A few months ago, Jaya Laxmi Upadhyay, 73, from Koteshwar in Kathmandu, was taken to a private hospital to consult a doctor for her rheumatoid arthritis.

She waited for hours before seeing the doctor at around 10:30 am, her son said. She was the 98th patient for the doctor that morning.

“After spending hours in line, the doctor took less than five minutes to examine my mother,” said Bishnu Timalsina, Upadhyay’s son, who is also the general secretary of the Forum for Protection of Consumer Rights. “Before taking the detailed medical history of my mother, the doctor handed a slip specifying the laboratory tests she had to undergo.”

Many patients visiting private hospitals often complain about having to wait for hours at the doctor’s clinic and not getting enough attention from doctors. The doctors spend only a couple of minutes with the patients, they say.

Despite paying comparatively higher doctors’ fees at private clinics, patients do not get the expected attention or enough allocated time with the doctor.

The Nepal Medical Association, the umbrella organisation of medical doctors, has almost ‘doubled the doctors’ fee which means patients and their families have to shell out more for the same amount of time and quality of attention they receive at private hospitals.

The Ministry of Health and Population, however, says it is unaware of the fee hike.

“I don’t know about the doctors’ fee hike,” Birodh Khatiwada, Minister for Health and Population, told the Post. “I can comment on the issue only after consulting officials.”

Dr Samir Kumar Adhikari, joint spokesperson for the Health Ministry echoed Khatiwada saying he too is unaware of the fee hike.

“The Health Ministry has to increase the fee on the recommendation of an expert panel,” said Adhikari. “The ministry has not increased the doctors’ fee. Charging additional fees is illegal, and if anyone files complaints against such a practice, action will be taken against those charging additional amounts.”

Officials at the association said that the decision to increase the doctors’ fee was taken around a year ago by the association after the Health Ministry did not pay heed to the demand of doctors asking for a fee hike.

“We will increase the doctors' fee next year again,” said Dr Badri Rijal, general secretary for the association. “The increase in doctors’ fee is pragmatic since it is based on the inflation rate of the Nepal Rastra Bank.”

As per the new list of charges implemented by the association, doctors with a degree of DM/MCH (Doctor of Medicine/ Master of Surgery) and five years of experience can charge up to Rs850, which was Rs450 earlier.

Doctors having MD/MS/MDS with 10 years of experience can also charge Rs850.

Likewise, doctors having DM/MCh with five years of experience can charge Rs770. Those having MD/MS/MCh with more than five years of experience can charge Rs700 and those having less than five years of experience can charge Rs660.

Doctors with a diploma and more than five years of experience can charge Rs590 and those with less than five years of experience can charge Rs515. An MBBS/BDs doctor with more than five years of experience can charge Rs450 and those with less than five years of experience can charge Rs370.

All of the above mentioned fee hikes are on consultation fees charged by doctors on patients’ visits.

Health facilities, where doctors run their practices, add an additional upto 20 percent in the doctors’ fees.

Doctors argue that the fee hikes are justified and the association agrees but it also stresses sufficient time allocation to each patient.

Doctors have to give at least 10 to 15 minutes to each patient to justify the fee hike, according to the association.

But consumer rights activists, as well as doctors and office bearers at the association concede that there is no mechanism to monitor whether or not the doctors allow 10 to 15 minutes to each patient as expected by the association and the patients.

“If the doctor had examined 97 patients before 10:30 am, we can only imagine how much time each patient received from him,” said Timalsina, Upadhyay’s son. “Patients are bearing the brunt of poor regulatory mechanisms. The authorities neither improve the quality of service provided at state-run health facilities nor do they regulate private health facilities.”

Officials at the association said that it is the responsibility of the Health Ministry to make rules about the time that should be allotted to each patient and introduce regulatory mechanisms to monitor if the doctors are charging fees as per their degrees and experiences or not.

“There is no mechanism to regulate the time spent by doctors with patients or whether the doctors’ are adhering to the rates set by the association based on their qualifications,” said Rijal, general secretary of the association. “To set time for doctors to see patients, the government should implement it from the state-run hospitals first.”

Doctors serving at state-run hospitals have to attend to hundreds of patients every day and are also involved in academic activities.

Those doctors also run clinics after their duty hours at their designated hospitals.

However, officials at the association also say that the outlook that all doctors spend only the minimum required time with the patients is unfair to those who uphold their medical professional values and spend enough time with the patients to understand their problems.

“I am a retired government doctor with a postgraduate degree but I don’t charge more than Rs300 per patient,” said Dr Kedar Narsing KC, former president of the association. “I don’t agree that the current fee charged by the doctors is exorbitant but the doctors should ensure that the patients are satisfied with their care. They should strive to identify the ailment and cure the patient so that the latter does not have to go to other doctors and spend more money.”

Nepal Medical Council, the national regulatory authority of medical doctors, says that it is the responsibility of the authorities concerned to monitor and prevent unfair practices.

“The government has set the price of certain services— medical education, doctors consultation and maximum retail prices of certain medicines,” Dr Bhagwan Koirala, chairman of the council, told the Post. “When it determines the price, it should show courage to revise it from time to time, enforce the decision and monitor if the decision has been implemented or not.”