Rita Oyiboka
Illness can feel like being trapped in a cage, with your ailment as the bars. But what happens when those bars fall away, and the place you sought for freedom becomes your new prison?
This is the plight of many Nigerians who come to the hospital seeking salvation but their happy endings are short-lived when with the euphoria of healing and the joy of new life comes the harsh reality of medical debt and unlike the benevolent Jesus, hospitals are not known to practice, “Loose him and let him go.”
In nations struggling to provide adequate medical care, patients are held captive due to unpaid bills. Hospitals justify this as a necessary evil, as once patients walk out the door, debts vanish into thin air.
But this justification only masks the harsh truth. Soaring medical costs have created a perfect storm, colliding with the dwindling financial resources of the average Nigerian. Patients are trapped in this maelstrom, forced to endure the double whammy of illness and debt.
The detention of patients over unpaid medical bills is a travesty that violates not only human dignity but also the law. By holding patients captive, hospitals flout the fundamental rights to freedom of movement and human dignity enshrined in the 1999 Constitution and African Charter on People’s and Human Rights.
Human Costs of Medical Debts, Hospital Detention
The ordeal of Mr. Godswill, a Delta-based tiler who lost his wife in childbirth, is a heart-wrenching example of this dilemma.
His newborn was detained in the hospital for months over unpaid bills, a cruel twist of fate that turned a joyous occasion into a prolonged nightmare.
Speaking with The Pointer, he recounts, “My baby needed incubator care after being born. At that time, I was paying for all the nutrients and fluid. When the baby was nine months and could be taken home, the problem was that I could not pay the 750,000 naira for hospital bills so I could not take my baby.
“While mourning my wife, I had to run around taking out loans even while the bills were still mounting. It took several months to gather half of the money and pay before I could get my child and later, my wife’s corpse,” he said.
But what about those who do not even get healthcare without paying money upfront?
For Mr. Victor Dirikebamor, he was not even afforded treatment without a downpayment. “In my experience, no Doctor came to check on me because I didn’t have the hospital card and, I couldn’t pay for it at that moment.
“I was rushed there because I had passed out but the only thing a nurse did was check my temperature.”
Meanwhile, Mrs J Emegha, a businesswoman recounted: “I witnessed a family smuggling the body of what looked to be their grandmother out of the hospital. They were carrying her down the steps from the fourth floor. It appears that they couldn’t pay the hospital bills so instead she incurred extra costs in the morgue where they took her.”
This raises a poignant question: where do hospitals draw the line between their business interests and their duty to show compassion?
Millions in Medical Debt Written Off Annually, CMD, FMC (Asaba)
In an interview with the Chief Medical Director of the Federal Medical Center in Asaba, Delta State, Dr. Victor Osiatuma, he underscored the financial realities of healthcare provision, saying, “Healthcare services are generally not provided free of charge. Unlike private hospitals that require upfront payments for admission, government hospitals guarantee emergency treatment for the first 48 hours regardless of immediate payment ability, followed by billing for services rendered.
“In non-emergency situations, you get a card, see the doctor, get drugs and then pay for the medication. The only patients who get free medical care are those from 0-5 years and delivering mothers. This shows that the government knows healthcare cannot be free.”
Dr. Osiatuma elaborated on the operational framework, “As a government-funded institution, our hospital operates on a model where the state provides the infrastructure, personnel salaries, and a modest overhead.
“We partner with private pharmaceutical companies to procure medications, which we sell to patients at a markup to recoup costs and generate a modest profit. This enables us to sustain our operations and provide quality care.
“While consultation fees are waived for patients, they are still responsible for paying for other hospital services.
“In cases where patients are unable to settle their bills after treatment, they may be required to remain in the hospital until payment is made. This is not tantamount to detention or a violation of their human rights, but rather a necessary measure to ensure that we can continue to provide services to other patients.”
Regarding financial assistance for indigent patients, he explained, “Our hospital’s social welfare department identifies and evaluates cases of financial hardship, conducting thorough assessments of familial and social circumstances to determine eligibility for financial relief. Annually, our hospital writes off bills exceeding N20 million, with charitable contributions from individuals and organizations assisting in alleviating the financial burdens of indigent patients.”
Dr Osiatuma detailed procedures concerning unclaimed deceased individuals, “For those who die and are kept in the mortuary, when the corpse has been abandoned for a year or more, we have to announce with news medium for relatives to come for the bodies of their loved ones. A statement is written to the police seeking approval and the coroner’s paper is gotten. When the ultimatum given elapses, the local government body is alerted and they take care of the bodies which is at a cost to the hospital and the government.”
He added: “In advanced societies, healthcare costs are predominantly covered through comprehensive insurance schemes.
“The sure way to end hospital detention and astronomical medical bills is through broad participation in health insurance, encompassing both formal and informal sectors which ensures enhanced healthcare access and treatment efficacy, instilling patient confidence while optimizing hospital operations meanwhile, the hospital staff will be even more motivated and efficient as they are sure of payment.”
Many Detained Patients Unaware of Legal Recourse, Dr. Umeh
According to Dr Charles Umeh, a medical doctor and Telemedicine professional,
“Detaining patients and bodies against their will due to unpaid medical bills violates human rights and is unlawful.
“Many patients are unaware of their rights in such situations and may mistakenly believe they have no legal recourse as debtors.
“Similarly, in emergencies, priority should be given to providing immediate medical care, with billing addressed subsequently. Hospitals should innovate their billing strategies to ensure fairness and compassion.
“One effective strategy is to collaborate with charitable organizations that support patient payments, promote enrollment in health insurance programs, and engage in partnerships with government agencies to explore options for bill resolution,” he said.
Reforming Nigeria’s Healthcare System
For years, Nigerians have struggled to access affordable healthcare due to the exorbitant cost of medications. Despite repeated government promises to tackle this issue, the situation remains bleak.
In 1999, the National Health Insurance Scheme (NHIS) was launched with great fanfare, aiming to provide universal health coverage and reduce out-of-pocket expenses.
However, the scheme has been plagued by inadequate funding, corruption, and inefficient implementation, leaving many Nigerians without access to essential medications.
Despite the National Health Insurance Scheme’s mandate to provide unrestricted access to healthcare, over 40% of the population lives in poverty, and only 6 million Nigerians are enrolled.
As a result, many resort to begging to cover medical expenses, while others die due to lack of financial support.
Meanwhile, the World Health Organization (WHO) reports that a staggering 95% of medicines used in Africa are imported, exacerbating the problem. To address this, the federal government has repeatedly announced plans to reduce drug prices by 50% and establish a pharmaceutical industry park to promote local manufacturing. Yet, these promises have yet to materialize.
The latest assurance comes from the Director General of the National Agency for Food and Drug Administration and Control (NAFDAC), Prof. Mojisola Adeyeye, who promises that the agency is working tirelessly with the pharmaceutical industry to reduce drug prices. But Nigerians are left wondering: will this promise be different from the others?
The detention of patients and bodies in hospitals due to unpaid medical bills presents a intricate predicament. To tackle this, government must widen access to affordable healthcare and ensure insurance schemes cover all bases. Hospitals, too, must shift gears – prioritizing care over bills, finding innovative ways to settle debts, and treating patients with fairness and compassion.
But government alone cannot shoulder this burden. Citizens cannot turn a blind eye to ailing neighbors. Humanitarianism’s true meaning must be redefined, placing the welfare of the sick at its core.
By uniting to support the sick, citizens can erect a safety net of social institutions, easing suffering and fostering a culture of care. For in the end, no one is an island – and the plight of the sick demands collective attention.
