A lot of Bangladeshis go abroad for treatment every year. They spend a whopping $3.5 billion for this purpose, according to Bangladesh Investment Development Authority (BIDA). But, experts believe the actual cost is likely to be more. This mammoth figure is, however, not reflected in the data provided by Bangladesh Bank. According to the central bank, only $1.7 million was spent on Bangladeshis’ treatment overseas in last fiscal year (2022-23). The amount stood at $3.2 million in the previous fiscal (2021-22). That means Bangladesh Bank is informed of less than one percent of the total cost of treatment of Bangladeshis in foreign countries.

In December, last year, a top executive of a private bank had a surgery at a hospital in Singapore. He had to pay $40,000 for the surgery. The executive made the whole payment using a debit card issued against his foreign currency account. Despite being a card payment, the spending could not be officially shown as treatment cost.                  

“I had to face a lot of troubles if I wanted to pay the bill with the approval of Bangladesh Bank,” the top executive told Bonik Barta on condition of anonymity.    

“I would have required to submit the recommendations of the medical board and all the relevant files on treatment. I could not have possibly gathered those. So, I made the full payment by the debit card,” he said.

“The transaction was 100% legal, but it was not registered with Bangladesh Bank as treatment cost. People will follow the rules if the process of Bangladesh Bank approval is swift and easy. It is not all possible under the existing system,” he added.

People, who receive treatment abroad, say they seldom pay their bills in foreign currency through banks and financial institutions. And, in most cases, people spend more than the amount endorsed in their passports.

There is no exact figure as to how many people go abroad for treatment every year, health economists say. People receive treatment while travelling on visit visa. Medical visa is only mandatory in case of surgery. It is estimated that about 3 million people go abroad for treatment every year. The top destinations for Bangladeshis are India, Thailand, Singapore, China, Japan, Malaysia, South Korea, Qatar, United Arab Emirate, United States, United Kingdom and Australia.                   

Many of the rich people use air ambulances for treatment abroad on emergency basis. The users of air ambulances mostly fly to neighboring India and Thailand and Singapore. Depending on the distance, a single journey costs from Tk 3 million to 5 million. As per the sources at the Bangladesh offices of two hospitals of India and Thailand, at least $29,500 is charged for transporting a patient from Dhaka to Bangkok. The amount is more or less same for the South Indian city of Chennai. The hospitals encourage their customers to pay in cash. People also can make payment through banks.

As per Bangladesh Bank data, Bangladeshis spent $3.2 million through banking channels in 2021-22 fiscal. In 2022-23 fiscal, the amount came down to $1.7 million. In the first six months of the ongoing fiscal (2023-24), people spent $1 million for treatment overseas.            

On the other hand, BIDA statistics show at least 700,000 Bangladeshis go overseas for treatment and spend $3.5 billion. Health economists and bankers, however, dispute the figure, saying that the actual number of people and the amount of money are much higher. Analyzing the data from BIDA and Bangladesh Bank, it can be determined that less than .05 percent of the total cost went through banking channels.

Bankers and health economists argue that the statistics of BIDA are based on information regarding treatment in India, Malaysia, Thailand and Singapore. So, the actual cost is higher than the one mentioned by BIDA. People receive treatment after going abroad on other visas. So, it will not be surprising if the actual spending turns out to be three or four times more. Bangladesh has yet to come up with an effective system to detect the spending on treatment abroad. In most cases, banks do not have the track of the money spent for overseas treatment. And, the approval process of this is very complicated. As a result, most of the people are buying dollars from black market and money exchanges, leading to the strengthening of illegal hundi business, an informal way to transfer money from one country to another.     

Syed Mahbubur Rahman, former chairman of the Association of Bankers Bangladesh (ABB), told Bonik Barta, “People are meeting the treatment cost through hundi transactions. Mainly, Bangladeshis go to India, Thailand and Singapore. Currencies of these countries are available at any money exchange. This is why people are taking cash or getting money through other means. Many are receiving treatment with the money they get on travel quota. People need to produce a lot of papers in order to pay for the treatment through banks. So, people avoid banks. Simplification of the process would have benefited the country along with the people seeking treatment. Hundi transactions would have come down too.”

Dr Syed Abdul Hamid, a professor at Institute of Health Economics of Dhaka University, told Bonik Barta, “If the money is bought from banks, Bangladesh Bank will have the information. It is not possible in cases of money exchanges if they do not provide the right information. And, we have people taking more than they are allowed. Another aspect is that credit card payments do not mention sectors in which people are spending.”

“Health and education should be ensured from the own sources of the state. Dependence on other countries is a loss to the country’s economy. People’s health-related data are also transferred which may entice foreigners to open healthcare institutions in Bangladesh,” he said.      

A PhD research at the Institute of Health Economics of Dhaka University shows that India is the most preferred country for Bangladeshis to receive treatment. The number people seeking treatment in India is increasing every year. Of the total number of patients, 21 percent go for cancer treatment, 18 percent with heart problems and 13 percent go for reproductive health. The remaining people are going for problems related to orthopedic, gastroenterology, liver, kidney, eye, ear and neurology.                                

Talking to Bonik Barta, Dr Enamul Haque, director general of Health Economics Unit under Health Ministry, lamented the lack of information about people seeking treatment abroad and said, “We are conducting a new research on healthcare cost giving an idea on this issue. However, it will not provide a clear picture.”

Public health experts say that the healthcare institutions got bigger both in public and private sectors. The number of doctors has increased and services have been expanded. But, people’s trust has not gone up proportionately. At the same time, specialized services are not available in every area of the country. People have long been complaining many aspects, especially absence of proper diagnosis, cheating and negligence. This is why a large segment of people are going abroad for treatment.

Frontiers, a Switzerland-based research publisher, released a paper last year titled ‘Determinants of Bangladeshi patients' decision-making process and satisfaction toward medical tourism in India’. It said that the Indian hospitals get about 450,000 Bangladeshi patients every year. The paper also mentioned that many people receive treatment there on other visas.

There is no scope for denying the fact that many people go overseas for receiving treatment, said Health and Family Welfare Minister Professor Dr Samanta Lal Sen.

“Bangladeshis are going abroad for treatment. Likewise, people from other countries are coming to Bangladesh for treatment. We cannot stop people from going abroad. But, the government is making effort so that they receive treatment at home. Endeavors are there to enhance people’s trust in healthcare. Our physicians are highly skilled,” he told Bonik Barta.

“We will try to ensure that people spend their money for treatment through banking channels,” the minister added.