Kickbacks for medical referrals which have become common in Nigeria, and making healthcare more expensive, even as the practice endangers the lives of many patients through misdiagnosis and complications, LEADERSHIP Sunday checks have revealed.
Findings have shown that medical referral kickback which has become a gold mine in the health sector in the country increases the cost of medical services by at least 25 per cent.
Investigations carried out by our correspondent showed that patients seeking medical care in government hospitals are often referred by medical doctors for diagnosis and further investigation to private laboratories, an act which makes poor healthcare seekers spend more or in most cases abandon treatment.
From all indications, many doctors have turned medical referrals to a money making venture as they refer patients to diagnostic centres just for kickbacks, even when the referrals are not necessary, or when the facilities do not have standard devices/equipment for effective diagnosis.
Experts have warned that it is a leading cause of why majority of Nigerians who pay for medical bills out of pocket are increasingly finding it difficult to afford treatment.
The experts who described kickbacks as fee-splitting between doctors and recommended laboratories as “racketeering”, “criminal”, and “unethical” , added that that the practice is not only entrenched but one of the banes of the health sector in Nigeria.
The experts who further lamented that misdiagnosis is one of the major causes of several deaths in hospitals due to wrong treatment which follows wrong testing, results done with substandard, fake medical diagnostic equipment and devices by operators of medical laboratories, also identified lax regulation as the reason the fraudulent practice has become entrenched.
The experts who pleaded not to be named, revealed that their colleagues are paid between 20 and 40 per cent of the charged fee, thereby forcing such operators to clandestinely cut corners and compromise the system.
They explained that although there is no official data of the actual revenue of hospitals and diagnostic centres in the country, billions of naira is stolen annually from poor Nigerians, majority of who pay for medical bills out of pocket.
The experts, mainly doctors, explained that they arrived at the estimate by computing the monthly revenue of some leading diagnostics firms in the country.
LEADERSHIP Sunday learnt that medical laboratories, both private and public, are supposed to be inspected and regulated by the Medical Laboratory Science Council of Nigeria (MLSCN) as well as validate reagents and equipment.
However, the president, Association of Medical Laboratory Scientists of Nigeria (AMLSN), Prof. James Damen, told our correspondent that the Medical Laboratory Science Council Act has not been fully implemented, and called on the government to support MLSCN to ensure that provisions of the Act are fully implemented.
He lamented that most of the hospitals try to frustrate the council from exhibiting the responsibility as contained in the Act.
“For instance, our council goes to public hospitals, mostly teaching hospitals and they want to go to the laboratories because part of their responsibilities is to inspect the laboratories to ascertain whether they have the right personnel and equipment.
“Checkmating them can guarantee that qualitative results are produced from the laboratories but in most cases, when they get there, you will discover that pathologists are there as heads of laboratory and they would prevent the council from coming to the lab. So, these are the challenges that we have.
“The act also gives the MLSCN the provision to be able to validate equipment and reagents coming into the country. From all indications, the National Agency for Food and Drug Administration and Control (NAFDAC) is also doing part of what our council is supposed to be doing, and it’s not in their Act,” he said.
Narrating her experience, an Abuja-based civil servant, Mrs Cordelia Anthony, told LEADERSHIP Sunday that her father who was ill was taken to one of the government hospitals in Abuja. She said the doctor they met on duty directed them to do a scan in a particular private facility but that the day they returned to the hospital with the result, they met another doctor on duty who then told them that the hospital had the equipment for the scan and that the scan was not even necessary.
She said the doctor asked her the cost of the scan and when she told her, she was told that the amount was triple the cost in the hospital.
She said; “I went back to the facility to know why the scan was that expensive but was shocked by the revelation. When I got there, I met a nurse at the reception and I told her why I was there. The nurse asked me if my father was referred there, I said yes, then she asked from which hospital, I told her, and she laughed. I was wondering why she was laughing until she explained to me that I was charged extra because 20 per cent of the cost was meant for the doctor that referred us there.”
Also, a pregnant woman in Jikwoyi, a suburb of Abuja who identified herself as Joy, told LEADERSHIP Sunday that in the private hospital she uses, she has her health insurance coverage but the doctors would always send to a particular diagnostic centre even when it has the equipment but that she later found out from one of the nurses that the doctors get commission for every referral.
Whereas she has health insurance coverage in the hospital, she ends up paying out-of-pocket for the scan outside the hospital.
Cecilia and Joy are just a few of the many Nigerians who have had to spend more and out-of- pocket due to racketeering.
Reacting to this, Prof. Damen blamed doctors for the practice which he described as corrupt and unethical, saying the Medical Laboratory Science Council has a disciplinary committee where any of their members reported for such act would appear and if found guilty, is punished.
“It is unethical because our responsibility is that, let patients get the best services at cheaper costs but you would discover that the corruption actually comes from these doctors because you would have a lab, before they would send a patient, they would want to get commission from every patient they send to you, it is not right, I think the emphasis should be on these doctors, the issue of money, let us all know that the issue of money should be secondary, our primary vocation, we are called to serve, so we should have that at the back of our minds and put the issue of money behind us.
“If we have a matter like that and it is reported, we have a disciplinary committee that those of our members have to appear before and if they are found wanting, they will be punished. Their licenses may be withdrawn to prevent them from practicing either permanently or for some years because it is actually unethical. We don’t encourage our members to do such unethical things,” he said.
A radiologist in training in one of the hospitals in Abuja who does not want his name mentioned, said it is true that doctors are more interested in the commission they get from referrals, saying no doctor would want to be misled by a diagnosis.
He believed that the doctors most times send patients to diagnostic centres outside to get second opinion.
“There is what they call second opinion scan, if a doctor is having doubts about the scan done in the hospital, he may send the patient outside to carry out the same scan. It is not necessarily because of the commission because no good doctor would want to be misled by a scan.
“These scan centres, there are several of them out there, so some may meet the doctors to bring patients to their centres, they may want to offer some discounts to attract patronage, but most times, a good doctor, even if he wants to send a patient for a second opinion would send the patient to a centre that he trusts because he had used this centres before and gotten good results.
Some medical doctors believe that the reason patients are referred mostly for scan is because a lot of the hospitals do not have equipment.
The former president of the Nigerian Association of Resident Doctors (NARD), Dr Uyilawa Okhuaihesuy, told LEADERSHIP Sunday that most hospitals don’t have what it takes to manage patients, so there would always be the need for referrals.
He said: “First of all, in the best of both federal and general hospitals, the teaching and specialist hospitals, they don’t have such equipment that work. I always make mention of Magnetic Resonance Imaging (MRI) and computerised tomography (CT) scan, most hospitals do not have these equipment. Even the ones that have are more like Private-Public Partnership (PPP). So if a patient comes that has a brain tumor or tumor in the chest or abdomen, and you don’t have the equipment, you would refer them because the first priority is to make a diagnosis, and all those equipment, you cannot make a diagnosis when over 80 per cent of the general hospitals don’t have such equipment. So that is it.
“I won’t say it’s entirely right and I won’t say it is wrong but we are not all the same in carrying out our duties. I know that most hospitals do not have what it takes to really manage patients and we may need to sometimes refer them for investigation for us to make a diagnosis.”
Also, a consultant family physician, Dr Adaeze Oreh, stressed the need for hospitals to prioritise communication.
She told LEADERSHIP Sunday that It is good for hospitals whether public or private to try and communicate the services that they provide, saying when people are aware that certain services are provided in a particular facility, then when a doctor says go to somewhere else to carry out a test, they can always say they are aware such services are available there.
“So once the patient is coming from a position of having some idea or having knowledge, it will not be so easy for doctors to send them to a place where they are making money or you are getting a commission.
“The hospitals need to prioritise communication, education of the community around them, it’s just that on one side, there is that thing about hospitals not advertising, it is not necessary advertising but offering a health education, that is why every hospital should also be involved with community health education,” she added.
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