Has cancer detection become big business for private hospitals?

by Carol Aloysius

Next to breast cancer, cervical cancer is the 2nd commonest cause for cancer related deaths among Sri Lankan females.

As morbidity and mortality rates continue to soar, the Health Ministry and a few non state agencies such as the Sri Lanka Family Planning Association ( SLFPA) have pooled their resources to fight this deadly non communicable disease, using the well tried and tested pap smear test, as their weapon to detect and prevent precancerous leisions that women unknowingly harbour in their bodies.

"The tests are vital and can prevent the spread of cancer and the risks it carries", health sources told the Sunday Observer. " The great thing about these tests is that they are free of charge. We don't charge a cent from any of the women who come to this hospital", a spokesman for the Lady Soyza Maternity Hospital at Borella said. She said the procedure which took only a few minutes was usually done in the OPD . "Patients don't have to go to a theatre or undergo any surgery. We tell them " Come early, collect your token as only a limited number of patients are taken in each day, hand over the sample and you will be informed when the test results are ready".

It is a similar procedure followed in most government clinics and hospitals.

" All our 300 odd MOH clinics and well woman clinics island wide now have pap smear tests done for those who visit the clinics, at their request. " No one is forced to undergo these tests. If anyone wishes, they can have the test done by well trained qualified persons, get their samples analysed, for no fee", a spokesperson for the Health Ministry said on grounds of anonymity.

So are there many takers ?

"Not as many as we wish, since it is women who are vulnerable to this disease. Some have never taken the test and some only once in the preceding five years", she lamented..

Her lament was echoed by the Sri Lanka Family Planning Association's Medical Director Dr Simithra Tissera. " We too do this test in our mobile clinics conducted in remote areas island wide, and in our clinic at Bullers Lane. We don't charge any fee for the test done through our mobile clinics. But for those attending our clinic at Bullers Lane, we charge a small fee towards the doctor's fees and lab costs. Asked what the amount was she replied, Rs 750/ "However , we have many women visiting us at this same clinic who tell us upfront they have no money to pay for the test. In such instances, we simply waive the fee and go ahead with the test", she said.

"We're only complementing the on going excellent program of the Ministry of Health which is the best both in quality and service", she emphasised.

Ironically, despite these tests being given to them free by the government health facilities, recent surveys have shown that women are now increasingly patronising private health institutions despite a hefty fee being charged for this simple, under ten minute test. The price difference is often due to various seemingly attractive package deals that unsuspecting women are handed out no sooner they come in for the tests.

These deals would include the pap smear test in a battery of other tests which the patient really does not need e.g. echo tests, mammograms, cardiac tests, blood glucose tests, ECG and Ultra sonic tests. The prices for these packages could be anything from Rs 20,000 to 40,000 with or without consultants' fees.

In a telephone interview with at least four leading private hospitals which offer such packages, we found out that the pap smear test was available without any frills starting from Rs 1,500 ( including doctors' fees plus the test) to over Rs 3,500 minus the consultants' fees . A patient who had just undergone the pap smear test at the OPD at a private hospital that morning said she was fortunate she was aware that the test was available for a low fee without having to part with thousands of rupees for tests she didn't require. " I paid Rs 2,500 . But my friend was not so lucky. She didn't know she could have the pap smear without having to take the additional tests and forked out Rs 25,000, ten times the amount I paid", she said.

What , we asked a Health Ministry official, was the reason for so many women who could ill afford to pay , going to private hospitals for this simple test? Shrugging, he said, " Probably because they can't be bothered waiting in queues. Or because the test results take long to be released".

It takes approximately 1 to 1 1/2 months for the report of a sample analysed in a hospital ( state) to be released, the Sunday Observer learns. When questioned, health officials were quick to say that if the results were needed urgently they would be released almost immediately.

As for the long delay, they assured the problem was being taken care of. ' We now have trained technicians posted to our labs exclusively to do these reports. The problem should be resolved in the near future".

But women for whom time is running out, cannot wait.

Unless the Health Ministry not only delivers free tests but makes sure the women get them as soon as possible, private hospitals, despite the fees they charge, will have the last laugh.