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. Firstly, everybody is 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. It follows therefore 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.
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.
Atwoli is Associate Professor of Psychiatry, Dean, Moi University School of Medicine; [email protected]