Mir Abdul Alim

The word "healthcare" once evoked a sense of reassurance—a belief that in times of illness, there existed a system committed to healing, to restoring lives. But in today’s Bangladesh, falling ill often means falling into fear, anxiety, and financial ruin. The first question at hospital doors is no longer about symptoms, but about solvency: “Do you have the money?”

In this country, healthcare has morphed from a service into a full-fledged business. The tears of patients and their families no longer count. Every step—consultation, diagnostic tests, medication, hospital admission—demands money. And if intensive care or life support is needed, the cost can drain an entire family's resources, sometimes even more quickly than the illness itself.

Bangladesh’s health sector now resembles a deeply entrenched syndicate. Middlemen, commission agents, unnecessary tests, and fear-inducing terms like “life support” have become the norm. The term “life support,” which should symbolize a last hope, has turned into a financial nightmare. Even when doctors know a patient is unlikely to survive, they often recommend continued support—not to save lives, but to inflate bills. Families sell jewelry, borrow from relatives, or empty savings accounts—all in the hope of saving a loved one, only to later hear: “We couldn’t save them.”

The situation is no better in public hospitals, which are supposed to be the last hope for the poor. Instead, they are marred by inequality and corruption. The well-connected can secure VIP cabins, while the impoverished often lie on floors. Medicines intended to be distributed free of cost often disappear—only to resurface in markets at exorbitant prices. The notion of "free healthcare" in public institutions has become more myth than reality.

The presence of brokers outside government hospitals has long been a plague. These brokers prey on poor, uneducated patients, using fear to lure them into private hospitals with promises of quicker or better treatment. There, families are presented with sky-high bills for unnecessary tests and procedures. These brokers work hand-in-hand with some unscrupulous doctors and hospital management, all profiting from the vulnerability of the sick.

Even within private hospitals, the cost of basic procedures—CT scans, MRIs, routine surgeries—can rival the price of buying a house. Many doctors operate under commission agreements with diagnostic centers and pharmaceutical companies, pushing patients towards expensive, and often unnecessary, tests and drugs. The prescribing pattern, influenced more by incentives than medical need, has created a system where the patient’s health is secondary to profit. Representatives from pharmaceutical companies crowd doctor chambers, monitor prescriptions, and sometimes even breach patient privacy—without consequence.

In the UK, the National Health Service (NHS) provides care regardless of wealth. As my son Dr. Mir Tanzil Ehsan, a Senior Registrar at Queen Elizabeth Hospital in Central London, explains: “Here, rich or poor, everyone receives the same care. Equality is embedded in the system.” But in Bangladesh, even public hospitals maintain VIP wards—special privileges accessible only by the elite, contradicting the very principle of universal care.

The data is damning. According to the National Health Accounts, out-of-pocket expenses dominate: 64.6% of health spending goes toward medicines alone, 13.4% to personal consultations, and 11.7% to diagnostics. In other words, medication—often prescribed unnecessarily—costs more than all other aspects of care combined.

There is no denying that medicine has become a lucrative “market.” Doctors are flown abroad by pharmaceutical companies, offered luxury perks, and incentivized to prescribe branded drugs regardless of patient need. As a result, poor families bear the brunt of systemic greed. Long-term patients—those with diabetes, hypertension, kidney disease—are particularly vulnerable, often pushed into lifelong debt just to survive.

To its credit, the government has taken some modest steps. A 12-member expert panel, led by former DGHS Director General Dr. MA Faiz, has been formed to recommend structural reforms. Consultative meetings with field-level stakeholders—including doctors, nurses, students, and journalists—are underway. However, questions remain: Will these initiatives lead to real change, or merely remain in the realm of discussion?

Healthcare is not a privilege—it is a fundamental right. Yet, in Bangladesh, it increasingly resembles a commercial contest where only the wealthy survive. The existing syndicates of brokers, diagnostic profiteers, and pharmaceutical giants thrive in the absence of effective regulation. To reclaim healthcare as a service—not a business—we need more than panels and proposals. We need accountability, transparency, and above all, a government willing to put people before profit.

Until then, the sick will continue to be victims—not just of disease, but of a system that sees their suffering as a source of revenue.

The writer is a journalist, social researcher, and Secretary General of the Columnist Forum of Bangladesh.