Has private healthcare become too commercialised?

The simple answer, by many, to the question in the headline is yes!

Many are complaining about the high costs, too ready to do procedures or surgeries and expensive treatments.

Is it true?

The real answer is much more complex than one sees.

Without understanding the many actors and players in private healthcare, each has differing objectives or motivations. As such, it would just be grossly inaccurate to place any labels on them.

One must also realise that at the core of private healthcare, patient and public-driven demands are the main drivers that brought us to the state of affairs today.

Let me list out the parties involved, namely the government, private or public corporations, hospital administrations, insurance agencies, third party administrators or managed care organisations, pharmaceutical and medical equipment suppliers, doctors, nurses and critically patients and the public.

The resultant level, availability, accessibility and affordability of services are all dependent on the many factors mentioned, some obvious to the public and some behind the scenes but, nevertheless, as important in terms of influence and impact.

Let’s start with the government. Its role is supposed to be regulatory on private healthcare facilities and services.

However, diagonally, there are also many private hospital chains owned or operated by government-linked corporations that are heavily supported by massive investment funds and have the might and resources to influence and shape private healthcare in the directions they so choose.

Their objectives as in any profit-oriented venture may not necessarily be always in sync with non-profit governmental objectives in serving the widest segment of the public and at times even at odds with certain policies.

Next are hospital administrators whose primary objectives are to run an efficient hospital and again maximise profits.

Many are run by non-doctors who read the ringgit and sen of every project, initiative or investment as ultimately their performance is based on profitability.

Some hospital administrators are headed by doctors but the objectives remain the same for most.

Profitability is achieved by earnings from large companies, corporations or third parties whose staff or customers are patients of the hospitals.

Alternatively, there are cash-paying patients too and frequently this category of patients who have to pay out of their pocket may feel the full brunt of the cost. Buying in bulk allows reduction in cost of medical supplies and medicines, especially for large chain hospitals.

The administrators’ initiatives and decisions, at times, may not always serve the needs of the doctors working in the hospitals or the patients who are being attended to.

Insurance companies, third party administrators or managed care organisations have to operate on profit as any private entity. Decisions to increase customers’ premiums, allow or disallow certain claims, processing time of claims and entitlement, among others, ultimately affect their profitability.

Again their actions or policies may not always meet the needs of the other parties involved, including the hospitals, doctors or patients.

Pharmaceutical and medical equipment suppliers are mostly or almost always privately owned and profit-oriented. Their yearly performance depends significantly on sales volume and profitability and many decisions are based on that ultimate objective.

Sadly, these profit-oriented objectives, the value of their stock or the amount of yearly bonus the chief executive officer or board of directors are entitled to do not always result in maximising benefits for patients, doctors or hospitals.

On the contrary, there were many unintended outcomes and patient access to affordable treatment or drugs severely curtailed.

How about the doctors?

No one can deny that doctors like any working person will need money for their daily needs or financial security. The fees for service concept translate to the more work and patients a doctor does or sees, the more the fees.

The complexity and line between what is earning a living or making more than one needs may be blurred at times, depending on one ‘s perception of how much is enough.

A doctor frequently has to consider the medico legal environment, threats, ethical concerns, governmental regulations, demands placed by the hospitals or patient-driven and a myriad of other factors in their daily work.

The fees which are capped by law, and services rendered, are a result of those complex factors and work done.

And finally the patients themselves!

Patients are not just attending private healthcare facilities, powerless, waiting for every advice and agreeing to every suggestion.

Frequently, patients may have a myriad of needs or demands which can be logical, natural to excessive, unreasonable and sometimes downright dangerous or unwarranted.

The majority of patients have needs that are expected and the majority of doctors are simply serving to their best of ability.

The outliers may sometimes be over represented and unfortunately result in trends and events that are not the most optimal nor desired.

The final level of fees charged and services rendered are a combination of all the above factors contrary to the common patient’s perception that only the doctor equates to the face of private healthcare.

In fact, private healthcare has many faces, bodies and even tails!

I have not mentioned the general practitioners but that will be another piece.

Suffice to say for now, the way forward should be:

  1. The government should not be in the business of healthcare and its role should be strictly confined to regulatory. In other words, the government has no business doing business.
  2. Hospital administrations should only be involved in ensuring smooth running of hospitals with an oversight committee on how profits are generated in an equitable fashion.
  3. Insurance companies, third party organisations or managed care organisations need to have an Act of Parliament in terms of regulations.

Doctors need to balance earnings, ethics, workload, patient safety, needs and a host of other factors to move forward holistically.

The increasing complexity of medical care and technology sometimes makes many lose sight of the need to go back to the basic patient-doctor interaction and rebuild that relationship.

Most importantly, patients need to have in-depth understanding of the complexity of what one is experiencing or seeing in private healthcare and advocate passionately where change is clearly needed.

The core component of receiving appropriate and needed care depends on raising patient education about disease patterns, demystifying false information, rebuilding trust, tackling unrealistic expectations and back to the basics.

In short, the government, private healthcare industries, stakeholders and doctors need to introspect and reflect deeply, so do patients and the public, on how private healthcare can move forward to serve the needs of all.

This is the personal opinion of the writer and does not necessarily represent the views of Twentytwo13.

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