Friday, December 14, 2012

The Medical Profession in a spot of envy and wants a balance



It is no secret that the Doctors in the State Sector receive a very low salary at whatever stage they happen to be, relative to the Private Sector, or any other country. They therefore moonlight after hours and some earn 10 times their state remuneration that way. Further they are entitled to heavily subsidized car permits I believe, every 5 years, that enable them to purchase vehicles at Rs5M(US$40,000) less than lesser mortals in many instances. Their salary / allowances for travelling etc amount in total to no more than US$400 a month for 10 years plus service.

Admittedly the state sector educates Doctors Free, so that a child of a relatively poor family, who gets into Medical College can with effort get places, people only dream of. I believe the two practicing doctors I go if I need to see a GP at short notice close to my home, are both  from low income backgrounds and on the full time staff of the Homagama Base Hospital, but both see patients before going to work and after they get back. One doctor sees over 75 patients in an evening 7 days a week after work. He is particularly good, and hence his wide following.

These Government Doctors have a transfer scheme, hierarchy and promotions based on a tried and tested model, usually with seniority based on years of service and NOT on merit, and so is their remuneration calculated on that NOT on merit.
They also belong to the GMOA (Government Medical Officers Association)

So it was interesting that I read today that the GMOA with consultation with the Health Ministry, who is their employer, has obtained some form of permission for the State Sector doctors to work in Private Hospitals under some form of program over and above the moonlighting that I referred to earlier. I am not privy to the details, but I presume they are permitted to work a day or two outside, when they may be docked some salary, but not their seniority or pension rights. This, so that they will be able to fill some of the vacancies in the Private Sector, that are now filled from overseas. It is this latter intention, where it is alleged that overseas doctors are of lower caliber and are a threat to patient safety that this step has been taken.

After all when a patient’s treatment gets cocked up in the Private Sector, the patient unable to pay, having lost faith in the Private Sector goes for free Healthcare in the State Sector and this is the excuse used, namely that it will stop this drain on the State Sector due to substandard care in the Private Sector! I do not know how far that is true as it works both ways, where cockups in the State Sector are referred to the Private Sector when the patient is able to financially afford that.
There is some form of licensing that the overseas doctors have to get before being able to practice in the Private Sector, and the Health Ministry expects it to be tightened further to ensure a higher standard.

It must also be remembered that today in Sri Lanka, 1000 doctors pass through the University System, annually, who need to find employment and the State Sector is unable to guarantee them employment to do the needed training. The shortage of doctors in the state sector is diminishing and is now only confined to Specialists and to Rural Hospitals. It is therefore a method to release some of the pressure on doctors in the State Sector, who are surplus to requirements to permit them to practice in Private Hospitals.

The counter argument is why are we importing doctors when we have a surplus of doctors in the Country? This is after sending out 5000 doctors overseas to work overseas, most of whom have emigrated to the West and are helping the health services of their host countries.

I believe we must also make provision for training new doctors who cannot be absorbed into the state sector, into the Private Sector where they are able to get the same level of training, and not lose out on promotions or seniority.

What we MUST stop are doctors (some, mainly in the rural hospitals) who refer patients to their own clinics outside hospitals, to perform unneeded tests, (unnecessary scans for pregnant mothers) and who take medicines from State Hospitals to sell to their patients who see them privately in their homes.

These are all matters that a future National Health Policy must take cognizance of. Further we are still awaiting the implementation of the National Drugs Policy that must provide for a two tier drug system, where the State orders from a list, and agrees on prices once a year for the drugs they purchase on a transparent basis, and allows the private sector to stock brand name drugs which a doctor in private practice is permitted to prescribe if he so wishes, the patient knowing that it is a risk he takes when seeking treatment Privately.

In my case when I visited the doctor privately I was prescribed the expensive branded drug Augmentin, which may not be available in the state sector if I had gone there to seek treatment. It is my choice of whether to go 5 KM to the hospital for free treatment or to pay $4 and seek private treatment at 7am a few hundred meters from my home, and get a prescription for branded drugs if they are considered to do the job better than the ones prescribed for the state sector.

6 comments:

Anonymous said...

you have a lot of experience with the SL medical system, and the debate between government-controlled and private health care provision is an interesting debate which cannot be allowed to go to either extreme otherwise you get unaffordable prices or lack luster service. the $4 provision of private service seems to be a happy medium. how affordable is this for the villagers of your area? also how appealing is it?

Ratmale,Minneriya,Sri Lanka said...

It is definitely affordable to all in my area as the cost of a trishaw to the base hospital is twice the cost of the docs charges here.

I just took two this morning to the doc, and for both consultations and some low price meds he charged only $2 for both patients.

The prescriptions I paid for at the pharmacy for their ailments cost about $7, and I believe even the State hospital would say they were out of it and give the prescription to the patient to buy outside from a Pharmacy.

Ratmale,Minneriya,Sri Lanka said...

The $4 I mentioned as the cost of my consultation also included an anti tetanus shot, so if I only got a prescription it would have been possibly $1.50. A one way trishaw journey to hospital would be $4!

Anonymous said...

it's good that the price of medicine has not kept pace with the price of gasoline!

are the medications real or counterfeits?

Ratmale,Minneriya,Sri Lanka said...

They are generally real but Indian manufactured!! Quality I hope is within acceptable norms

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