Almost over a decade ago, Kathmandu Metropolitan City had requested the Ministry of Health and Population (MoHP) to not allow new hospitals to be built inside Ring Road. Had an act been passed then, a lot of private hospitals, that are now located within the valley, would have been established elsewhere perhaps making healthcare service easily available in rural areas.
Now there are 99 registered hospitals within the valley, a number even the government officials, at MoHP, agree there’s no need for in a relatively small city like Kathmandu. A matter of concern, however, lies in the fact that patient satisfaction with hospital care is actually declining at the same rate hospitals are increasing.
“There’re so many hospitals within the valley still, I don’t feel I can rely on them. The fact that I can’t understand how they are being sustained adds to my worries and discomfort,” says Tenzing Tamang, 35, a kidney transplant patient. [break]
When Tamang was diagnosed with kidney failure, he chose to go to Vellore, India for treatment. Though his recovery rate has been amazing, he keeps suffering from minor ailments like throat infection, anemia etc that, in his case, require urgent attention. But Tamang doesn’t trust hospitals in his own hometown. He makes it a point to visit at least three hospitals for consultations and tests.
“Cross checking is of paramount importance to me since I don’t trust the test results at any particular hospital,” he says adding that the hospitals around the valley aren’t well equipped to cater to the various needs different patients might have.
If you’ve ever spent time at a hospital either as a patient or as someone accompanying the patient then you know that health care is extremely complicated and visiting hospital immensely stressful. Technology aside, over a dozen of people need to be orchestrated to care for a single patient: physicians, nurses, administrative staff, pharmacists, technicians, laboratory staff and many more.
Also unlike a factory where work flows can be standardized, each patient is unique and requires special treatment. And there’s the fact that, at any given time, each health professional is dealing with multiple patients. Given this complexity, it’s a minor miracle that hospitals are thriving the way they are and it’s also obvious why people are skeptical about the treatment available at one.
The care-giving standards of private hospitals, clinics and laboratories across the country are being called into question. Many also question the quality of service delivered by hospitals which are run in residential-purpose buildings.
On a random survey conducted recently by The Week, 75% of the people expressed anguish over the fact that they simply don’t know which hospital to go to when faced with health problems.
Dr Padam Bahadur Chand, spokesperson at MoHP, admits it’s because of a weak regulatory mechanism on the government’s part that the capital is being inundated by hospitals and not many of those hospitals are up to the mark. He also admits that there’s no regulation or control over hospital bed charge, doctors’ fee, different laboratory tests and surgical charges.
“Hospitals have to be established keeping the needs of the place in mind. We don’t need more hospitals in Kathmandu now but what we do need is a healthcare system people can rely on,” says Chand adding that the government is working towards it and that a new law, aimed at bettering the current situation of private hospitals, will soon come into being in the interest of public health.
Bijay Kumar Jha, training officer at Nepal Health Research Council (NHRC), says hospitals have to fulfill certain standards set by the 2004 guidelines on private and public hospitals. The hospitals should take construction approval, environment impact assessment from the Ministry of Environment and final consent from the Ministry of Health and Population, among others before registering at the Company Registrars office under the Ministry of Industry. In Kathmandu, however, many hospitals fail to meet the standards.
But according to Chand, since there is no policy to govern hospitals it’s hard to talk about standards. When and if the government is clear on its policy and serious about the implementation of those very policies, only then will the situation be under control. He also said that it’s high time a new law be made immediately to monitor and supervise these infirmaries but at the same time admitted that it will take a while.
In such a scenario, the big question that looms over us is that of the private healthcare systems’ cost advantage and reliability to consumers as the choices will only continue to grow given the government’s lack of initiative to tackle the issue with the urgency it requires.
Dr Mahesh Raj Ghimire, resident at National Medical College, Birgunj and former medical officer at Sumeru Hospital, explains that when people seek medical help at teaching hospitals and government hospitals, they pay less in comparison to private institutions but patients are often kept on waiting lists. According to Ghimire, this is one of the main reasons why private hospitals are mushrooming.
“Sometimes, a doctor will only be available after a week or so. People can’t and shouldn’t have to wait that long to address their health issues,” says Dr Ghimire adding that such circumstances lead to an increase in demand for healthcare. The result of which is evident; there’s at least one hospital on almost every street – sometimes even two.
“Growing urbanization will make sure that private medical facilities continue to do good business because consumers now want facilities that are better than the best. But how do they make a decision regarding which hospital to go to seems to be a conundrum that has perplexed many in the recent times,” he adds.
On the other hand, these private hospitals could change the way medical research is conducted opening doors for advanced technology and treatments since there are many institutions involved in research. But then again, they need to be monitored and properly regulated.
“A lot of private hospitals that are registered as research centers are conducting useful research programs that could benefit the healthcare system in the future,” says Jha adding that NHRC runs a check on these research centers during the process of registration renewal and that they are required to publish at least two research papers per year.
Though this might be beneficial in the long run, as of now the healthcare system needs to be patient driven and the good news is that the government realizes the importance of that. Amidst this storm of increasing number of hospitals and decreasing patient satisfaction, a glimmer of hope flickers in plans the government is working on. Whether these plans will materialize and bring some respite to hundreds of bewildered patients or not, only time will tell.
People´s Perspective
The capital city has witnessed the mushrooming of hospitals over the past few years. With a hospital at almost every corner, how does one decide which one to visit when faced with health issues? The Week talked to some valley denizens to find out.
My wife had some gynecological issues and we went for a checkup at Bir Hospital considering it’s the oldest medical service provider around. But when the doctors told us that she would have to get admitted, both of us weren’t very sure about getting treated there. As we all know, the government run hospital is in a very miserable state. We started looking for alternatives but since there’s a hospital at almost every corner in Kathmandu, we were quite confused. Some of our friends then mentioned that Alka Hospital was neither very expensive nor were the service and facilities bad. So my wife got admitted at Alka Hospital. But even now as my wife gets treated at the hospital, I constantly find myself fretting over our decision. Maybe we should have asked around and done some research ourselves before rushing over to Alka. With choices abound, you’re never really sure if you’ve made the right decision. Depending on what your friends and relatives suggest seems to be the only solution at hand. One can only hope what worked for them will work for you as well.
BHIMSEN BURATHOKI, 36, government officer
I visit Sumeru Hospital whenever I have any health problems because my company looks after the hospital’s technical requirements and I get a discount there that I wouldn’t receive elsewhere. Nowadays, it’s difficult to make a decision regarding which hospital you should go to when you have health issues since there’s a hospital at every step. I think one should keep a lot of factors in mind while choosing a hospital. First and foremost, the doctor who will be attending to you makes the biggest difference. Then you should keep the expenses in mind. The rates vary and sometimes, the same treatment is cheaper at another hospital. For minor ailments, why should one squander away a lot of money? Just because the service is expensive doesn’t necessarily mean its better. The facilities available at the hospital should also be taken into consideration else you’ll just end up wasting a lot of time rushing from one place to another. I don’t think selecting a hospital just because it’s close by is a wise idea. A lot of people seem to be doing that these days since everybody has a hospital nearby where they live.
UJJWAL RANA, 25, IT officer
I visit Sumeru Hospital whenever I have any health problems because my company looks after the hospital’s technical requirements and I get a discount there that I wouldn’t receive elsewhere. Nowadays, it’s difficult to make a decision regarding which hospital you should go to when you have health issues since there’s a hospital at every step. I think one should keep a lot of factors in mind while choosing a hospital. First and foremost, the doctor who will be attending to you makes the biggest difference. Then you should keep the expenses in mind. The rates vary and sometimes, the same treatment is cheaper at another hospital. For minor ailments, why should one squander away a lot of money? Just because the service is expensive doesn’t necessarily mean its better. The facilities available at the hospital should also be taken into consideration else you’ll just end up wasting a lot of time rushing from one place to another. I don’t think selecting a hospital just because it’s close by is a wise idea. A lot of people seem to be doing that these days since everybody has a hospital nearby where they live.
UJJWAL RANA, 25, IT officer
My sister had been suffering from severe nosebleeds for quite a while when we decided to get it checked out. Since we live in Kalanki our first choice of hospital has always been Star Hospital because of the close proximity and we’ve always relied heavily on Dr Ranjan Singh. But when he went on leave for a while, we were left in a quandary. Then a friend recommended that we visit Dr Bishesh Poudyal at Civil Hospital who then referred us to Dr Binit Vaidya. Finally, my sister’s condition has been diagnosed and though it’s nothing serious, the hassle of visiting one hospital after another has taken its toll on her. I think visiting hospitals is a harrowing experience for patients. And on top of that, there’s the conundrum of having to decide which one is best for you. Another thing that causes great distress to patients is the fact that no particular hospital has all the facilities required. Sometimes, doctors at one hospital send you to another for tests. In such a scenario, it takes a lot of time to even get a proper diagnosis.
HIRA SHRESTHA, 27, housewif
I live in Baneshwor. There are three hospitals near my home but still I have chosen to come all the way to Norvic International Hospital. There’re just too many hospitals in the valley and if someone in your family falls sick then it’s obvious you spend a lot of time agonizing over which hospital to visit. But even if the choices are many, I don’t think they’re all that reliable. Sometimes you get a checkup done at one place and then they refer you to some other place for further investigation which, I believe, is a nuisance. So it’s best to go to a reputed hospital and get everything done at one place. Norvic is definitely an expensive hospital but in the long run, I’ll be saving time and money as well as getting proper treatment. I wanted to get a consultation with Dr Achala Vaidya and she’s available at Norvic. It would definitely have been easier to visit a hospital close to home but I don’t believe in compromises where health is concerned. Go to a good doctor at an equally good, if not better, hospital.
SUMANA SOTI, 27, housewife
cillakhatry@gmail.com
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