Treating COVID-19 patients in private sector

By Dr. Prasanna Cooray

It is reported that some medical specialists have made representation to Lt. Gen. Shavendra Silva, head of the National Operation Centre for Prevention of COVID-19 Outbreak (NOCPCO), seeking his permission for treating COVID-19 patients in private hospitals. (It is surprising that this request comes, not from the representatives of private sector hospitals—employers, but from a group of doctors – employees). We hear this request is being discussed at ministerial level. While awaiting the government’s decision, on this matter, I wish to highlight some issues, related to the matter, that impinge on the public’s interest. I fervently hope that the health authorities will take due cognizance of these facts, before arriving at a decision.

1. Why was COVID-19 treatment, and control, kept under government in the first place? For some reasons, best known to the health authorities, all procedures, related to corona investigation, treatment, and control, were kept under stringent government control. The ultimate objective of this move was to provide the best care possible for the patients, and their contacts, with the least possible financial burden on them. This initiative, by the government, needs to be applauded. However, whether this happened, as expected, is another question. If there are lapses in the process, then that again has to be best addressed by the government through strengthening the government sector facilities. (The private sector will never be able to intervene as a suitable alternative to the state sector).

2. Why was the private sector kept out of this, at the beginning? The reason is known to the government and the public.

Further, COVID-19 infection, which is viral, has no specific treatment. Treating whatever the symptoms and attending to general wellbeing, with periodic PCR testing being carried out, while patients are kept under observation for complications, is what it needed. The complications are rare, but could be life threatening, needing intensive care, (which, in private sector, could be very expensive for a majority of the general public).

The cost of PCR testing is far beyond the reach of the general public of this country (and they are still). However, as the government stepped in timely, that eased the burden. It is also very unlikely that the private sector will have separate hospitals, wards and staff, dedicated to COVID-19 patients, unlike the state sector health institutions. There is also the possibility of the disease spreading to other patients.

3. COVID-19, by now, has become an unprecedented health emergency. Is the private sector equipped to face it? PCR positives average 500 a day. A few days ago, 878 cases were reported, the highest for a single day up until now. An increase in the detection of patients means more general, as well as, more intensive care. With regard to intensive care, issues of availability and affordability, in the private sector, loom large.

4. Another important consideration on this issue is the ‘equity’ in healthcare. The very tenets of public health system, in this country, are bases on the principle of equity. (However, there are many issues that negatively impact on healthcare equity in the country, and that needs to be addressed; the present epidemic provides an ideal opportunity for the authorities to act. Nevertheless, a possible involvement of the private sector, in treating COVID-19 patients, could put equity in jeopardy and lead to “catastrophic heath expenditure” and “impoverishing health costs”.

Overall, the health authorities are duty-bound to handle the current pandemic, cautiously and responsibility, placing public health and wellbeing above the interests of the rich and the powerful.