Should we view health as a service sector, or as an industry? In recent times, this question is no longer confined to economic discussion; it has become an important debate touching on the humanity of medical care, patients’ rights, the dignity of health workers, the state’s responsibility, and the fair limits of private investment.
The short answer is that healthcare is fundamentally a service sector, but the medicines, equipment, technology, infrastructure and supply systems needed to keep it running are part of the health industry. Healthcare and the health industry are not rivals; rather, they complement each other. But when an industry’s profit motive begins to control the humane goals of service, the health system loses its moral foundation.
A patient does not come to hospital as a buyer. They arrive with chest pain, breathing difficulty, a stroke, an accident, childbirth complications, cancer, kidney failure, or some other life-threatening crisis. They have no time, no information, and in many cases, no capacity to make decisions. In this helpless state, medical treatment cannot be treated as an ordinary commodity or a market transaction. At the centre of treatment must be the patient’s life, safety, dignity and best interests.
The purpose of healthcare is disease prevention, diagnosis, treatment, rehabilitation, and ensuring people can lead productive, dignified lives. This includes:
- safe water, sanitation, nutrition and health education
- maternal and newborn care
- vaccination and infectious-disease control
- early detection of hypertension, diabetes, cancer and heart disease
- emergency departments, ambulances, operating theatres and intensive care
- medicine, testing, rehabilitation and mental health services
- necessary support for people with disabilities, the elderly, the poor and marginalised communities
Each of these is tied to the public interest. When one person falls ill, it is not only their family that suffers — their workplace, education, national productivity and the wider economy suffer too. When a family sells land or falls into debt to cover medical costs, that is not merely personal misfortune; it also reflects a weakness in the social safety net.
Healthcare is therefore part of the state’s fundamental duty to society. An effective state must ensure that no one is denied emergency treatment for lack of money, that diseases are detected at an early stage, that life-saving medicines and tests remain within people’s reach, and that a patient in crisis can quickly reach a suitable hospital.
Where and why the health industry is needed
Although healthcare is a humane service, modern medicine cannot function without strong, industry-based support. Medicine, saline, oxygen, insulin, reagents, blood bags, catheters, stents, pacemakers, ventilators, dialysis machines, ECG and echocardiogram machines, CT scanners, MRI machines, laboratory technology, hospital software, telemedicine and ambulances — behind all of these lie research, production, import, maintenance, distribution and skilled manpower. This is the health industry. A quality pharmaceutical industry is an asset to a country: producing safe, effective medicine locally lowers patient costs, reduces dependence on foreign supply, and strengthens the supply system in emergencies. Building domestic capacity in medical equipment, biomedical technology and research expands access to modern treatment. But the health industry carries one fundamental condition — products and technology must be used in the patient’s interest, not to turn the patient into a market for products. Decisions about which test is needed, which medicine is suitable, which device should be used, or whether an operation is necessary should be governed above all by medical evidence, ethics and the patient’s interest.
Where market logic has its limits
In an ordinary market, people choose products, compare prices, and decide whether to buy. But in emergency medical care, this freedom is often limited. A heart-attack patient, a severely injured person, or a patient in a complicated delivery cannot compare products and make a decision. The patient and their family place their trust in the doctor and the hospital, and because of that trust, ethics matters more in medical care than in almost any other sector. Unnecessary tests, irrational prescriptions, admissions without need, overpriced treatment packages, or commission-based referrals are not simply financial irregularities — they damage patients’ trust and the humane foundation of medicine. Equally, a health system cannot be called complete if it offers only profitable services. Emergency departments, intensive care, infection control, blood banks, rehabilitation, palliative care, mental health services and rural healthcare are often not profitable, yet they are essential to saving lives. Ignoring them may make a hospital profitable as a business, but it will fail as a public health system.
Health workers are not just employees
Doctors, nurses, midwives, technologists, pharmacists, physiotherapists, cleaning staff, ambulance workers and administrative support staff together run healthcare. No matter how modern a hospital’s building, equipment or advertising may be, quality service is not possible without trained and safe manpower. But the reality is that many health workers work under limited staffing, excessive patient loads, a lack of adequate rest, unsafe working environments, irregular pay, shortages of necessary equipment, and social disrespect. There must certainly be accountability for a doctor’s error, but if every complication in treatment is treated as a crime, no one can work safely — and in the end, the patient suffers too. Health workers’ safety, fair pay, reasonable working hours, housing, rest, training and professional dignity are not luxuries; they are also conditions for patient safety. The highest quality of care cannot be expected from an exhausted, frightened or undervalued health worker.
The relationship between the public and private sectors
In a country like Bangladesh, both the public and private sectors need to be realistically strengthened. The public sector’s responsibility is public health, primary care, emergency services, maternal and child care, infectious-disease control, treatment for poor patients, and extending healthcare to remote populations. The private sector also plays an important role: it can invest in hospitals, testing, advanced treatment, specialised services and technology. But that investment must come with transparency, fair pricing, quality control, patients’ right to information, impartial grievance redress, and adherence to medical ethics. Private hospitals can make a profit, but they cannot turn medicine into a field for exploitation. Public hospitals can provide free or low-cost care, but they cannot take refuge in a lack of accountability, mismanagement or negligence. In both cases, quality, ethics and patients’ rights should be the same.
Questions of patients’ rights and transparency
Healthcare cannot be called humane unless patients’ rights are ensured. Patients and their families have the right to know:
- the likely nature of the illness
- why a particular test is needed
- what the treatment alternatives are
- the possible risks, benefits and limitations
- the approximate cost of treatment and tests
- where and how they will be referred in an emergency
- how to obtain their treatment records and reports
Doctors, in turn, have the right to see patients within a reasonable amount of time, to carry out necessary tests, to obtain patient consent, and to make professional decisions free of unreasonable pressure or threats. Pitting patients and doctors against each other solves nothing. What is needed instead is transparent policy, a strong regulatory framework, an impartial system for investigating complaints, and fairness toward both patients and doctors.
What kind of policy Bangladesh needs
The future of healthcare in Bangladesh will depend on how much national priority we give to health. Several things are essential for this. First, a realistic, long-term national health policy is needed, one that sets out a clear framework for preventive healthcare, public health, emergency medicine, non-communicable diseases, mental health, rehabilitation and health insurance. Second, primary healthcare must be strengthened, with early detection of hypertension, diabetes, kidney disease, heart disease and cancer made readily available at the upazila and community level, since catching disease early reduces both complications and treatment costs. Third, emergency medical networks need to be built at the district and divisional level — rapid ambulance service, telemedicine, ECG, appropriate referral and skilled treatment coordination can save lives in cases of heart attack, stroke, accidents, and maternal and newborn emergencies. Fourth, quality control of hospitals and diagnostic centres must be strengthened, bringing licensing, trained manpower, patient safety, infection control, blood banks, emergency response, equipment maintenance and transparent price lists under regular oversight. Fifth, research and local production in the health industry should be encouraged, but never at the cost of compromising the quality of medicine and equipment — ensuring safe, effective medicine, reliable tests and quality medical equipment should be the core of policy. Sixth, patients’ out-of-pocket costs must come down, so that illness does not push a family toward poverty; necessary medicines, emergency tests and life-saving treatment need to be brought within people’s purchasing power, alongside an effective financial-protection system for poor and at-risk families.
Health as a human right
Calling health an industry means seeing only the economics; calling it merely a service hides the necessity of modern medicine’s technology, investment and management. The correct position is that healthcare is a human right and a humane service, while the health industry is the necessary supporting structure for that service. So the success of the health sector should not be measured only by how many hospitals, how many buildings, or how much money was invested. It should be measured by whether a poor patient received timely treatment, whether a mother gave birth safely, whether a heart-attack patient received life-saving care quickly, whether a child was vaccinated, and whether a health worker could work safely and with dignity. Keeping human life above profit, while embracing science, skill, technology and good governance together, is how a humane, accountable health system that works for everyone must be built.