A renowned physician provides patients with medical treatment at a private hospital-cum-diagnostic centre in Dhanmondi area. An on-the-spot visit showed many patients waiting there at even 11:30 pm. Some patients were in waiting room while some others in the doctor’s chamber. At one stage, the chamber assistant told the doctor “Sir it is time for you to have tea. And they are waiting.” In reply, the doctor said “Oh Yes! Don’t send any patient now. Make the tea ready. And send them to me.” There were four/five visitors waiting outside the doctor’s room. They were all young. Various kinds of bags were seen in their hands. They were talking to each other at low voice. One said he brought cash money. Another said “Now-a-days, Sir is not willing to take cheque. He prefers cash money. So, I always bring cash money. But my office likes to give cheque.” Getting green signal, one of the visitors entered the room of the doctor. His exit was followed by entry of another few minutes later. Finally, all of them gathered at a tea stall in a nearby footpath. One of them shouted “This job is becoming bitter gradually. He misbehaved with me. He threatened not to send any patient if commission rate is not hiked. Concealing identity, the reporter talked to the visitor. It was gathered that he had been doing job as marketing executive of a diagnostic centre in Dhanmondi area for 11 months. His task is to visit the doctors’ chambers. There are two kinds of visits. First visit aims at convincing a doctor to send patients while second visit at paying commission money. There is a marketing department in his diagnostic centre to deal with the physicians. Around 20 staffs are doing jobs under a marketing manager there. Another visitor shared similar experience. He, however, is not marketing executive of any diagnostic centre. He came from a hospital. He visits the doctors’ chambers with a view to taking away patients to his hospital. The patients who need ICU service are their main target. Several marketing executives said the doctors take 20-30 percent commission for testing urine, stool, blood and cough. For other kinds of tests, they take 30-50 percent commission. A physician takes 10-20 percent commission for sending a patient to a hospital and 20-25 for therapy. Some doctors take commission on weekly basis while some others monthly and daily. Many doctors prefer cash money while others like cheque. One of the major sources of income of doctors is commission. This commission business is widespread in Dhaka and other parts of the country. Various persons related with survey on the doctors said the commission business is getting expanded day by day. New windows of getting commission are being opened. The doctors are in a desperate bid to collect commission money. The commission business has given birth to a separate commercial section. As a result, the patients have to count more money for their treatment. Prof Dr Rashid-E Mahbub, president of health rights movement and former president of Bangladesh Medical Association (BME), said the public welfare sectors like hospitals, diagnostic centres and pharmaceutical companies are locked in a mad competition. To win the competition, these organisations have introduced a culture of giving commission to doctors. A section of unscrupulous doctors are being trapped. The treatment cost has become many time higher for this commission. The patients are getting pauper. If commission is stopped, treatment cost will be low. On condition of anonymity, a researcher of a public university said, “Physicians are not only taking commission from the pathological laboratories for urine and cough tests, commission is charged on all new technology-based tests. New technology has been added to digital x-ray, ECG, ultra sonogram, Eco, color Doppler, city scan and MRI. The rate of commission is high in those tests. The commission is divided according to necessary technology and examinations. Besides the physicians are also taking commission for sending patients to hospitals. In this field, they are getting special commission if they refer patients to ICU and CCU. They are also getting operation commission. Besides this, physicians are collecting commission from chemotherapy for the cancer patients, physiotherapy from orthopedic patients and dialysis from the kidney patients. Most of the doctors are taking commission from heart patients for setting bulb, bone jointing to the orthopedic patients and transplanting various appliances to eye patients. Also the physicians are getting facilities from the renowned medicine companies for prescribing their selected medicines for the patients. A marketing executive said that there are a small number of doctors whom we could not convince for taking commission. Though some doctors are taking commission, they advised us not to take commission from poor patients. Dr Jahangir AM Khan, Coordinator, Health Economics and Financing Research Group of ICDDR,B said, “A research paper revealed that about 20 percent of the total population of the country are getting destitute for meeting health-related expenditures. On the other hand, 64 percent people of the country irrespective of rich and poor are taking healthcare services with their own money. To meet the healthcare problem, many people are selling their house-hold belongings, landed properties, domestic animals and taking loan from dear and near ones.” A recent survey of Transparency International Bangladesh (TIB) revealed the commission trade of the doctors. There are allegations of unwritten contract between doctors and diagnostic centres on sharing commission. Of them, doctors get 30 to 50 percent commission while middlemen are getting 10 to 30 percent commission. Sources at a hospital said not only selected hospital staffs but also some floating middlemen are engaged in managing commission for doctors in various ways. The brokers are very active in the small hospitals, diagnostic centres or pathological labs as there are not enough staffs. These brokers maintain communication with doctors and different hospitals or labs. In addition, the brokers persuade the patients in the area of government hospitals to go to private hospitals or clinics. Prof Dr Rashid-e-Mahbub said only the doctors are not responsible here. All the people concerned are accountable for it. People related with every sector have to come forward in stopping commission business. Besides, the concerned authority has to play crucial role. Monitoring is must to check the illegal act. Furthermore, those who are committing such acts have to be brought to book. Different organisations can play role in preventing commission businesses such as BMDC for ethical practices of doctors, Drug Administration for pharmaceutical companies and Health Directorate for hospitals or diagnostic centres. Vice chairman of BMDC and secretary general of BMA Iqbal Arsalan said, “The allegation of commission business cannot be ignored. We are finding the way out from this malpractice. All should come forward in this regard as this (practice) is now a big disease for our health system. It is also urgent to halt those who are practicing this illicit practice for their own interests.”
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