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When patients flee hospital without paying

IHK building in Namuwongo. The hospital lost more than Shs 400m in unpaid bills last year.
IHK building in Namuwongo. The hospital lost more than Shs 400m in unpaid bills last year.

As Ugandan private hospitals lose millions, some are considering assessing patients ability to pay before offering treatment

When relatives of Patrick Obiga, a patient who had been detained at Uganda’s top private hospital; the International Hospital Kampala (IHK), over failure to clear a Shs19 million medical bill sued and was released, they appear to have opened a flood-gate. Obiga’s got support to sue IHK from the Center for Health Human Rights and Development (CEHURD). They argued that the continued detention of Obiga at the hospital amounted to “holding him at ransom”.

They said the hospital was making demands that were unrealistic when they asked Obiga for a land title and postdated cheques to act as security for payment of the outstanding bill.

Almost as soon as Obiga’s reprieve became public, another patient with a similar case at another private hospital, the St. Francis Hospital Nsambya in Kampala, also ran to the press. John Basalirwa, who had been at the hospital for about a month, was detained for failing to settle a debt of Shs4.3 million. He said his family members are unemployed and could not raise the money.

The cases have rattled private medical service providers.

“Why would you go to a private hospital if you don’t have money?” says Dr. Ssentongo Katumba, who is the registrar of the Uganda Medical and Dental Practitioners Council (UMDPC).

He says patients should stop blackmailing medical practitioners because they are operating in a market economy where everything is affected by market forces.

At IHK Brenda Naluyima; the Public Relations Officer, told The Independent that the hospital lost up to Shs400m last year alone in unpaid bills. She said some patients flee without paying the bills.

Margret Mawanda, a communications officer at another private hospital, Mengo Hospital in Kampala, says the hospital also loses millions of shillings every year under similar circumstances. She didn’t mention a specific figure.

In all cases, however, public opinion seems to favour the patient. No one seems to be paying attention to the cost on the private health facilities of patients who fail to pay.

The attitude of Primah Kwagala, a Legal Officer at CEHURD is technical but typical. She said in an interview that the demands of the hospital are unrealistic.

“A hospital is not supposed to detain anyone even if a patient doesn’t pay. It’s an offence. There are courts authorised to handle that. The law is to the effect that when someone breaches a contractual commitment -then courts can come in to resolve the situation. Individuals and hospitals cannot turn into debt collectors, court and Judges at the same time,”she said.

The managers of private health facilities concede that detaining patients is illegal. But they argue that there are currently no viable solutions to strike a balance as hospitals seek to recover their money.

“It’s because we are offering a public good,” says Grace Ssali Kiwanuka, the Executive Director Uganda Healthcare Federation an umbrella organisation for private health facilities in Uganda, “If we were a supermarket and gave a million shillings worth of products and the person didn’t pay who would you side with?”

The problem has become so big that private health service providers are mulling over numerous interventions.

In one case, they have hired an international consultant to come up with an appropriate fees structure that private health service providers will use and will give patients a clue on what they are likely to be charged when they seek services from a particular category of hospitals.

Dr. Ssentongo Katumba says all hospitals categorised in the tertiary slot will be given a range of how much to charge from when treating a minor infection to a complicated surgery.

“Our consultants are doing final touches on the structure. Once they are done the figures will be published. This will also help private health insurance providers who have also found challenges with customers,” he says.

He adds that due to ethics of the profession, private hospitals cannot refuse to attend to an emergency case, but he advises that thereafter they should forward such patients to government run hospitals.

ShamimNalugemwa, a human rights advocate, says hospitals need to draw up guidelines on payment procedures. She says hospitals should also form legal departments to advise them on how to deal with such eventualities. For-example, she says, patients should sign agreements upon admission and when they fail to meet the requirements, then a patient can be sued based on the agreement arrived at by both parties.

“There is need for quick processing of the health insurance bill because healthcare is being commoditised yet some of the drugs are not taxed,” she says. Kiwanuka also says because there is an aspect of “involuntary consumption”, it is the duty of the government to relieve private hospitals by setting up a fund to cushion the private sector for such situations of patients running away from free services at public facilities even when they know they cannot afford private healthcare.

He said the government needs to consider an incentive for private sector to keep giving the service because they are filling a gap. The incentives could include agreeing to meet the excess charge on medical bills for patients that fail to pay. Otherwise, she warns, private health service providers could be compelled to “start checking who can afford what before giving care”.

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