Massive medical bills leave families of COVID patients in deep debt in Bangladesh

Businessman Farhad Hossain never gave a second thought to spending more than Tk 100,000 per day when it came to saving his mother Fatema Rahman’s life after she contracted the coronavirus. The woman did not make it home alive from the Intensive Care Unit of a hospital in Dhaka.

She lost the battle for her life on May 9 after a month of treatment. They were in for another shock: the outrageous medical bills.  The family had to pay the ICU bills for 31 days, eight hours and four minutes -- around Tk 60,000 per day on an average.

Doing so meant it ate up their savings and they sunk deep into debt. They are struggling now to repay the loans they took to clear the enormous treatment expenses.

“Sometimes we had to spend Tk 100,000 a day only on medicine,” said Farhad, a trader of agricultural products in Thakurgaon.

Financial woes tied to healthcare are nothing new for Bangladeshis and high costs of COVID-19 interventions have only exacerbated problem.

Last August, Fatema’s son-in-law also died from COVID-19. The family have had to shell out Tk 4.5 million in total for the treatment of those two members, they said.

Most people in Bangladesh cannot afford such high healthcare costs of their loved ones. Farhad’s family did: just about. They now plan to sell off their ancestral assets to clear the debt.

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Farhad and his brother Fayez Ahmed, who works in Palmal Group of Industries, borrowed heavily from friends and relatives. They still had Tk 700,000 of that money when their mother died.

“Now we're worried about how we’ll repay the rest of the money we borrowed,” said Farhad.

Not all coronavirus patients need to be hospitalised and spend such a huge amount like Farhad’s family did, say public health experts.

According to the Institute of Epidemiology, Disease Control and Research or IEDCR, 44 percent of the coronavirus patients were hospitalised from Jan 28 to Apr 15.

The rest of the patients recovered by receiving treatment at home.

Those who were hospitalised, however, had to spend a large sum of money for treatment. Patients who remained in general beds spent Tk 125,000 to Tk 250,000 on an average. The bills went up to between Tk 400,000 and Tk 500,000 for patients who needed intensive care.

Medical care in the government hospitals are subsidised, which eases the financial strains on the patients. But for those who turn to private hospitals, by choice or by circumstance, the financial burden becomes huge.

Abdullah Al Mamun, a resident of Adabor in Dhaka, saw his entire family contract the coronavirus in the beginning of April.

After three days, his father’s condition deteriorated. They called an ambulance, but his father had passed away before it arrived, Mamun said.

He sent off his father’s mortal remains to their village home for his burial and got admitted himself in a hospital. Other members of the family were quarantined at their Dhaka home.

“My father passed away but I couldn’t take part in his last rites. My wife was expecting at that time while my mother is aged and fragile," said Mamun.

He paid around Tk 200,000 for the eight-day stay in hospital.

TREATMENT COST AT GOVERNMENT AND PRIVATE FACILITIES

A research by the Health Economy Unit of the Ministry of Health and Family Welfare found that the healthcare cost for each patient in a general bed in a government hospital is Tk 128,000 on an average. The cost is Tk 408,000 for an ICU bed.

The figure is much higher in the private sector where a general bed for each patient costs Tk 242,000 on an average and the ICU bed Tk 509,000.

The research was based on the information accumulated from 31,147 general bed patients and 2,918 ICU patients in four government hospitals and two private hospitals.

“The entire cost shown in the public hospital is indeed spent by the government,” said Deputy Secretary Dr Nurul Amin, director of Health Economy Unit.

At government hospitals, a general patient needs to pay Tk 7,000 in additional cost while the amount is Tk 33,000 for an ICU patient.

“But private hospital patients need to bear the entire cost.”

Each patient in government hospitals stayed for 8 days in ICU on an average, while the average time is 7.39 days in private hospital ICUs, said Dr Amin.

The average time of stay in general beds is 10 days in government hospital and 6.52 days in private hospitals.

Considering the average stay, a general bed in a private hospital costs Tk 37,116 a day, while an ICU bed costs Tk 68,876 per day.

When asked about the difference of average stay in government and private hospitals, Dr Amin said the families ask the private hospital authorities to discharge the patients when they recover a bit, because the bills are too high.

EXPENSIVE MEDICINE

Expensive medicines are another part of the big expenditure for the families of the COVID-19 patients, according to some physicians.

Most of the hospitals are using remdesivir, which is bought for Tk 3,500 to Tk 4,000 per 100mg vial in the open market. A patient needs remdesivir worth more than Tk 30,000 to complete the full course of treatment.

For patients in critical condition, doctors are administering tocilizumab injection (Actemra) which costs between Tk 50,000 and Tk 70,000 depending on the patient’s body weight.

Most of the hospitalised COVID patients suffer from pneumonia. These patients need antibiotic injections to prevent bacterial infection, which costs Tk 1,000 per dose. On top of that, they need to buy other medicines and medical oxygen.

COVID-19 patients undergo some pathological tests almost every day. Many of the government hospitals do not run those tests and the private facilities charge Tk 3,000 on an average a day for them. All these push the treatment bills up for the COVID-19 patients.