Patients paying the price for ‘poor’ health regulation

        Dar es Salaam. Concerns are growing over the “weak” regulation of private health facilities in Tanzania, leaving room for cases of over-charging, over-diagnosing and over-treating patients.

This, according to experts, leaves patients with a huge economic burden to shoulder.

Over the years, researchers have warned that the number of private health services were expanding and becoming more complex.

They suggested that they should be regulated to save patients from incurring exorbitant costs.

That would tackle distortion in the quality and price of health services as well as anti-competitive behaviour.

“In the context of an expanding private health sector, then, regulatory frameworks are required to ensure that the sector operates in a fashion that, at least, does not undermine social objectives and, at best, contributes towards their achievement,” says a 2015 report titled ‘Regulating the for-profit private health sector: lessons from East and Southern Africa’.

Published in the Journal of Health Policy and Systems Research, the report detailed challenges that ministries of health in East and Southern African countries face in attempting to monitor and guide private health facilities.

On prices, according to the report, one informant from Tanzania was quoted as saying: “The big issue around pricing has been that we have not been able to get information from private providers because they refuse to provide it.”

The report says that in almost all surveyed countries in the region, consumer protection bodies were weak and the tort law against malpractices was poor.

South Africa was cited as the only country in the surveyed region to have a dedicated regulator of non-indemnity health insurance with considerable powers and capacity.

Disease mongering

“Disease mongering” is a term that was coined by Lynn Payer, a science writer, in her book titled ‘Disease Mongers: How Doctors, Drug Companies, and Insurers Are Making You Feel Sick’.

Payer was trying to convince the people to understand that they could be mildly sick but end up being declared very ill

There have been reported cases in local hospitals, whereby doctors exaggerated mild problems, offered treatment for them or recommended unnecessary diagnostics with the aim of boosting profits for their facilities.

But also, as the medical industry makes advances, there is an “irresistible push” from drug firms and insurance companies, which could lead medical doctors into a decision-making dilemma.

Pharmaceutical companies perceive a need to build and maintain markets for their big-selling products.

The deputy minister of Health, Community Development, Gender, Elderly and Children, Dr Faustine Ndugulile, said Tanzania had drawn up new treatment guidelines and directed all medical practitioners to adhere to them as part of long-term solutions.

“I am aware of such forces and vices. Quite often, our doctors fall in that trap. What we have done as the government is to come up with guidelines that require healthcare providers at all levels to prescribe only the listed medications,’’ he said.

During the launching of the Standard Treatment Guidelines and National Essential Medicines List on Thursday, Health minister Ummy Mwalimu said the initiative would help deal with “some dishonest health professionals who recommend expensive drugs which are not listed in the guidelines, but sold at private pharmacies.”

According to Dr Ndugulile, the government has been carrying out spot checks in private health facilities and relying on complaints from patients at those facilities before intervening.

“The government cannot deny that such cases [of over-diagnosis, over-treatment…] don’t happen. They do. We have issued a directive to all facilities on how to handle customers’ welfare.’’

Muhimbili National Hospital Heri Tungaraza said that could be controlled if all health stakeholders, especially clinicians adhere to ethics. Raising the patients’ awareness is also important.

“There should also be watchdogs whose role should be to identify the weaknesses and find ways of intervening,’ Dr Tungaraza opined.

Fraudulent claims

Over four months ago, the National Health Insurance Fund (NHIF) raised the alarm about some health facility owners submitting fraudulent payment claims and exaggerating costs of medication and health services for patients, thus sabotaging the government’s efforts to increase health insurance coverage to its members.

NHIF director general Bernard Konga told the Parliamentary Public Account Committee (PAC) in Dodoma that some accredited health facilities tended to provide low-cost health services, yet claim high amounts of money in repayment from NHIF.

“Some healthcare providers entertain poor practices. They claim higher amount in repayment of the services they offer. That’s actually higher compared to what they spend in catering for our members. We are very determined to do away with them,” he said.

How to deal with over-charging

To counter this, the commissioner of insurance, Dr Baghayo Saqware, wants an independent body to be formed to regulate healthcare business, especially now as the country strives to attain a middle-income status and promote Universal Health Coverage.

The Citizen understands that the commissioner of insurance has no mandate over the cost of medical services in health facilities. However, as an insurance regulator, he is a stakeholder.

When contacted on Friday, The Citizen sought to establish the basis of claims raised by patients who spoke to this paper recently, saying that they had been over-charged at private health facilities as well as others who said they had noted a “tendency of hospitals claiming huge payments” from insurance companies even after “they [hospitals] had offered to them [the patients], low-cost services.”

However, a regulatory body for prices of health services and medicine has proved difficult to establish in Tanzania due to the complexities in healthcare investment and the market forces that determine health products, said Dr Ndugulile when asked by The Citizen if the government has put in place any regulatory body on the matter.