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7 January, 2017 12:08:09 PM
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Call the doctor’s ‘commission’ kickback to denigrate the practice

The prime need of the hour is to make a thorough overhaul of the health sector, slap ban on taking kickback by doctors, fixing their fees in slabs according to their professional achievements
Kazi Mushtaque Ahmed
Call the doctor’s ‘commission’ kickback
to denigrate the practice

The doctors take percentage from the diagnostic centres for the medical tests that they ask their patients to perform, because those who operate these centres give them. And the owners of the centres give these percentages to doctors because they want to earn money though they call this an effort by which they ‘survive’ in the business. And the poor patients who are ailing become the victims of this unholy nexus between doctors and diagnostic centres. 

This foul practice in the medical service has become so rife that it is creating a stupendous hurdle on the way of getting health treatment for people who are not financially solvent. However, even the solvent people are not morally obliged to pay this undue percentage to doctors or incentive to the diagnostic centres. Yet due to absence of government’s any effort to stop the practice or downright social rejection, it is ever increasing in Bangladesh’s health service delivery.   
Even several decades ago, in Bangladesh, proper diagnosis of a disease was rather hard because there were not many tests available. Due to advancement in medical technology, pin pointing a health problem has become much easier now and some diagnostic tests—culture reports of urine or blood for example—even tell you the treatment drug accurately. But the merit for the advanced diagnostic tools is going to doctors’ pocket. 
With about 50 percent of the cost of a diagnostic test, the patients are paying the doctor’s exorbitant consultation fee that is increasing leap and bound with each passing year. Now can a diagnostic centre do a test properly with the rest 50 percent of the money? Does it really use right amount of necessary reagents or other diagnostic equipment for performing the test correctly? Or for making profit just they do a ‘bucket test’ as it was once known in West Bengal in India in which a diagnostic centre used to throw the sample taken from the patient providing an report with imaginary facts and figures?               
That is why it has now become very urgent to stop doctors earning the undue money from patients, if necessary by enacting a law and effectively monitoring the whole system. A study of the city’s one of the prime hospitals and research centres, ICCDR,B, came out some years ago about how this practice was affecting the population. According to this international health centre, 20 per cent of the country’s total population is growing paupers for meeting the health expenditures directly because of doctor’s taking kickback. Newspapers often present facts and figures about what a mind boggling proportion the health professionals’ so-called ‘commission’ business has assumed. 
Previously the prescribing physicians only used to take percentage from lab tests; nowadays the practice has widened to cover all newer technology-based investiga­tions such as digital x-ray, ECG, ultrasonogram, echocardio­graphy, CT scan, MRI, etc. Physicians also take ‘commission’ from treatment procedures such as chemotherapy, physiotherapy, haemodialysis, angioplasty and others. The percentage of commission varies according to the tests and technology involved. In general, a diagnostic or treatment centre gives 20-50 per cent of the fees to the relevant doctors as ‘commission’ which should better be called kickback, ‘ghush’ in Bangla, plain and simple. 
The fleecing of the patients does not stop here. When you take reports of the prescribed diagnostic tests to your doctor, you have to pay again, more than half of his original fee in most of the cases, as charge for going through these reports.      
More appalling is when doctors just for sake of earning money advise patients to do certain tests or go through costly technology-based treatment procedures which are not necessary at all. The patient follows the doctor as he urges them to do for very practical reason thinking that the doctor knows better. Then there is the apprehension that his disease may get worse if he does not follow his advice.
   Besides all these, physicians also take undue money from various devices such valve, stent, cornea, false tooth, etc., that makes the treatment cost much greater. Say the original price of a European stent is one lakh 10 thousand taka, you have to buy it from the relevant hospital at a price of 30 thousand more, that is, at one lakh and 40 thousand taka. In a poor country like ours where it is natural expectation that in the service-oriented sectors, people would not be burdened with undue, extra cost, it is an irony that in these very societies these unhealthy trends among professionals are more common and doctors as a community of this society get involved in this unholy practice.          
Several years ago, at a seminar of the BSMMU, the country’s one of the most famous ENT specialists Prof. Dr. Prangopal Dutta revealed—he was the vice chancellor of this lone medical university of the country at that time—that 30 per cent of the medical expenditure would decrease if doctors stop their unethical practices. This means that the relevant people of this otherwise noble profession are well aware of what is going on in the name of medical service in this poor country but they are failing to generate effective awareness against that.
 For stopping taking kickback by doctors, it is now necessary to act seriously and, for this, the government as well as the relevant stakeholders, including the BMDC (Bangladesh Medical and Dental Council) and owners of diagnostic centres, clinics and hospitals, 
have to come to a unanimous decision to stop the practice by making a law.
Doctors are not alone in society have become unscrupulous. The corrosion of moral values has engulfed every sector of our society, but here it would be pertinent to say: “Physician, heal thyself”.

The writer can be contacted at: kazi.mostaque@theindependentbd.com

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Editor : M. Shamsur Rahman

Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

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