The High Costs Of Nepal’s Fee-For-Service Approach To Health Care

Go to just about any clinic, pharmacy, or hospital in Nepal with a head cold. Your symptoms are invariably caused by a virus, for which time is the only remedy, rather than antibiotics, steroids, or vitamins. Despite the substantial harms and lack of benefit of such medications, you will most likely receive them all. If you are feeling particularly unwell, you might also get intravenous fluids, perhaps some antacid medications, and certainly some amount of analgesics like paracetamol or diclofenac. You will emerge from your consultation 1,500 Nepalese rupees poorer, despite not having received anything of particular benefit to your health. Of all the problems facing the post-earthquake Nepal health care system, its greatest challenge remains the one that long pre-dates April 25: a system built around unregulated fee-for-service health care delivery. As we go about the process of rebuilding the health care system, we must bear in mind this fundamental threat. A Global Pandemic Unregulated fee-for-service medicine is not a problem unique to Nepal. In the United States, the country that one of us (Maru) calls home, over one-third of cardiac catheterizations performed are unnecessary, and over one billion US dollars are spent on antibiotics for adults with viral respiratory tract infections. The problem is that the basic business model at play gets provider and institutional incentives all wrong. You suffer from a health ailment, you visit a health care worker, you get some diagn...
Source: Health Affairs Blog - Category: Health Management Authors: Tags: Costs and Spending Equity and Disparities Featured Global Health Health Professionals Hospitals Organization and Delivery Payment Policy Population Health Public Health Quality Duncan Maru fee-for-service globalization Kathmand Source Type: blogs