HIGHCOST MEDICAL SCHEME FACILITY (MY BITTER EXPERIENCE)

One of the greatest benefits of being an employee is that in most cases the employer has a medical scheme facility that takes care of one’s health requirements as well as a listed number of family members. This enables the employee enjoy good health in order to remain productive. In addition an employee is at ease knowing that any medical problems that arise at any time, to any of the listed family members will be attended to by the medical center appointed by the employer without the employee necessarily having cash at all times.

So when my employers wanted to improve the medical scheme facility for a group of employees where I fall, I was greatly elated. The truth is that our group was not adequately covered under the old scheme. The old scheme provided for those of us who were neither unionized nor in senior management, to go to St George’s clinic and access medical services without instant payment. The only thing one had to do was present an ID and a letter from the employer, in this case the HR department.

The cost of the medical services would then be deducted from the monthly earnings and payment made to St George’s clinic by the company. For a long time this had worked well, but there was always a hint of inadequacy about it. Especially considering the fact that senior management were sufficiently covered by a scheme facility with care for business (cfb) clinic, and the unionized employees a scheme with UTH high cost. As was expected, the HR department recognized the inadequacies in the whole arrangement and acted to remedy the situation by approaching a few medical institutions with a view for them to offer us a scheme facility.

I am not privy to the full list of the medical institutions that were approached, but I recall some representatives from Fairview hospital coming to hold a meeting with us and they show cased all the medical services and facilities they offer. What followed that meeting were extensive deliberations among us. Those deliberations almost unanimously rejected a private hospital citing the reason that, most private medical establishments do not have the capacity to handle and treat complicated medical cases hence they eventually refer patients to the University Teaching Hospital (UTH). It was further alleged that, even though most private medical institutions know that they cant treat particular cases, they would still make an attempt just so the patient accumulates a bill.

Considering the aforementioned and without giving chance to Fairview hospital or any other private medical facility, we convened a meeting with the HR manager at which we unanimously settled for UTH high cost medical scheme. Among us, there were people that bore testimony of how they had carried research and came to the conclusion that UTH high cost scheme was the best available anywhere in Lusaka especially when emergencies or complicated medical problems arise.

Sufficient examples of friends or relatives who had been to private medical centers and been referred to UTH at the last minute were given. We were told that with the UTH medical scheme, patients receive preferential medical services for the premium price that was charged. I was one of those that truly became convinced that UTH high cost scheme facility operated like a private clinic within UTH with the benefit of experienced and specialized doctors at all times. I agreed with this line of thought because a few months before then, I had been to UTH block C03, to visit my friend’s wife who had been admitted awaiting some medical procedure.

This high cost medical scheme membership card
can land you a night's sleep on the floor

She was admitted at a side ward where there were only three beds of which one was empty. This was in contrast to the main ward which from a distance I could see at least two people sleeping on the floor. The sight of women sleeping on the floor was not pleasant, but not as bad as I had seen a year before in the male admission ward adjacent to the casualty section where I could estimate the number of people admitted to at least a third more than the available bed space. The situation I was looking at in C03 was much better but still I could see at least two people on the floor and as I turned to enter the side ward I overheard a nurse asking one woman why she had come to UTH instead of going to a clinic in the locality of her home. “You are the people casing congestion at UTH”, the nurse blurted out.

So recollecting how incredibly nice the side ward hard looked and comparing to only seeing two people on the floor as opposed to a third more, I easily warned up to the idea of the UTH high cost scheme I was about to be a member of.

More than a year on, I found myself making that not so interesting trip to UTH. I presented my ID and high cost scheme card at the filter clinic reception, at which a record card was given to me and doctors consultation fee charged (well an invoice was raised, the facility is credit). The next step was for me to have my body temperature and BP recorded so I sat on a bench to queue while awaiting my turn. When finally I was done with temperature and BP readings, I went to another bench this time waiting to go for a check by a doctor.

It was at this bench that my frustrations began. Just before my turn to see the doctor, the man who spoke English with an apparent Congolese accent walked out and explained to me that he was just giving his driver some money for him to buy lunch. A minute later the doctor returned and now mentioned that he was actually going out for lunch so we needed to join the queue that was waiting to see the doctor in the next consultation room. That meant going to the back of the queue.

As it turned out I was seen by another doctor who requested for an ultra sound scan so I went to the radiology department where they in turn sent me to the D block. At the D block I was given an appointment to come at 07am the following day. The scan was duly done the following morning and by the time the doctor who requested the scan was reporting to her consultation room, I was already seated on the bench awaiting her arrival.

After seeing the ultra sound scans, the doctor requested clinical tests and I went to the high cost laboratory where a total of four different tests were performed. I was informed the results for one of the tests would be available one hour later, two more results at 15hrs that same day while the other one would be available the following day. The stout gentleman who had carried all the tests then asked me to take the sample of one of the tests (urine) to the main lab at the main building myself. As I walked to the main building I kept wondering how on earth a patient was being asked to ‘transport’ lab samples. The time then was only about 10am and it felt pointless to have to wait until 3pm for me to get at least 3 of the 4 sample results. Therefore I elected to leave UTH and get back to other duties for the day.

The following morning when I got there, only the results which I had been told would be available by 11hrs were given to me. The results for the other tests just couldn’t be found. An extended search into their computer system was done but yielding nothing. In the end, I was asked to do the tests all over again. I was told to go to the cashier to have an invoice made and only then, queue at the lab for the three tests. I tried to protest the idea of having another invoice done as that would amount to me paying for the same service twice, but my protest was to no avail. The gentleman insisted that was the only way I’d be attended to.

In the end I complied and got invoiced once more after which I took the tests again. This time around I waited until 15 hrs and lucky enough I got the printed results for two of the tests done. The urine test, I was told once again would only be available the following day. When I got to UTH the following day, I had a feeling of dejavu, and true to my instincts no one could find my urine test results. For a second day, an extended search into their computer database was done all to no avail.

At that point my frustration had reached peak position. How on earth was such important medical test result going missing? If medical test results could disappear with relative ease, how possible was it that the results I had been given weren’t accurate? If results could go ‘missing’, is it not possible they could be swapped with those for another patient? And why on earth was the name the search field? Who does that? What database has name as the unique field? In my mind, the integrity of the whole process was now in question.

In all fairness if a John Banda does a test at that laboratory and the sample are taken for analysis under the name John Banda then when the results are ready then stored in the computer system as John Banda, how would another John Banda who is attended to on that day be treated? Is it not possible that there could be a hundred John Banda’s out there? Is it how the software was created, that the name would be used as the unique field? I doubt this. Any software developer, especially database software, will agree with me that a unique field is usually one where the characters cannot be identical. This could be a National Registration Card number, pass port number or even a hospital card number.  

In the case of a unique ID field, even though there could be hundreds of John Banda’s, only one would have a particular ID number which would be used to enter the test results into the computer system. This is how I understand is the way a database works. What I saw at UTH is like one withdrawing their money at a bank counter by primarily identifying themselves by name and not account number. Unless such a person is the only John Banda with an account with that bank. Unless I am convinced otherwise by a software development expert, the UTH way is wrong and many more results will go missing.

So after another futile but extended search of the test results, I was asked once more to go to the cashier and restart the process once more. But this time around I wasn’t prepared to do the test again, especially that I would have to be invoiced again. It didn’t matter if I would be the one paying there and then or not. The payment my employers would make would still be an overhead cost that reduced on company profitability and I wasn’t prepared to escalate the cost and not getting any service. At that point I just threw in the towel and decided to just go and queue in readiness to see the doctor without any urine test results. As I turned to walk out, there was a young lady I overheard complaining that she had been waiting for her malaria test results for more than 2 hours. All along I thought malaria test results take only a maximum 5 minutes!

As the young lady continued with her complaints a man that was sitting next to her answered by telling her that government medical staff had their salaries increased by more than 300% in some instances, hence they could now all afford smart phones and tablets and were now spending most of the time learning how to use the gadgets.

As if the troubles I had with the personnel at the high cost laboratory was not enough, my perception of the UTH medical scheme came to an all-time low last week when my wife, was admitted to the labour ward after developing pregnancy induced BP then being given a mattress on the floor which she shared with another patient since 9am until 10am the following day. During the more than 24 hours she spent in the labour ward while her BP was being monitored, there were other women coming in for their labour with all sorts of scream and mourns and one wonders how BP can stabilize in such a noisy environment. Besides the noise, there was the mess of blood spatter on the floor she and other women were laying on. 

In my view, this was not an ideal situation hence the women couldn't have taken the whole situation easily. Again I’ll need a qualified medical practitioner to convince me that BP can normalize when faced with such a harsh, noisy and messy environment. Never mind her state of mind seeing other women coming in for labour and going while she is fully aware that her BP could cause quite a lot of harm to her and the baby she is expecting.

Such cases should have at the very least a separate confined room where the BP is closely monitored. This is a high cost scheme card holder who is being made to share a mattress on the floor. In saying all this, I am not in any way suggesting that because one is a high cost scheme holder, then the rest of the patients must be ignored while the high cost patients take precedence. No, not at all. All cases must be given maximum attention bearing in mind the gravity and nature of urgency. But if someone has paid or is going to pay a little more, they expect a par excellence service and a comfortable environment.

In as much as UTH has the available facilities and the best medical experts in Zambia, there is a very big vacuum in terms of the support the medical people get from the support staff. An institution as big as UTH has many people who play a part in shaping the perceptions of the public on the institution. These are the doctors, nurses, cleaners, radiologists, laboratory technologist, IT experts, cashiers, etc. Then again, UTH has become inadequate to serve as the only referral hospital in Lusaka, let alone the whole Zambia. What Lusaka needs is another hospital as big as Levy Mwanawasa Hospital in Chilenje, another in Matero and yet another in Makeni.

In addition, there is need to increase the number of clinics in all the areas to respond to the growing population. I can’t imagine how we only have chilenje clinic that is meant to carter for all the areas between Libala, Chilenje, Woodlands and Chalala in all its breadth. At the moment, UTH is overcrowded and good initiatives for the institution to raise much needed revenue under initiatives like the high cost scheme facility just seem to be thrown out of the window without delivering as they are intended to. Then again, that is just wishful thinking from me.