Is consultation fee a rip-off or is it justifiable?
Apr 18, 2011
MANY people are disgruntled at the exorbitant consultation fees that private healthcare providers charge, despite the fact that some of them provide quality services.
MANY people are disgruntled at the exorbitant consultation fees that private healthcare providers charge, despite the fact that some of them provide quality services. Vicky Wandawa explores the motive behind consultation fee
Roy’s story
My son was operated on at a popular hospital recently, but I was shocked when the doctor asked for sh20,000 for consultation fee. But because he was in a lot of pain, I paid, although to date, I still wonder why I had to pay for consultation yet I was being charged for the operation and medication.
What would happen if all professionals asked for consultation fee? Imagine a scenario where a teacher asks for consultation fee before he teaches his students! The ministry ought to come up with measures to control private healthcare providers.
How the fee is determined
In the early 1990s, they were mostly two-roomed; a waiting area with a chair and table for the nurse or receptionist as well as a few chairs for the patients, and a considerably smaller room for the doctor. These were the private health facilities.
Fast forward to the 2000s. A considerable number of private clinics have uniquely furnished waiting areas with a plasma screen and the doctor’s office is air-conditioned. However, it is not only the ambience that has noticeably changed, the consultation fee is exorbitant.
Consultation fee, according to Henry Bukenya, a physician working with a private facility as well as Mulago Hospital, is a commission given to a specialist in a branch of medicine which does not accept total responsibility for a patient, but acts in an advisory capacity.
During the early 1990s, the fee was charged, only that most health facilities did not clearly draw a line between the charge for the drugs and consultation fee. Patients were mostly handed a general bill, whose total was more than the cost of the drugs.
Then, it was common place to walk into a private clinic, consult a doctor and not pay for consultation, especially if no medicine had been dispensed.
Today, however, at most private clinics and hospitals, consultation fee is paid at all times, and it differs from one facility and practitioner to another.
What determines the consultation fee?
Dr. Godfrey Aliya, a private gynaecologist, says among the factors that determine consultation fee is the location of the health facility. “If a private clinic is found in the city centre, do not expect to pay a low consultation fee because of the high rental charges,†he adds.
Aliya adds that medical consultation fee charges heighten when it comes to specialists as well as the fact that some specialists are few.
Additionally, Ali Mwambu, a physician with Hamedicare, says compared to the past, costs of equipment and staff have sky rocketed, so health facilities have no choice, but to match these costs with the consultation fee.
Health facilities with aggressive expansion plans are also most likely to charge a higher consultation fee.
He also notes that the fee might actually rise further since the Uganda shilling has weakened, making the imported medical machinery expensive.
Health ministry speaks out
Paul Kaggwa, the ministry spokesperson, says Uganda is a free economy, so the government cannot regulate the consultation fees charged by private health facilities.
He adds that since Uganda has different categories of health services, patients are not limited to particular places that charge high consultation fees. There are government health facilities that do not charge consultation fees. “Patients need to make an informed choice on where to seek treatment,†he advises.
“These private facilities charge consultation fees, depending on their location and have overheads to take care of such as rent, paying workers and procuring equipment.
Of course if you put a hospital in a convenient place within the city, and have great staff that you pay well, this will have a bearing on the consultation fee.â€
How clinics spend the consultation fee
Our reporter consulted a number of clinics and hospitals to explain how they spend the money raised from consultation fees, and they declined to comment on the issue.
However, a doctor who preferred anonymity let us in on how much the clinic where he is employed makes from consultation fee and how the money is spent.
He said on a good day, the clinic registers about 15 patients daily. Each patient pays a consultation fee of sh15,000. Therefore, making about sh225,000 a day and about sh7m a month.
Rent takes sh600,000.
About sh3m per month is spent on employees, including the midwife, nurses, cleaners, a dispensing chemist and cleaners.
When a specialist, for instance a gynaecologist, comes in, the clinic pays him 10% of the fee he charges his patients.
Sh1m is spent on utility bills including water and electricity, per month.
A total of sh600,000 is spent every month on servicing vehicles, including the ambulance.
The total comes to about sh5m, leaving profits of sh2m.
However, the anonymous source says the healthcare sector is not a profit-making business, but a service to the people. He adds that despite the sh2m balance, the clinic still has to cater for daily staff allowances which amount to sh60,000 per day.
How developed countries go about the charges?
According to online sources, developed countries like the UK and US charge a fee for consultation To set fees, some consultants simply take the hourly wage (plus benefits) that they would earn when working for someone else and then double or triple it.
Some set their rates by the project. They estimate the number of hours they expect to spend on a project, then multiply by their hourly rate. However, some consultants set their project fees using the value the client derives from the consultant’s advice.
For others, it comes down to what the market will bear and what your competitors are doing. If you fall in line by charging the same as everyone else, you are signalling that you are qualified and you play fairly.
Doctors speak out
International Hospital Kampala (IHK)
According to Ian Clarke, a medical doctor and proprietor of IHK, consultation fee at the hospital depends on the kind of doctor a patient wants to see.
“The fee charged for a general doctor is much less than that for a specialist. However, the fee for specialists also varies. There are specialists that set their own consultation fee,†Clarke notes.
Furthermore, there are separate packages for the East Africans and non-East Africans. For a general physician and most specialists, consultation fee is sh50,000 for East Africans and sh75,000 for non-East Africans.
Nsambya General Clinic
Dr. Ben Kiwanuka, the chief executive officer of Nsambya General Clinic, says consultation fee at the clinic is sh10,000 for a general doctor and sh20,000 for a specialist. Even in cases where a parent has two or more children seeing the same paediatricians at ago, they each pay sh20,000.
“They are each seen as individuals because they may have different health ailments, thus justification for each to pay a consultation fee to see a specialist,†Kiwanuka notes.
Case Clinic, Buganda Road
At Case Clinic on Buganda Road, patients pay sh25,000 to see a general doctor and sh10,000 each time they turn up for medical review. To see a specialist, one has to part with sh35,000 and sh25,000 for each review visit.
Basil Dental Clinic
At Basil Dental Clinic, the consultation fee is sh20,000.
Roy’s story
My son was operated on at a popular hospital recently, but I was shocked when the doctor asked for sh20,000 for consultation fee. But because he was in a lot of pain, I paid, although to date, I still wonder why I had to pay for consultation yet I was being charged for the operation and medication.
What would happen if all professionals asked for consultation fee? Imagine a scenario where a teacher asks for consultation fee before he teaches his students! The ministry ought to come up with measures to control private healthcare providers.
How the fee is determined
In the early 1990s, they were mostly two-roomed; a waiting area with a chair and table for the nurse or receptionist as well as a few chairs for the patients, and a considerably smaller room for the doctor. These were the private health facilities.
Fast forward to the 2000s. A considerable number of private clinics have uniquely furnished waiting areas with a plasma screen and the doctor’s office is air-conditioned. However, it is not only the ambience that has noticeably changed, the consultation fee is exorbitant.
Consultation fee, according to Henry Bukenya, a physician working with a private facility as well as Mulago Hospital, is a commission given to a specialist in a branch of medicine which does not accept total responsibility for a patient, but acts in an advisory capacity.
During the early 1990s, the fee was charged, only that most health facilities did not clearly draw a line between the charge for the drugs and consultation fee. Patients were mostly handed a general bill, whose total was more than the cost of the drugs.
Then, it was common place to walk into a private clinic, consult a doctor and not pay for consultation, especially if no medicine had been dispensed.
Today, however, at most private clinics and hospitals, consultation fee is paid at all times, and it differs from one facility and practitioner to another.
What determines the consultation fee?
Dr. Godfrey Aliya, a private gynaecologist, says among the factors that determine consultation fee is the location of the health facility. “If a private clinic is found in the city centre, do not expect to pay a low consultation fee because of the high rental charges,†he adds.
Aliya adds that medical consultation fee charges heighten when it comes to specialists as well as the fact that some specialists are few.
Additionally, Ali Mwambu, a physician with Hamedicare, says compared to the past, costs of equipment and staff have sky rocketed, so health facilities have no choice, but to match these costs with the consultation fee.
Health facilities with aggressive expansion plans are also most likely to charge a higher consultation fee.
He also notes that the fee might actually rise further since the Uganda shilling has weakened, making the imported medical machinery expensive.
Health ministry speaks out
Paul Kaggwa, the ministry spokesperson, says Uganda is a free economy, so the government cannot regulate the consultation fees charged by private health facilities.
He adds that since Uganda has different categories of health services, patients are not limited to particular places that charge high consultation fees. There are government health facilities that do not charge consultation fees. “Patients need to make an informed choice on where to seek treatment,†he advises.
“These private facilities charge consultation fees, depending on their location and have overheads to take care of such as rent, paying workers and procuring equipment.
Of course if you put a hospital in a convenient place within the city, and have great staff that you pay well, this will have a bearing on the consultation fee.â€
How clinics spend the consultation fee
Our reporter consulted a number of clinics and hospitals to explain how they spend the money raised from consultation fees, and they declined to comment on the issue.
However, a doctor who preferred anonymity let us in on how much the clinic where he is employed makes from consultation fee and how the money is spent.
He said on a good day, the clinic registers about 15 patients daily. Each patient pays a consultation fee of sh15,000. Therefore, making about sh225,000 a day and about sh7m a month.
Rent takes sh600,000.
About sh3m per month is spent on employees, including the midwife, nurses, cleaners, a dispensing chemist and cleaners.
When a specialist, for instance a gynaecologist, comes in, the clinic pays him 10% of the fee he charges his patients.
Sh1m is spent on utility bills including water and electricity, per month.
A total of sh600,000 is spent every month on servicing vehicles, including the ambulance.
The total comes to about sh5m, leaving profits of sh2m.
However, the anonymous source says the healthcare sector is not a profit-making business, but a service to the people. He adds that despite the sh2m balance, the clinic still has to cater for daily staff allowances which amount to sh60,000 per day.
How developed countries go about the charges?
According to online sources, developed countries like the UK and US charge a fee for consultation To set fees, some consultants simply take the hourly wage (plus benefits) that they would earn when working for someone else and then double or triple it.
Some set their rates by the project. They estimate the number of hours they expect to spend on a project, then multiply by their hourly rate. However, some consultants set their project fees using the value the client derives from the consultant’s advice.
For others, it comes down to what the market will bear and what your competitors are doing. If you fall in line by charging the same as everyone else, you are signalling that you are qualified and you play fairly.
Doctors speak out
International Hospital Kampala (IHK)
According to Ian Clarke, a medical doctor and proprietor of IHK, consultation fee at the hospital depends on the kind of doctor a patient wants to see.
“The fee charged for a general doctor is much less than that for a specialist. However, the fee for specialists also varies. There are specialists that set their own consultation fee,†Clarke notes.
Furthermore, there are separate packages for the East Africans and non-East Africans. For a general physician and most specialists, consultation fee is sh50,000 for East Africans and sh75,000 for non-East Africans.
Nsambya General Clinic
Dr. Ben Kiwanuka, the chief executive officer of Nsambya General Clinic, says consultation fee at the clinic is sh10,000 for a general doctor and sh20,000 for a specialist. Even in cases where a parent has two or more children seeing the same paediatricians at ago, they each pay sh20,000.
“They are each seen as individuals because they may have different health ailments, thus justification for each to pay a consultation fee to see a specialist,†Kiwanuka notes.
Case Clinic, Buganda Road
At Case Clinic on Buganda Road, patients pay sh25,000 to see a general doctor and sh10,000 each time they turn up for medical review. To see a specialist, one has to part with sh35,000 and sh25,000 for each review visit.
Basil Dental Clinic
At Basil Dental Clinic, the consultation fee is sh20,000.