NOT a single day passes without a case of medical negligence reported in the local media. As a result, the general perception is that the Saudi healthcare system is replete with problems. Due to an increase in public awareness, the number of complaints against healthcare providers and physicians has also gone up, resulting in an upward trend in malpractice litigation. After the Kingdom introduced mandatory health insurance coverage for all guest workers and a government decision to expand the network of healthcare providers in the country, the private healthcare sector has witnessed an unprecedented boom. However, instead of extending consummate care to the patients in one of the most vital service sectors, it is alleged that hospitals and health insurance companies blatantly engage in unethical practices to increase their revenue. Many people accuse hospitals and polyclinics in the Kingdom of treating patients with insurance coverage and those who pay in cash up front differently. They say many physicians prescribe expensive medicines and make requests for unnecessary lab tests and other investigations for patients who pay in cash while they give cheap alternatives to insurance patients. Meanwhile, the difference between the way patients are examined and treated by doctors in government-run hospitals and private medical centers are shockingly glaring. Al-Madinah Arabic daily recently published an investigative report, shedding light on the extent of the problem. Al-Madinah reporter Abdul Aziz Al-Ghamdi said he decided to investigate the matter following his bitter experience at a private clinic where he had accompanied a friend who had been suffering from seasonal flu. "While opening the medical file, the first question the receptionist asked was: cash or insurance? My friend said cash and he paid SR100 for consultation. After a routine checkup, the doctor prescribed a number of medicines, including antibiotics, worth SR400," Al-Ghamdi said. "That huge medical bill for treating a simple flu was really shocking. This prompted me to look into what has been going on at different hospitals and clinics in the city," he said. Al-Ghamdi began his journey from a polyclinic in Sulaimaniya District. "I pretended having severe stomach pain and nausea. The receptionist asked the usual question: Cash or card? I told her ‘insurance' and paid SR5 to open the file. I was taken to the clinic of an internist, who was an expatriate. When I explained my problems, he made me lie on the bed. Then he checked my heartbeats and felt my stomach. The nurse took my blood pressure and temperature. The doctor said he would give me a tablet for acidity, which is enough to stop the pain. "I asked the doctor whether he could ask for necessary blood tests or prescribe some antibiotics so that my recovery will be quick. I informed him that I have medical insurance, which will cover the bills. The doctor then told me he could not prescribe any medicine that would not be of any benefit to me. He said he understood what was my problem and insisted the medicine he gave me was suitable." Al-Ghamdi then went to a clinic in Al-Mushrifa District where he did not show his insurance card and paid SR100 for opening the file. He pretended the same illness. After conducting a checkup, the doctor recommended some blood tests and prescribed antibiotics. "I will write a number of other medicines that will speed the recovery," the doctor told Al-Ghamdi. When Al-Ghamdi told the doctor that he didn't need a long list of medicines or medical tests because he could not afford a huge bill. The doctor insisted that all the investigations and medicines are essential to avoid any complications and ensure a full recovery. To provoke the doctor further, Al-Ghamdi said he had visited another clinic where the doctor did not call for those tests or prescribe such medicines. The doctor burst out in anger: "That doctor lacked experience and professionalism." He advised Al-Ghamdi not to become a prey of such inexperienced and unqualified medical practitioners. "These doctors are afraid that insurance companies would not pay for additional investigations, which are essential to properly diagnose a disease," the doctor said. Al-Ghamdi conducted all the tests and the bill reached SR390. He then went to a polyclinic in Al-Samir in east Jeddah. He told the receptionist that he had medical insurance. "I explained to the doctor the same health problems and he gave me tablets to treat gas trouble. After waiting in the car for a couple of hours, I went back to the same clinic and opened a cash file for a different doctor. To my astonishment, the doctor asked me to conduct some medical tests before prescribing medicines, including antibiotics. Entirely different treatment for the same disease by two doctors at the same hospital," said Al-Ghamdi. He visited another clinic on Prince Sultan Street, pretending to have the same problems. "The receptionist seemed to be happy when I informed him that I am a cash patient. He sent me to the doctor without waiting for long. The doctor gave me medicines and vaccines worth SR800," said Al-Ghamdi. The huge medical bill at the private clinic prompted Al-Ghamdi to look into free medical care at a government hospital in Al-Samir. "I stood in the long queue of patients. Many doctors were absent on the day. The hospital was not clean and there was no water in the toilets. The overall service at the clinics was poor. Abu Saleh, an elderly man who was standing just before me, said: ‘I came to this clinic because of an inflammation on my right leg and severe pain. I had to wait for a week to get an appointment'." Abu Saleh had come to Jeddah to visit his son. "After Abu Saleh it was my turn. I told the doctor of my problems. He wrote a prescription without even looking at me. He did not ask for any blood test or take my blood pressure. He asked my name and wrote a tablet for acidity. I looked at the doctor in amazement but he told me I do not need any other medicine for the condition," said Al-Ghamdi. In the excitement created by the confounding approach of medical practitioners, Al-Ghamdi decided to discuss the matter with a doctor. "He diverted my attention to another issue. He said insurance companies force polyclinics and hospitals to extend the time of treatment and prevent doctors from prescribing antibiotics and vaccines. They also ask doctors, especially internists, to prescribe low-priced medicines. If we act against their instructions, they would close the patient's file and the clinic has to bear all the costs," he explained. "To be frank, we doctors do not like patients carrying insurance cards," the doctor said. "Because, there is an army of doctors with every insurance company to check patient files and prescriptions. They look for small mistakes to refuse payments. On an average, insurance companies reject 30 percent of bills submitted by hospitals," he added. During his investigation, Al-Ghamdi met Khaled Al-Rifaee, who had come to one of the clinics to consult a dermatologist. "I asked him: Cash or card? He said cash. I told him it would have been better if he had gone to a government hospital." Al-Rifaee said he had indeed gone to a government hospital but had to wait for months for an appointment with a consultant or specialist. "I could not wait for long because of severe pain. So I decided to consult a doctor at this private clinic," he said, adding: "So far I have spent more than SR1,500 on consultation, tests and medicines." While sitting in the lobby of a well-known polyclinic in Jeddah thinking about the sad plight of the patients, including children and the elderly, I asked the receptionist who was their favorite patient. She said without hesitation: "Of course, cash patients." Doctors exploit the health condition of such patients and ask them to do various tests, including X-rays, to milk them of money. The receptionist continued: "I still remember a young man who came to our clinic. He was having small bruises on his leg. After seeing him, the doctor prescribed a lot of unnecessary medicines and the poor guy had to part with SR450."
