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| For many Filipinos, a serious medical emergency can lead to personal bankruptcy.
Should Philippine hospitals run like businesses?
The buzz may have started when a big investor started
acquiring a string of Philippine hospitals in what appeared like a shopping
spree that ultimately leads to a potential monopoly of hospital services in the
country.
Other big competitors also followed a similar strategy –
that of acquiring various hospitals, including provincial hospitals, for future
expansion.
It is not clear when or how this practice may have
originated but there are informal discussions that
some hospitals now operate like profit-oriented businesses where doctors are required to turn
in a certain number of hospital admissions in order to remain active
consultants. There is also a reward
system for those who reach the hospital quota.
In one social media conversation, a Filipino doctor from a leading hospital in the Philippines clarified that he thinks it is still the ongoing
practice to have a minimum number of admissions/patient encounters in order to
maintain an active consultant status – but his hospital was the first to undo the practice around three to four years ago. According to him, the yearly incentives that
included European, American or Asian tours, for top performing doctors were replaced
by an annual raffle that includes a car as a prize.
The above minimum patient admissions requirement and doctor sales incentive was fact checked with the medical
director of another tertiary hospital.
Although he requested anonymity, he agreed to have his response
published: “Your supposition is correct
but these are for hospitals not requiring any financial investment from the
doctor. A trip might be an act of
appreciation for the doctor’s continued patronage of the hospital, since the
hospitals are competitive against each other and the doctors are free to choose
where to admit their patients.”
Hospital administrators would also defend this sales strategy as
a means to ensure the establishment’s survival.
This logic is understandable, if such profiteering is not pursued at the
expense of patients, and that is usually where the problem lies. It is hard to find lasting equilibrium.
Since the Hippocrates Oath that doctors swore to uphold suggests that the practice of
medicine is more a vocation to heal than a profit center, the above “hospital
sales quota” appears to conflict with the patient’s needs and interests, as the
natural tendency is to sell or promote the use of hospital facilities,
especially if other potential rewards are attached to it.
For the ordinary patient, the reality leaves many
questions.
An example of profit
orientation
A Manila Times columnist Fred Rosario once wrote about his
hospital ordeal:
“The hospital had been holding my son’s body for almost
three days in stark violation of the law, Republic Act No. 9439, which states
that no hospital or medical clinic can detain a patient on grounds of
non-payment of hospital bills and medical expenses.
Given its hostile behavior, I believed that the hospital
couldn’t care less to let my son’s body rot in its freezer unless I succumbed
to its oppressive terms relative to the settlement of a net bill amounting to
P1.9 million.”
Age-old academic and
ethical question
Actually, this idea of operating hospitals like businesses
is not a new one. It is both an academic
and ethical question that has been dissected and analyzed around the
world.
Even in other countries, certain governments have tried to privatize hospital operations. Here is an example of one that did not succeed: http://www.bbc.com/news/business-30742845
“As we have once again been reminded by the collapse of
Circle’s contract to run Hinchingbrooke hospital, businesses fail at public
service delivery not because they are intrinsically evil; they fail because
they are fundamentally unfit to do the job.”
Hospitals as social business
Muhammad Yunus, who introduced a framework for social
business, believes that shareholders keeping profits and pursuing social
purpose don’t mix:
“I am not opposed to making profit. Even social businesses
are allowed to make profit with the condition that profit stays with the
company; the owners will not take profit beyond the amount equivalent to
investment. Social business is a new category of business….
When you mix profit and social benefit it gets complicated
for the CEO. His thinking process gets clouded. He does not see clearly. More
often this CEO will take decision in favour of profit, and exaggerate the
social benefit. Owners will go along with it. Social business gives a clear
unambiguous mandate to the management. There is no balancing act involved.”
Hospitals not like
Google
On the other hand, many articles have been written by health
care experts on this idea of running hospitals as businesses. John Hopkins Medicine International has
weighed in on the question, “Should hospitals act like other businesses?”
“Should they be aggressively marketing their services, and
trying to find ways to raise their profit margins to fund improvements and the
acquisition of new technology? Aren’t these sorts of pure business behaviors
and goals at odds with the mission of trying to improve patients’ and
communities’ health and saving lives?
I think the answer is: No, hospitals shouldn’t be exactly
like other businesses. But they can be almost like other businesses in most
ways, and can do an even better job in fulfilling their health-related mission
as a result of it. Indeed, not running a hospital like a business invites a
whole new set of potentially serious negative implications for patients.”
The article continues,
“OK, so what’s the problem? Why can’t a private hospital
just operate like any business might and try to enlist marketing to squeeze as
much revenue as possible out of customers? Well, that approach can work pretty
well if you’re Google or General Motors, and your sole goal is to maximize
profits. But health care is not an unbridled business; it has heart in it; it
is a community trust. Society wouldn’t want much to do with a health care
provider that placed high financial margins ahead of doing a good job with its
mission of saving lives and relieving suffering.
The fact that there’s a good-of-society element to health
care prevents private hospitals from being purely commercial sorts of ventures.
To put it another way, private health care organizations face a tension between
mission and sustainability.”
Other issues with the
pharmaceutical industry
Furthermore, the relationship between doctors and the
pharmaceutical industry in general has also been widely reported. Famous American OB-GYN Dr. Christiane
Northrup writes, “The current situation with the pharmaceutical industry can be
likened to the influence of the tobacco industry on the medical profession back
in the ‘40s and ‘50s when doctors and the AMA espoused the “benefits” of
smoking to their patients and were paid handsomely by big tobacco. Eventually the truth won. And it will again.”
Another Filipino doctor commented on social media about this
“connivance” (term he used) saying that there is no denial about the connection between
doctors and the pharmaceutical industry as it is very much in the newspapers
here and abroad. However, he continues
that the relationship has both positive and negative outcomes for the patient
and that doctors are trying to establish a balance.
Do you think
Philippine hospitals should be run like profit-oriented businesses? The future lies in the hands of concerned Filipinos
who will take the time to think through these questions.
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Thursday, August 6, 2015
Should Philippine hospitals run like businesses?
