By Topilla Isaac
I come from a community that uses herbs a lot to treat many diseases. There are specific individuals who are experts in the ‘field of herb.’ Those people can examine a patient and prescribe a medication which will interestingly work. Such people are experts in that aspect. This expertise is normally passed from one generation to another and so some families are known for that.
Normally there is a fee for such expert. The amount of fee depends on the seriousness of the disease as well as the condition of the patient. Mostly the fee is affordable and reasonable. Reasonable in the sense that it is the patient (or patient’s family) who gives fee as a way of appreciating ‘the healer’ for the hospitality. This is not to say that there are not some few elements who use their expertise to extort people. But generally there is a communal standard that is expected from the ‘healers’ because it is believed to a divine gift to be a healer.
Looking at the current situation in our country on the matters of doctors and the exorbitant fee charges they demand, one is left wondering if it is right or they are just in business. Over the past few weeks there has been a clamour for the reduction of the fees charged by doctors in private practice. An argument has been made that the fees charged by private doctors in their private facilities had something to do with the Universal Health Coverage (UHC) push by government.
It was argued that reducing the ‘exorbitant’ rates would somehow help achieve UHC in this country, and a few brilliant fellows came up with the argument that since the government ‘cannot achieve UHC using public facilities alone’, it was necessary to involve the private sector, hence the need to control the rates charged by private practitioners in support of UHC.
This disingenuous argument only creates confusion in the public mind, and it is important to clear up the confusion once and for all, and help direct the conversation where it ought to be. I spoke to Dr. Menach, an Ear, Nose and Throat (ENT) surgeon on this matter. According to him everybody has agreed that UHC will only be achieved if it is public-led and tax-funded, and focused primarily on improving public health facilities in order to ensure that all Kenyans have access to life-saving services without being impoverished. The implication here is that we must invest in the public health sector, and only involve the private sector when the capacity in the public sector is either overwhelmed or inadequate. We can, however, not predicate our entire public health policy on the private sector, as is being done at the moment.
Secondly, in the event private health services are required to support UHC, it is clear that such services will not be accessed by coercion, but through a process of negotiation as has been the case. Whatever the professional fee ceilings may be set by the Board, the government will have to approach private health providers and negotiate cost-effective rates. Dr. Eugene also corroborated what Dr. Menach said by adding that reducing the upper limits of the private practitioners’ charges will not change the need for government to negotiate favourable rates. Neither will it change the need for the provider to voluntarily agree to provide the services at whatever rate is set for them.
For instance, even if the government decides that a private practitioner will charge a maximum of one thousand shillings per consultation, there is nothing in law that compels the practitioner to leave her house and go to her clinic to see patients under this arrangement.
Being a private agent, her freedom to choose how and where to earn a living cannot be limited by fiat. On the other hand, even if the maximum consultation fees are set at Sh10, 000, nothing stops the government from negotiating with willing providers to charge a thousand shillings per consultation for patients under the UHC programme.
Dr, Beda, who is a lecturer at University of Nairobi threw a spanner to the matter adding that as things stand today, private doctors charge fees mostly within limits set by the regulator, with a significant majority charging for most of their procedures well below the non-binding minimums set by the Medical Board. Lowering the maximum chargeable fees will therefore have absolutely no effect on the fees charged by most private doctors, and may even have the unintended effect of causing many to raise their fees nearer the new maximum.
Thankfully, many leaders have seen the light and are now shifting the discussion more usefully towards improving public health services and addressing the total cost of healthcare to the government and other payers. And this is as it should be.
My interaction with these doctors made think about the amount of money people spent in these country to access medical services. The government has tried to increase the number of people who are covered by National Hospital Insurance Fund (NHIF). It is a noble thing to do. But the question in my mind as I think about my community is, are the private practitioners noble enough to treat first and think about money later?
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