The Independent Uganda: You get the Truth we Pay the Price
Understanding the billing crisis
In several interviews The Independent did to try to understand the story behind the excessive hospital bills, most experts in the health sector agreed on one thing: Intensive care services are very expensive.
“Ugandans should not look at the cost from the perspective of the patient,” said Dr. Sam Orach, a medical doctor for 38 years who is now the executive coordinator of the Uganda Catholic Medical Bureau (UCMB). He says patients must consider what it takes to provide this health care.
Dr. Ian Clarke, the Chairman of the Uganda Health Care Federation also told the HEPS-Uganda virtual forum on July 15 that private health facilities that increased charges should not be condemned.
“We have looked at the costs and I don’t see any profiteering,” he said, “These high costs have always been there.”
Clarke said the only change he noticed is that the costs have previously “not been visible because they are mostly covered by insurance.”
“During this pandemic, the insurance companies have not covered as much,” he said.
Dr. Richard Lukandwa, a consultant physician and acting director of Medipal International Hospital in Kampala agreed with Clarke.
“In the past, about 40-60% of people who would go to ICU would be covered by medical insurance,” he told The Independent in an interview, “(Now) most of the people paying for the ICU are paying directly from their pockets and therefore, the outcry is understandable because they have never seen this in their life.”
He said traditionally, ICU care has been very expensive and therefore, not accessible to most people.
“We have to put things into context. We have to realise that we are a resource-constrained country,” he said, “If you take away insurance out of tertiary health care, majority of people, not only in Uganda but all around the world cannot afford this treatment.”
He said when he recently referred a patient to Aga Khan Hospital in Kenya, the deposit fee was the equivalent of Shs 37 million while daily expenses for the critical care were about US$3,000 (Approx. Shs10 million). That is higher than what Ugandan hospitals have been charging.
Dr. Lukandwa also told The Independent that in June, when private hospitals were overwhelmed by COVID-19 patient numbers, the prices for hospital sundries, medicines, and utilities suddenly shot up. And stocks of consumables were running out fast.
“We had to buy most of these essential commodities on the local market whose prices were now inflated,” he said.
“Some drugs which were costing as low as Shs15,000 suddenly shot up to Shs120,000 and these are required drugs,” he said, “So you have a patient having the burden of drugs alone costing between Shs 1.5 million-Shs 2 million.”
He said investigations that are important since COVID-19 tends to affect multiple organs are costly. Checking blood sugar levels four times a day, for instance, costs Shs 80,000. The check for blood gases costs Shs120, 000 which could be done two or three times per day. A liver test is Shs 50,000, kidney test Shs 50,000 while feeding a patient artificially (parenteral nutrition) is Shs 300,000 per vial. Dr. Lukandwa added that at the peak of the wave, a patient could need 8-10 cylinders of oxygen a day with each costing about Shs50, 000 up from Shs 36,000 pre-pandemic to refill. This excluded the cost of transport.
He said some critically ill COVID-19 patients needed to be seen by a physician, an intensive care unit doctor, a physiotherapist, and neurosurgeon because there was a worry about bleeding. Other specialists required include urologists and hematologists. And some of these consultants are not available in the private facilities.
“We don’t have these external consultants in one place and each of these specialist doctors charges about Shs200, 000 as the professional consultancy fees per visit,” he says, “That is before you add PPE costs which range between Shs 60, 000 and Shs100, 000 depending on the quality.”
“The issue of specialized human resource is big because they are very few in the country; there are, for instance, about 70 intensivists and each cost about Shs500, 000 per shift,” explains Dr. Lukandwa.
“So the cost of traditional ICU, plus the risk allowance, the specific cost for the COVID-19 drugs coupled with the cost for PPE makes it appear like it is expensive but the truth is that ICU care for COVID-19 patients is just unaffordable for the majority of the Ugandan population.”
He said traditionally, patients in ICU could spend between 3-7 days but with COVID-19 treatment, they have been seeing patients stay for between 20-30 days.
“If you stay for 20 days in the ICU at a daily cost of Shs 5 million, that would push the patient’s bill to about 100 million,” he said, “When people see Shs 100 million, they look at a bill which is unexplainable but they don’t know how much of this bill has gone into drugs, investigations and ICU care”
