Editorial, NewAge, April 7, 2009
IT IS an ominous development that the government is proposing an increase in user fees at public hospitals, doing away with crucial free services and raising the prices of an array of tests and services that users already pay for. While these proposals are yet to be approved by the health ministry, it is said to be in line with the decision by the previous interim regime to grant autonomy to public hospitals, according to a report in Monday’s New Age.
Across the world there is more or less a policy consensus that health care is a common good and not a market commodity and that state expenditure in public health care has far-reaching redistributive effects. According to the World Health Organisation, more than 100 million people across the world slide into ever deeper poverty every year as a result of out-of-pocket expenditures on health care for a family member. Given this reality, providing free universal health care in a country like Bangladesh could have a tremendous positive impact of preventing tens of thousands of families from sliding deeper into poverty and debt as a result of a single disease or accident. What this also implies is that when families that live marginally above or on the poverty line have access to free health care, they have more resources to divert towards better nutrition and better education for their children, both of which are keystones of economic development.
It is no wonder that almost all developed countries of the world ensure free universal access to quality health care to their citizens, though significant sections of the citizenry could very well afford to pay for healthcare services. In fact, the lack of such universal healthcare services is also evident from the plight of the United States — one of the wealthiest economies in the world — where 47 million people reportedly have no access to health care because of the prohibitive costs involved, and are mired deeper and deeper into debt and poverty when they incur heavy expenditure on healthcare.
While public sector health care in Bangladesh is indeed in a shambles, rife with corruption and neglect, this cannot be a good enough argument to corporatise health care rather than institutionalise reforms which ensure more accountability and better services. We see it fit to oppose, in the harshest possible terms, what can only be the government’s first step to abdicate its central responsibility in providing universal free health care to its citizens by introducing the concept of user fees in health care, which typically precedes a gradual retreat from provision of such services. Such a move is immoral in that it accentuates the deep-seated inequities that already characterise Bangladeshi society, and will likely exacerbate poverty, undoing considerable good achieved by government and NGO-run anti-poverty programmes of the past decades.