THINKING ALOUD: Patients also do have certain rights while in hospital

May I ask – as a patient – what my rights are when I am seeking medical treatment? In the health sector, patients need to have their rights protected by law – just as is the case other sectors. Do we have a ‘Patients’ Bill of Rights,’ I wonder!

I know there are laws that protect patients’ rights in developed countries. But the laws mostly respond to the concerns of a bygone era, like patients right to ‘understandable information concerning diagnosis, treatment and prognosis’ – and, more recently, to ‘a smoke-free environment’ in hospitals. But, are these the real concerns of patients? Maybe not...

Patients’ rights might seem a fantasy in weak health systems.

But, rights in the health sector are similar to the rights we expect in any other sector of the economy. For example, a month after I have paid for and taken a flight, I don’t expect to be told that the pilot’s fee was not included in the fare!

The most important patient’s right is to know in advance the estimated cost of treatment. Patients have the right to be told the estimated hospital charges before care is provided. But, only a few hospitals actually provide estimated costs in writing – just like airline tickets of the past, or insurance policy whose print is so small that it requires a magnifying glass to read it.

Today, patients’ worries are financial as much as they’re medical. Medical bills can be one of the reasons for impoverishment. In an era when patients are told to be better consumers of health care, they need a Financial Bill of Rights, too!

Patients have the right to an itemized bill in plain language. Patients cannot detect – and are, thus unable to dispute – improper charges, particularly if their bills contain medical scripts and abbreviations.

Studies have found that 30-to-50 per cent of hospital bills contain errors. I interviewed a parent whose bill included thousands of shillings for his newborn’s circumcision – even though no circumcision was actually done!

If a contractor charges you for a kitchen when he only renovated the bathroom, it would be fraud. When hospitals do more-or-less the same it’s regarded as a simple mistake. Why?

Patients have the right to accurate information about what their health insurance plan covers. There shouldn’t be any hidden surprises.

These are very tricky situations… For example: are the pediatrician’s fees included in the delivery of a newborn? I have seen cases where the insurance plan included polyps removal – but did not include fees for colonoscopy!

Patients have the right to be informed of conflicts of interest. They should know if their doctor has a financial stake in a testing or procedure facility before a test or procedure is ordered. They should know if a hospital is paying its doctors according to how much income they generate for the hospital, or how much they bill – and be informed of any other mutually-beneficial financial relationships.

Will this ever happen in a country like Tanzania?

The right to be informed in advance about any facility fees – or even any extra charges for a procedure – should be discussed and agreed upon in advance. It is uncommon to see a price list for elective procedures; but this is a patient’s entitlement.

Informed consent is a bedrock principle of health care. Unfortunately –and conveniently, no doubt – it does not include the fees to be charged. Why?

Importantly, it is a patient’s right to be informed of cheaper options. Many doctors recommend the most expensive course of care, and don’t tell patients that there are other options.

One example: instead of ordering months of thrice-a-week physical therapy after a hip replacement, hospitals should tell patients that they can also do a few instructional sessions – and then do the exercises at a gym. That is the norm in many countries, and researchers have found it works just as well.

The threats of dealing with bill collectors, and a damaged credit rating, are used to intimidate patients into paying up without asking questions.

In any other kinds of business, this would be regarded as extortion. Indeed, patients have the right to know that a disputed bill will not be sent to a collection agency.

When I pick up bread and yogurt at the supermarket, I don’t have to guess what they might cost. Bill collectors don’t start harassing me when I dispute a charge on my credit card.

When the ‘product’ is our health, and the bills are potentially bankrupting, don’t we deserve as much?

Maybe, at the very least, a ‘Financial Bill of Right’ should be added to the ‘Right to a smoke-free environment!’