How to use private hospitals in Covid-19

Expert shares a model

As Bangladesh is grappling to manage COVID-19 patients and the government is yet to engage private sector in this fight, an expert shares a model of how to do that in an efficient way.

“The solution is in an integrated approach from the private hospitals,” Musfiqur Rasheed, who works in Qatar’s largest tertiary hospital Sidra Medicine as an expert on healthcare strategy and finance, told Bangladesh Post.

“It has never been done, it will sound strange, but it is the time to do the unprecedented,” he said about his model from Doha.
“Bangladesh with its high population density needs the best of all models with one of the least funding available.”

The government confirmed 4689 cases as of Friday with 131 deaths. As the number of cases is rising by the day, there will be a certain level after which it will be difficult for the government hospitals to manage all patients.

“Bangladesh government has so far done a pretty decent job of managing the situation, with the honorable prime minister taking the lead; there has been significant progress in the preparedness,” Rasheed said.

“But let’s accept the fact that the government can only do up to a certain level, when it gets past the capacity, there will be disaster.”
According to research published in Journal of American Medical Association, 20 percent of infected patients require hospital admission, and 26 percent among them would require ICU facilities.

The research is based on data from China. Due to demographic differences this hospitalisation and ICU admission rates may differ.
“Even with this estimate we will run out of ICU beds since the total infected patients continue to rise. We need more hands on the deck,” he said.

“At this moment we need the best in the business to come forward and the best ability to respond to this crisis lies with the private hospitals.”

There have been rise in ICUs and neonatal-ICUs in the private sector and it is at the heart of the private hospital business model.
The major hospitals like Apollo, Labaid, Square, and United among others have invested heavily in the equipment and manpower to run ICUs.

“We can discuss procuring and manufacturing more ventilators by the government, but they are useless if we don’t have trained manpower to run those,” said the expert.

“The private hospitals possess that; they have the intensivists, they have the nurses, they have Bio-Medical engineers and above all they have the infrastructure.

“Only one of the private hospitals can match the combined capacity made available by the government for Covid.”
“But the private hospitals have their own limitations,” he said, “they have to look at their bottom line, they need to ensure safety of their existing patients, they need to ensure safety of their staffs, specially the senior physicians, who are mostly at the vulnerable age.”

“It will be unwise to ignore these facts as they are also part of our health system as well as the broader economy. At the same time we cannot leave the best underutilised in this crisis,” he said, adding that the solution lies in an integrated approach from the private hospitals.

He explained: all private hospitals at this moment are experiencing a drop in their activities.
Patients are not coming from outside the capital for elective cases, people tend to stay home with mild to moderate illness, and kids without school are not contacting seasonal flu as much.

All major hospitals are running at 30-35 percent below the level expected at this time of the year. A financial loss is already in the forecast.
“Due to lower volume we actually have more capacity available, but you cannot risk the remaining patients by taking Covid-19 patients in your empty beds. This is where we need hospitals to join hands,” he said.

“In the integrated approach one of the hospitals will act as a Covid center and rest will share its volume of non-covid patients.”
For example, if Hospital A steps forward and takes the Covid Patients, it will refer its Cardiac patients to Hospital B, cancer patients to Hospital C and deliveries and children to Hospital D. Each hospital will play a consolidation role for specific specialties, he said.

“To do this we need to compensate Hospital A (Covid) for the lost revenue of 3-4 months period and perhaps more.
“As a private hospital they can charge the Covid patients, but due to the sensitivity and national emergency it will be unwise to charge the usual ICU rates.

“We can set a standard daily rate for Covid Patients in Hospital A- for example BDT 5,000 per night all-inclusive from the patient.
“Other hospitals who are acting as non-covid consolidation centers will also pay Hospital A (Covid) a daily rate- for example, BDT 2,500 per night for each bed in Hospital A.

“If there are 3 consolidating center, they will contribute BDT 7,500 per night per bed in total,” he said.
“The idea of this arrangement is to minimize the loss and help Hospital A (Covid) avoid a cash crisis. Hospitals B, C & D who gets benefited by the additional revenue will share burden of Hospital A (Covid).”

“Another method would be to reimburse Hospital A for each of patients that got referred. But this doesn’t work in longer term as non-covid patients will stop coming to Hospital A (Covid) for referral. Also we will have to set up a referral process which is cumbersome, and we don’t have time on our side.”

“A joint taskforce from the participating hospitals can decide a on a reasonable financial arrangement. DGHS can also take part in the arrangement and play the role of mediator. More hospitals joining the coalition will reduce the individual burdens,” he said.

In Australia the government came forward and announced a stimulus of AUD 1.3 billion for the private hospitals.
“We (Bangladesh) cannot afford that, but we can share some burden of the private hospitals,” he said.

“In the integrated model, Hospital A can also easily expand its ICU capacity by setting up ventilators in other wards. All major private hospitals have comprehensive medical gas systems installed at each bed.

“They all have, and can also collaborate on the workforce specially for the respiratory services. A large private hospital can readily provide best in class expertise for 70-80 ICUs and expandable.

“This is equivalent to the capacity made available by the government for Covid and better in terms of expertise.
“Although an integrated approach will be developed among the large private hospitals, they need support from external stakeholders,” he said.

“First of all, from the government. The Prime Minister can reward the Covid (Hospital) with a 2 year tax holiday including it’s physicians. Other hospitals participating in the integration can be rewarded with one year tax holiday.

“Government can give them interest free cash credit during the period to ensure the healthcare professionals are getting paid in time during this challenging time,” he said.

“As part of the integration we need to introduce virtual consultation facilities for the hospitals. ICT ministry and BASIS can come up to support this initiative.

“Engineers from BUET can come forward to innovate ways of quickly updating the rooms with negative air pressure.
“Plastic industries need to prepare for ventilator valves and tubes. These are anecdotal initiatives but they all contribute to saving lives,” he said, adding that this is the time to join hands.