Perspectives of Nigerian doctors on the practice of rebates, fee-splitting, and kickbacks
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Abstract
Background: Fee splitting is a global pandemic in the health-care industry, whereby financial and nonfinancial inducements are offered to health-care practitioners in exchange for guaranteed patient referral, continuous patronage, or preferential usage/prescription of the payer’s products.
Methods: We surveyed 280 medical doctors from August 2017 to October 2017 to assess their knowledge, perception, and attitude toward fee-splitting using self-administered questionnaires.
Results: The majority (89%) of our respondents indicated that they were aware of the existence of fee-splitting in the Nigerian health-care industry. About 34% accept rebates, while 70% admitted to knowing other colleagues who accept rebates. The amount received as rebates was ≤20% of the cost of an investigation. More than half of the respondents (52%) opined that the practice is a nationwide phenomenon. An astonishing 78% of respondents either did not know (61%) or asserted wrongly (17%) that the practice is not a violation Nigerian
Medical Council rules. Only 46% affirmed that the practice is unethical. Compared to private hospitals,fee-splitting is less in public hospitals. Sixty-one percent noted that other health-care workers (besides physicians) are also involved. The primary allures of fee-splitting were a quest for an extra source of income (64%), poor/irregular salaries (60%), ignorance of its illegality (56%), and greed (47%). The identifieddeleterious consequences were unnecessary investigations/procedures, inflated health-care cost, quackery, delayed treatment/prolonged hospital stay, beclouded clinical judgment, and negative public perception.
Conclusion: Stricter regulatory enforcement and continuous ethics education are needed to disrupt the widespread fee-splitting culture.
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