An illegal and growing culture of “commissions” and kickbacks involving medical professionals is undermining a section of the multi-billion shilling health industry. Investigations by The Standard on Sunday reveal that many private facilities offering critical services such as radiology, laboratories and pharmacies are struggling to stay afloat amid skyrocketing demands for huge “commissions” from unscrupulous doctors.
The most affected in this racket is the radiology sector, which conducts vital medical tests such as computerised tomography (CT Scans), X-rays, Magnetic resonance imaging (MRI’), nuclear magnetic resonance imaging (NMRI), or magnetic resonance tomography (MRT) and the ultra-sound, needed to make critical medical decisions.
Such facilities are increasingly being compelled to part with a huge part of their income to pay out greedy doctors and avoid the “nightmare” of not having patients referred to them.
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“The situation is so bad that some of us have even begun worrying about the economic sustainability of this sector. Patients are being referred to those who can pay the highest commissions. The issue of quality is being thrown out of the window,” said a radiologist in private practice in Nairobi who sought anonymity.
“If this unethical culture of commissions and kickbacks is not stopped, it will discourage further investments in the medical sector. Much of the profits are being taken by the huge commissions demanded by unscrupulous doctors.”
Some facilities that have turned down demands for the illegal commissions are losing out due to sharp reductions in the number of patients referred to them. Their ability to remain in operation is threatened even if they are offering quality services.
On average, a CT scan costs between Sh5, 000 and Sh12, 000 while a Magnetic Resonance Imaging (MRI) costs between Sh16, 000 to Sh33, 000. Ultrasound costs between Sh600 and Sh4, 000 while x-rays cost between Sh1, 200 and Sh3, 000 depending on the facility. Doctors are said to demand anything from 20 percent up to 40 per cent commission for referring patients to some facilities.
Another doctor who runs a private medical lab in the city lamented that some labs have resorted to taking short-cuts and compromising on certain costs to recoup the losses from the illegal commissions being demanded by dodgy doctors.
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“Many laboratories and diagnostic centers that pay commissions operate at below-par standards, thus relevant bodies should step in to ensure all facilities meet the minimum standards,” she said. “Corruption needs to be tackled openly and head-on like has been done in other countries for the medical industry to survive.”
The unhealthy culture of commissions appears to have gained further strength in the recent years with the entry of some foreign companies into the radiology, laboratory and pharmaceutical sectors. To gain a foothold and the market and elbow out their rivals, they often seek out doctors and propose huge “commissions” to send patients to them for tests or drugs. Most of the local facilities can’t match the huge kickbacks they pay out to doctors.
In reaction to the investigations by The Standard on Sunday, the Chairperson of the Kenya Radiology Society Dr Vera Manduku said the vice - whether practised or demanded by doctors or provided by some private facilities to entice doctors to send more patients, undermines the professional practice of medicine in the country.
“The focus on providing quality services will be sacrificed at the altar of commissions. The highest bidder in providing commissions will win the day if this culture is not stopped. This is a vicious cycle that needs to be broken,” she responded.
Conflict of interest
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Kenya Association of Clinical Pathologists chairman Dr Andrew Gachii, to which many of the doctors running laboratories belong, says the vice creates conflict of interest among doctors prescribing medical tests. “The problem with paying commissions is that somebody has to absorb that cost somewhere down the road. In most cases, it is the patients who end up paying more for services or the laboratory compromising quality to mitigate the cost. We hope this situation can be reversed in the near future,” he said.
The Code of Conduct by the Kenya Medical Practitioners and Dentists Board as well as rules under the Ethics and Anti- Corruption Commission classify commissions amongst medical professionals to be unethical and immoral, if not illegal.
Secretary General of the Kenya Pharmaceutical Association Dorcas Too said establishing the extent of the vice of illegal commissions within the pharmaceutical industry is difficult since the matter is a private arrangement between doctors and individual pharmacies or drug companies “If the issue exists, it can only be a few pharmacies doing that. But the majority are operating above the board. Paying commissions means that one has to recoup through higher prices of drugs. This makes one uncompetitive in the current market,” she said.
In some countries, including South Africa and the US, hospitals and doctors are ranked as prescribers, and are not allowed to own laboratories, radiology or pharmacies which are supposed to be independent.
This is meant to reduce conflict of interest. The laws and regulations in these countries are strict as a way of curtailing corruption and bribery among doctors.