Jordanians see red over blood transfusion charges

A new policy requires them to pay US$21 for each unit at public hospitals and still donate blood for free.

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A new policy requiring Jordanians to pay for blood has sparked widespread anger, with many calling it another example of the public being forced to shoulder the burden of the government's financial woes. Jordanians undergoing surgery are used to being given units of blood free from the country's blood banks, provided they donate the same amount in return. But the new policy requires them to pay US$21 (Dh77) for each unit at public hospitals and still donate blood for free.

After much criticism of the new policy, the health ministry on Monday appeared to soften its stance and said it would charge a fee only for the first five units. At private hospitals, patients are asked to pay $45 for each blood unit, and for non-Jordanians the rate has doubled to $60. Cancer patients and those diagnosed with blood diseases or hepatitis are excluded from the payments. The decision has become so unpopular in the country, that it has become a national joke.

Imad Hajjaj, the country's renowned cartoonist, played on the theme in one of his cartoons published in Alghad newspaper last month. He depicted Abu Mahjoob, his main character, ridiculing the pricing formula. "I donate my blood so that they would sell it for $45! ... Dracula is better ... come and have one [suck] for five dinars," Abu Mahjoob tells the mythical vampire. The health ministry defended itself against the criticism. Nayef al Fayez, the health minister, said the ministry is not a vampire, and that it is not selling blood to make a profit.

"Jordanian's blood is too precious to be sold," Mr al Fayez told reporters last week. He said it is simply asking citizens to pitch in part of the fees it incurs from running a host of tests on donated blood to ensure its safety. The minister explained that the fee at public hospitals covered only 25 per cent of blood-testing costs that reached almost $9 million last year. On average, 100,000 Jordanians donate their blood annually, refilling the blood bank with 95,000 units or litres, but Mr al Fayez said private hospitals and doctors are responsible for wasting half of the blood units they receive.

"The [measure] is to help curb squandering of the blood caused by the private hospitals," he said. "Private hospitals in western Amman asked for a total of 50,166 blood units, but they only used 25,325 units." But the Private Hospital Association and private-sector doctors disagreed with this assessment. "Surgeons are the ones who determine how many units they need, not a hospital's administrations," Fawzi Hammouri, the head of the hospital association, said.

Mazen Hanna, a gynecologist, described the decision as illogical. "The ministry is asking for too much. In some instances, if I wanted to perform a minor surgery, I ask my patients to secure up to five blood units and between 10 and 15 for major ones. We return the ones that are not used to the blood bank. "It is not logical that the fee of blood transfusion might cost more than the surgery itself. We do not approve of such measures."

Mr al Fayez insisted that the decision would only affect five per cent of Jordanians because 87 per cent are covered by insurance. There are also uninsured citizens who can obtain medical exemptions from the Royal Court, he said. Since Jordanians donate their blood for free, many are furious at the thought of having to pay for units in return. "My cousin and I donated blood for my friend's son," said Firas Mustafa, 27.

"My cousin's blood group is rare and I think the lab should be paying him money," he said as he left a blood bank in eastern Amman. "I don't think I will ever donate my blood again. People are hardly making ends meet. It is as if one is buying his own blood." The fees are most likely to affect those not covered by a health insurance scheme. Most of those without insurance are refugees who are ineligible for public insurance. There are 120,000 Palestinian refugees from Gaza registered by the United Nations Relief and Works Agency (UNRWA) who do not hold a national identity number that recognises them as citizens. Jordan is also home to between 500,000 and 750,000 Iraqi refugees.

Abu Husam, a Palestinian refugee from Gaza whose wife is awaiting an operation to remove a dead foetus, said he was surprised by the decision. "I managed to get an exemption from the UNRWA for the operation," he said. "The hospital asked me to bring two blood units for my wife. If I am donating my blood, why should we pay, this is not acceptable. But I will not let my wife die."