged by an upscale private hospital is justified or not. Apparently, yes. The processes to the diagnosis are made so complex, thanks to the technological breakthroughs, that the high cost of treatment looks justified. One study showed how when prices for chemotherapy (anticancer) drugs changed, physicians switched to more expensive drugs. It was considered a rational response to the economic incentive culture.

Another justification for the high cost of treatment is derived from a successfully advanced idea that when it comes to payment policy: “Doctors knows best.” In an overall policy vacuum, the physician-directed payment billing code system was adopted as a policy instrument and became standard across the entire private healthcare system.

The outcome of expensive healthcare has not been satisfactory either. In the US where the costliest healthcare system exists, quality or outcome hardly matches the expenses incurred. The framework has survived because of the country’s exploitative insurance system and also because the government bears most of the brunt of the high cost and not the ordinary public. In the context of Pakistan, the framework has survived because the government abdicated its responsibility of providing quality and inexpensive healthcare services in the public sphere, and to compound the issue every regulatory oversight to the profession was set aside. It was just a piece of cake for the private health sector, that included both the imposters and the professionals, to get the asking price.

Now when questions are being raised over the ethics of the medical practitioners, one may expect the physicians to revisit their commitment to their profession. If people are dying because of preventable diseases, in spite of sprawling and highly equipped hospitals, the wages of their death is on all those holding the cards of this corporate culture.

 

The writer is a freelance journalist based in Lahore.

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