Patients who are billed to undergo surgical procedures at the Federal Government-owned Lagos University Teaching Hospital, Idi-Araba, are being mandated to equip their surgeons before they can be scheduled for their surgeries.
The patients are required to buy disposable goggles, face masks, disposable gowns, polypropylene mesh and Home Medical Equipment — a category of devices used for patients whose care is being managed from home or other private facility managed by a nonprofessional caregiver or family member.
This is separate from the charges they will still pay for the surgery, PUNCH HealthWise can report.
A patient at the tertiary hospital who decried the high cost of the surgical materials billed for his surgery said the materials alone cost N74,400, excluding the cost of surgery.
He presented his receipt showing the list of materials he is mandated to buy and the total cost —N74,400 (seventy-four thousand, four hundred naira only).
The receipt, dated 20th May, 2020 and issued on LUTH’s letterhead as ‘prescription’ bill, lists the following:
• NAS face masks (nine pieces) —N43,200
• Disposable goggles (four pieces) —N9,600
• Disposable gowns (nine pieces) —N21,600
• HME (two pieces)
• Polypropylene mesh
The patient, who preferred anonymity, told PUNCH HealthWise that the cost of the materials was out of reach of ordinary Nigerians.
He frowned upon a situation where he would be made to buy surgical materials and still pay for the cost of surgery and post-surgery management.
He called on the Federal Government to urgently look into the matter, lamenting that medical equipment has gone up as a result of the COVID-19 pandemic.
The World Health Organisation described the out-of-pocket payments like this as “catastrophic expenditure.”
The United Nations agency noted that out-of-pocket payments are part of the health financing landscape in all countries relying on user fees and co-payments to mobilise revenue and rationalise the use of health services.
It warned that “Unregulated direct charges often constitute a major access barrier to needed health care and contribute to high out-of-pocket payments generating problems of financial protection.”
The global health body added that there is a very strong correlation between the level of out-of-pocket payments and the two indicators that are currently used to monitor how well a health system is performing in terms of financial protection — the incidence of catastrophic and impoverishing health expenditures.
“These two indicators are solely determined by the extent to which out-of-pocket payments absorb household’s financial resources,” WHO said.
In an interview with our Correspondent, the Chairman, Medical Advisory Committee at the Lagos University Teaching Hospital, Idi-Araba, Prof. Wasiu Adeyemo, however, said non-COVID-19 patients are required to buy or pay for surgery materials.
“Patients pay for surgery, they pay for materials; these are patients that are different from COVID-19.
“So, whatever they need to provide to do the surgery is what we ask them to do,” Adeyemo said.
Continuing, he said, “When we want to do surgery for patients, they usually pay for materials, including the materials that the surgeon, anaesthetics and nurses will use.
“But in case we don’t have the materials in the hospital, we will ask them to go and buy them before they are booked for their surgery.
“This is what they do before COVID-19. They pay for face masks, gloves, and surgical gowns.
“The people that don’t pay for personal protective equipment are those we are treating for COVID-19.”
Patients not supposed to buy, pay for surgical materials—NARD
Reacting, president of the National Association of Resident Doctors, Dr. Aliyu Sokomba, blamed the government for not providing the necessary materials in the hospitals.
“Patients are not supposed to buy or pay for surgical materials; but if these things are not available, they have to make a choice of whether they buy themselves or go back home.
“It is just the demonstration of the failure of the government to make sure that all these things are available; but when they are not available, patients have no choice but to buy them.”
Continuing, Sokomba said, “We don’t know what the government wants us to do. Should we close the hospitals if these things are not available or we should leave it open? We can’t be the ones buying these things for patients.
“We are trying; the ones we can buy, we will buy; but we will leave the ones we cannot buy.
“Government is not providing these things; the government is not helping hospitals to make these things available. Hospitals cannot help themselves and patients cannot help themselves too.
“If we close down the hospitals, they will say we close down the hospitals, so, what do we do?”
Also, a public health physician, Dr. Laz Eze, said, “If the hospitals have the supply, the patient will still pay for them, somehow. But if the hospital doesn’t have the supply, they will write it for the patients to buy. Whichever way, the patient will still bear the cost.
“That is why we say citizens should add their voices and demand for health insurance for everybody but they will see it as health worker advocacy.
“Healthcare is not cheap anywhere in the world; and someone has to pay for it. It’s either the government provide these things, which they don’t provide in many cases; and when you go to the hospital, the health workers don’t have the minimal tools to work with and they will have to write a long list and give patients to buy.”
Eze, who is also the convener of #MakeOurHospitalWork campaign, added, “The cost of service is the one that is almost free because government pays for that; but the cost of equipment or tools that will be used in the course of any procedure will be borne by the patient.
“If the hospitals have the supply, they will still charge the patient for the ones they are going to use for that patient; but really, so many people cannot afford it.”