In and Out of Medical Centers: Fancy Clinics and Pricey Cures 

Muhaned Faris

10 May 2024

"Most gynecologists admit more than one patient at a time, which prevents me from speaking freely to the doctor out of embarrassment in front of the other patients, ”.. on navigating costly clinics within medical centers in Iraq.

Rana Al-Jubouri is a dermatologist that chose to resign from her government job and transition to a medical center in Baghdad, where she could earn a salary more than double her previous monthly income. Previously earning 1.5 million Iraqi dinars monthly (about $980), she now earns four million Iraqi dinars (about $3040) in her new role. She doesn’t regret her decision to move to the private sector, citing the significant salary increase and shorter work hours as major advantages. “At Ghazi Al-Hariri Government Hospital, I used to work 12-hour shifts, but now, at the medical center, I work only six hours a day and earn a higher salary,” she told Jummar. The substantial salaries in these medical centers highlight the lucrative nature of the industry, particularly in Baghdad and other cities across Iraq. These centers, once relatively uncommon until the turn of the century, have now emerged as prominent alternatives, surpassing traditional private clinics as preferred destinations for medical care. 

However, at the beginning of the third millennium, “cooperative” medical centers began to emerge. These are government-supervised complexes that offer services at lower prices than private clinics. These centers primarily appeared in impoverished, densely populated areas. This phenomenon began to evolve and expand after 2003, and over the past decade, the popularity of clinics has waned in favor of the appeal of these centers. Many doctors now opt to lease a new clinic within these centers, leaving their old one in pursuit of a more pristine and refined setting. Moreover, the consolidation of diagnostic and examination equipment within a single center streamlines the process for both physicians and patients, expediting diagnoses. This, as noted by Osama Ismail, a specialist in community medicine, serves as another incentive for doctors to transition to these centers. In recent years, hundreds of centers have been erected in key healthcare hubs in Baghdad, such as Al-Harithiya, Al-Wathiq Square, and Beirut Square. Some of these centers span five floors or more and are comprised of dozens of interconnected clinics. 

Medical center owners compete to infuse their facilities with a touch of luxury, employing embellishments like decor, lighting, elevators, and other enhancements. They also prioritize the inclusion of amenities like pharmacies, laboratories, and facilities for radiology, ultrasound, endoscopy, and MRI alongside clinics, enabling patients to access comprehensive services conveniently under one roof.  

Such opulence and convenience, however, comes with a cost. Patients are now required to pay higher fees to doctors in exchange for access to air-conditioned waiting rooms, elevators, and clinics with luxurious views. With rents for clinics inside active medical areas soaring to $1600 or more per month, doctors are compelled to raise their consultation fees. In locales like Al-Harithiya, Al-Wathiq Square, and Beirut Square, some doctors charge up to 50,000 Iraqi dinars (about $40) or more for a consultation. The exorbitant cost of rent may be the reason why many doctors ignored the decision issued by the Doctors Syndicate in May 2022, which prescribed consultation fees for practicing doctors at 15,000 Iraqi dinars (about $10), specialists at 25,000 (about $20), and consultants at 40,000 (about $30). 

Some doctors exceed the consultation fee limit by resorting to devious tactics to extract extra funds from patients, including delaying diagnosis and treatment. This is what happened to Rihab Mahdi, a woman diagnosed with breast cancer who underwent surgery to remove her affected breast. 

After the surgery, Rihab continued to visit the doctor who performed her operation for four months. Each time she went, the doctor requested new tests and examinations to ensure the stability of her condition. These consultations cost her more than three million Iraqi dinars (about $2280). Suspecting potential fraud, she sought a second opinion. Rihab described this new doctor as “a nice guy.” He promptly informed her, after conducting necessary tests, that she had recovered from the illness, and the tumor was no longer present in her body. Rihab believes that the proliferation of luxurious centers with high rents incentivizes some doctors to resort to “unprofessional and unethical” practices to maximize profits, cover expenses and achieve financial gains.  

Along these lines, Maria Hakim Younan (33 years old) expressed frustration with the practice of admitting multiple patients into a doctor’s office without regard for privacy. “Most gynecologists admit more than one patient at a time, which prevents me from speaking freely to the doctor out of embarrassment in front of the other patients,” she told Jummar.  

She is convinced that the reason behind this behavior is to accommodate the largest possible number of consultations in a day, even at the expense of privacy and the time that the patient needs to spend with the doctor. While Zeina Al-Mousawi, a specialist in gynecology, admits to examining three to five patients at once, she denies that it is for financial gain. She attributes it to meeting the patients’ desires by not postponing their examinations and avoiding long waits in the waiting room.  

Many doctors have various methods of obtaining additional income, including making agreements with pharmacies, laboratories, and diagnostic clinics, where the doctor receives a percentage for every prescription, test, or examination he refers to them. Patients cannot bypass these agreements, since the doctor uses codes when writing prescriptions, understood only by the pharmacist they’re affiliated with. In addition, the patient does not want to risk purchasing a medication that may differ in effectiveness from the one prescribed by the doctor. Similarly, doctors direct patients to specific laboratories or radiology clinics under the guise of lacking trust in others. A pharmacist, speaking anonymously to Jummar, shared that such agreements may encompass the pharmacy covering the monthly rent for the doctor’s clinic and shouldering its furnishing expenses. 

Other agreements involve paying a percentage of the pharmacy’s profits, typically ranging between 10 and 15 percent, depending on the volume of prescriptions referred.  

For doctors esteemed as “First Class” among pharmacists, renowned for their high patient influx, this percentage can reach 50 percent. These arrangements resulted in sky high bills for Sawsan Majid Al-Refaii.  

Al-Refai was experiencing an irregular heartbeat and visited a cardiologist whose clinic was situated in one of Al-Harthiya’s centers, and reputed to be a “good doctor.” The doctor prescribed a medication called Centrum for her, priced at 90,000 Iraqi dinars (about $70) for a two-week supply, and advised her to return for follow-up after completing the treatment period to monitor her condition. 

She found the treatment duration surprisingly short and decided to seek advice from a pharmacist in her neighborhood in Baghdad. The pharmacist told her that the prescribed medication was just a vitamin supplement and should cost no more than 25,000 Iraqi dinars (about $19). She purchased it for 90,000 Iraqi dinars due to its American origin.  

Wissal Mohammed, also living in Baghdad, encountered a situation similar to Al-Refai’s. She consulted a doctor in one of Al-Harthiya’s centers for a joint ailment and was prescribed an American medication called Osteo Bi-Flex at a price of 130,000 Iraqi dinars (about $100). She later discovered that a medication that had equal effects, called Osteocare Plus, was available in other pharmacies for a mere 15,000 dinars (about $10.) 

The protection of violations  

Diagnostic clinics, such as laboratories, radiology centers, ultrasound facilities, MRI centers, and mammography clinics located in bustling neighborhoods, also get a share from patients’ wallets. 

During a quick survey conducted by Jummar in Al-Harthiya and Beirut Square areas to investigate pricing, it became evident that the cost of cancer screening within MRI centers ranges between 100,000 (about $80) and 200,000 Iraqi dinars (about $160). Kidney function and renal failure tests, along with thyroid hormone analysis, are priced at 35,000 Iraqi dinars (about $30) each. CT scans are offered at 25,000 dinars (about $20), while tests for diabetes and anemia are set at 15,000 (about $10) each. 

Hearing tests in some Al-Harthiya centers are priced at 50,000 Iraqi dinars (about $40), with medical hearing aids reaching 25,000 (about $20) for each unit. 

In contrast, prices for similar medical tests in other areas are notably lower than those in these two regions. Although the Ministry of Health is tasked with monitoring these prices and preventing overcharging, it appears that oversight is merely a formality. 

One of the members of the inspection committees within the ministry, speaking anonymously to Jummar, says that inspection campaigns are essentially “just media statements.” This is because the ministry struggles to regulate prices, given that most doctors have become adept at evading committee inspections and deceiving them by claiming to adhere to official pricing. 

 About the prices of medication in pharmacies, Dr. Mahmoud Shaker, the secretary of the Pharmacists Syndicate council, explains that while the syndicate has collaborated with the Ministry of Health to set drug pricing, it may be far into the future until those prices are limits are implemented. He further notes to Jummar that corruption has permeated many inspection committees, with several officials in the ministry and health professional syndicates owning medical centers in bustling areas, impeding the enforcement of decisions and pricing regulations. 

Medical centers owned by these individuals often are immune to accountability, even when cited for violations. For instance, Article 5 of the Practicing Pharmacy Profession Law No. 221 for the year 1970, which remains in effect today, mandates that the space of a pharmacy should not be less than 20 square meters, and the distance between pharmacies should not be less than 50 meters. However, this regulation does not apply to adjacent pharmacies within centers. 

A member of the Pharmacists Syndicate, speaking anonymously to Jummar, revealed that influential individuals impede the enforcement of this law on their own centers or those belonging to their close associates, often invoking it selectively to undermine competitors. 

Although there are no official statistics regarding the number of medical centers in Iraq, a health source approximates that in Baghdad alone there are around two thousand licensed and unlicensed centers. They further assert that roughly 40 percent of these centers are under the ownership of “corruption whales” entrenched within the ministry and syndicates. 

Despite several attempts, the Ministry of Health declined requests from Jummar to comment on this information.  

What do doctors say? 

Dr. Ismail doesn’t see Iraqi’s medical centers as inherently negative. He believes that   exploitative dynamics are not necessarily linked to the fact that these centers exist. While he condemns doctors who engage in profit-driven agreements with pharmacies, laboratories, and diagnostic centers, he also notes that some doctors only establish relationships with specific pharmacies and laboratories they trust. This ensures their patients receive high-quality medication and accurate tests at fair prices. “The doctor thus fulfills their humanitarian mission and duty towards the patient in order to obtain the best service,” he told us. 

On the other hand, Dr. Mahdi Al-Saadi, a cardiologist, considers violations within certain medical centers to be a breach of the principles outlined in the Hippocratic Oath, which every medical student recites when they graduate. Al-Saadi asserted, in a conversation with Jummar, that it is crucial for doctors to maintain independence in private clinics, in contrast to the commercial practices devoid of humanity that may be prevalent in centers. While Al-Saadi stresses the importance of not making sweeping generalizations and acknowledges the many doctors who still adhere to the Ministry of Health’s salary guidelines, Dr. Mohsen Al-Sheikhli, a dermatologist, attributes the rise in fees to escalating rents, particularly in bustling neighborhoods.  

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Rana Al-Jubouri is a dermatologist that chose to resign from her government job and transition to a medical center in Baghdad, where she could earn a salary more than double her previous monthly income. Previously earning 1.5 million Iraqi dinars monthly (about $980), she now earns four million Iraqi dinars (about $3040) in her new role. She doesn’t regret her decision to move to the private sector, citing the significant salary increase and shorter work hours as major advantages. “At Ghazi Al-Hariri Government Hospital, I used to work 12-hour shifts, but now, at the medical center, I work only six hours a day and earn a higher salary,” she told Jummar. The substantial salaries in these medical centers highlight the lucrative nature of the industry, particularly in Baghdad and other cities across Iraq. These centers, once relatively uncommon until the turn of the century, have now emerged as prominent alternatives, surpassing traditional private clinics as preferred destinations for medical care. 

However, at the beginning of the third millennium, “cooperative” medical centers began to emerge. These are government-supervised complexes that offer services at lower prices than private clinics. These centers primarily appeared in impoverished, densely populated areas. This phenomenon began to evolve and expand after 2003, and over the past decade, the popularity of clinics has waned in favor of the appeal of these centers. Many doctors now opt to lease a new clinic within these centers, leaving their old one in pursuit of a more pristine and refined setting. Moreover, the consolidation of diagnostic and examination equipment within a single center streamlines the process for both physicians and patients, expediting diagnoses. This, as noted by Osama Ismail, a specialist in community medicine, serves as another incentive for doctors to transition to these centers. In recent years, hundreds of centers have been erected in key healthcare hubs in Baghdad, such as Al-Harithiya, Al-Wathiq Square, and Beirut Square. Some of these centers span five floors or more and are comprised of dozens of interconnected clinics. 

Medical center owners compete to infuse their facilities with a touch of luxury, employing embellishments like decor, lighting, elevators, and other enhancements. They also prioritize the inclusion of amenities like pharmacies, laboratories, and facilities for radiology, ultrasound, endoscopy, and MRI alongside clinics, enabling patients to access comprehensive services conveniently under one roof.  

Such opulence and convenience, however, comes with a cost. Patients are now required to pay higher fees to doctors in exchange for access to air-conditioned waiting rooms, elevators, and clinics with luxurious views. With rents for clinics inside active medical areas soaring to $1600 or more per month, doctors are compelled to raise their consultation fees. In locales like Al-Harithiya, Al-Wathiq Square, and Beirut Square, some doctors charge up to 50,000 Iraqi dinars (about $40) or more for a consultation. The exorbitant cost of rent may be the reason why many doctors ignored the decision issued by the Doctors Syndicate in May 2022, which prescribed consultation fees for practicing doctors at 15,000 Iraqi dinars (about $10), specialists at 25,000 (about $20), and consultants at 40,000 (about $30). 

Some doctors exceed the consultation fee limit by resorting to devious tactics to extract extra funds from patients, including delaying diagnosis and treatment. This is what happened to Rihab Mahdi, a woman diagnosed with breast cancer who underwent surgery to remove her affected breast. 

After the surgery, Rihab continued to visit the doctor who performed her operation for four months. Each time she went, the doctor requested new tests and examinations to ensure the stability of her condition. These consultations cost her more than three million Iraqi dinars (about $2280). Suspecting potential fraud, she sought a second opinion. Rihab described this new doctor as “a nice guy.” He promptly informed her, after conducting necessary tests, that she had recovered from the illness, and the tumor was no longer present in her body. Rihab believes that the proliferation of luxurious centers with high rents incentivizes some doctors to resort to “unprofessional and unethical” practices to maximize profits, cover expenses and achieve financial gains.  

Along these lines, Maria Hakim Younan (33 years old) expressed frustration with the practice of admitting multiple patients into a doctor’s office without regard for privacy. “Most gynecologists admit more than one patient at a time, which prevents me from speaking freely to the doctor out of embarrassment in front of the other patients,” she told Jummar.  

She is convinced that the reason behind this behavior is to accommodate the largest possible number of consultations in a day, even at the expense of privacy and the time that the patient needs to spend with the doctor. While Zeina Al-Mousawi, a specialist in gynecology, admits to examining three to five patients at once, she denies that it is for financial gain. She attributes it to meeting the patients’ desires by not postponing their examinations and avoiding long waits in the waiting room.  

Many doctors have various methods of obtaining additional income, including making agreements with pharmacies, laboratories, and diagnostic clinics, where the doctor receives a percentage for every prescription, test, or examination he refers to them. Patients cannot bypass these agreements, since the doctor uses codes when writing prescriptions, understood only by the pharmacist they’re affiliated with. In addition, the patient does not want to risk purchasing a medication that may differ in effectiveness from the one prescribed by the doctor. Similarly, doctors direct patients to specific laboratories or radiology clinics under the guise of lacking trust in others. A pharmacist, speaking anonymously to Jummar, shared that such agreements may encompass the pharmacy covering the monthly rent for the doctor’s clinic and shouldering its furnishing expenses. 

Other agreements involve paying a percentage of the pharmacy’s profits, typically ranging between 10 and 15 percent, depending on the volume of prescriptions referred.  

For doctors esteemed as “First Class” among pharmacists, renowned for their high patient influx, this percentage can reach 50 percent. These arrangements resulted in sky high bills for Sawsan Majid Al-Refaii.  

Al-Refai was experiencing an irregular heartbeat and visited a cardiologist whose clinic was situated in one of Al-Harthiya’s centers, and reputed to be a “good doctor.” The doctor prescribed a medication called Centrum for her, priced at 90,000 Iraqi dinars (about $70) for a two-week supply, and advised her to return for follow-up after completing the treatment period to monitor her condition. 

She found the treatment duration surprisingly short and decided to seek advice from a pharmacist in her neighborhood in Baghdad. The pharmacist told her that the prescribed medication was just a vitamin supplement and should cost no more than 25,000 Iraqi dinars (about $19). She purchased it for 90,000 Iraqi dinars due to its American origin.  

Wissal Mohammed, also living in Baghdad, encountered a situation similar to Al-Refai’s. She consulted a doctor in one of Al-Harthiya’s centers for a joint ailment and was prescribed an American medication called Osteo Bi-Flex at a price of 130,000 Iraqi dinars (about $100). She later discovered that a medication that had equal effects, called Osteocare Plus, was available in other pharmacies for a mere 15,000 dinars (about $10.) 

The protection of violations  

Diagnostic clinics, such as laboratories, radiology centers, ultrasound facilities, MRI centers, and mammography clinics located in bustling neighborhoods, also get a share from patients’ wallets. 

During a quick survey conducted by Jummar in Al-Harthiya and Beirut Square areas to investigate pricing, it became evident that the cost of cancer screening within MRI centers ranges between 100,000 (about $80) and 200,000 Iraqi dinars (about $160). Kidney function and renal failure tests, along with thyroid hormone analysis, are priced at 35,000 Iraqi dinars (about $30) each. CT scans are offered at 25,000 dinars (about $20), while tests for diabetes and anemia are set at 15,000 (about $10) each. 

Hearing tests in some Al-Harthiya centers are priced at 50,000 Iraqi dinars (about $40), with medical hearing aids reaching 25,000 (about $20) for each unit. 

In contrast, prices for similar medical tests in other areas are notably lower than those in these two regions. Although the Ministry of Health is tasked with monitoring these prices and preventing overcharging, it appears that oversight is merely a formality. 

One of the members of the inspection committees within the ministry, speaking anonymously to Jummar, says that inspection campaigns are essentially “just media statements.” This is because the ministry struggles to regulate prices, given that most doctors have become adept at evading committee inspections and deceiving them by claiming to adhere to official pricing. 

 About the prices of medication in pharmacies, Dr. Mahmoud Shaker, the secretary of the Pharmacists Syndicate council, explains that while the syndicate has collaborated with the Ministry of Health to set drug pricing, it may be far into the future until those prices are limits are implemented. He further notes to Jummar that corruption has permeated many inspection committees, with several officials in the ministry and health professional syndicates owning medical centers in bustling areas, impeding the enforcement of decisions and pricing regulations. 

Medical centers owned by these individuals often are immune to accountability, even when cited for violations. For instance, Article 5 of the Practicing Pharmacy Profession Law No. 221 for the year 1970, which remains in effect today, mandates that the space of a pharmacy should not be less than 20 square meters, and the distance between pharmacies should not be less than 50 meters. However, this regulation does not apply to adjacent pharmacies within centers. 

A member of the Pharmacists Syndicate, speaking anonymously to Jummar, revealed that influential individuals impede the enforcement of this law on their own centers or those belonging to their close associates, often invoking it selectively to undermine competitors. 

Although there are no official statistics regarding the number of medical centers in Iraq, a health source approximates that in Baghdad alone there are around two thousand licensed and unlicensed centers. They further assert that roughly 40 percent of these centers are under the ownership of “corruption whales” entrenched within the ministry and syndicates. 

Despite several attempts, the Ministry of Health declined requests from Jummar to comment on this information.  

What do doctors say? 

Dr. Ismail doesn’t see Iraqi’s medical centers as inherently negative. He believes that   exploitative dynamics are not necessarily linked to the fact that these centers exist. While he condemns doctors who engage in profit-driven agreements with pharmacies, laboratories, and diagnostic centers, he also notes that some doctors only establish relationships with specific pharmacies and laboratories they trust. This ensures their patients receive high-quality medication and accurate tests at fair prices. “The doctor thus fulfills their humanitarian mission and duty towards the patient in order to obtain the best service,” he told us. 

On the other hand, Dr. Mahdi Al-Saadi, a cardiologist, considers violations within certain medical centers to be a breach of the principles outlined in the Hippocratic Oath, which every medical student recites when they graduate. Al-Saadi asserted, in a conversation with Jummar, that it is crucial for doctors to maintain independence in private clinics, in contrast to the commercial practices devoid of humanity that may be prevalent in centers. While Al-Saadi stresses the importance of not making sweeping generalizations and acknowledges the many doctors who still adhere to the Ministry of Health’s salary guidelines, Dr. Mohsen Al-Sheikhli, a dermatologist, attributes the rise in fees to escalating rents, particularly in bustling neighborhoods.