Private sector medicine is no Scrooge

Tue, Dec 11, 2012

by Wayne D. Murray MD

The private practitioner is a highly underestimated contributor to the machinery of the health care system. Though many would be quick to characterize the private doctor as a money-grabbing, cash producing machinery, who is always eager to see a full office of sick paying patients, it is far from that scenario, even though, I dare say, some make it look that way.{{more}} The latter feeling has made many fail to appreciate the contribution of these entrepreneurs and thus blinded by the possibilities of their role in our present situation.

In our state, the public health machinery has been established to provide all health care needs for the population. The funding for this is garnered from the tax-paying public. Monies are apportioned in the annual budget to service all expenditure of the health ministry: labour, equipment, medications et cetera. The public health system has a network of district clinics strategically located throughout the state to provide emergency care, regular assessment and management of the needs of the population in the district that it serves.

This system is perfect only in theory, but very much inadequate for a growing population in size and knowledge. The district clinics are generally managed by a staff nurse, nursing assistant and can have a one day a week visit by the district doctor and pharmacist. The doctor has a five-day week schedule, visiting one clinic daily, if multiple clinics are in the district served. Each clinic day is a potpourri of many patients or persons who want to see the doctor. The doctor has limited time with each patient, as there could be more than fifty patients to be seen. Generally, the doctor and his team do the best that they can, but even the most experienced of practitioners would find it impossible to deliver proper care to patients in this scenario. The patient load consists of mainly recycled patients who had not gotten their problem solved the week prior, or simply developed into the routine of “visiting the doctor”. To complicate the scenario, there is always the red herring thrown in, with poor ability to communicate due to the language barrier. Many patients are referred to the emergency unit at times, not because of there being a need to, but that the doctor could not fully evaluate the patient and as a safety mechanism assumes that his colleague at the emergency unit would “catch” what was missed. Many patients have realized that and simply by-pass the district clinics and head directly to the emergency unit. We now have situation where the main and only proper hospital facility has its emergency unit being operated as a clinic, as opposed to a unit addressing specific problems.

The latter illustrates the scenario as it really exists and without any exaggeration. It is true that our public health care system is bursting at its seams due to inability to handle the demands of the population. It is not wrong to believe that funding in this area is too limited. Health care is an expensive commodity and gone are the days where patients appeared at the clinic and hospital and were told “tek dat, the doctor prescribed it for you”, but rather the population expects the best and cutting edge in medical care as it is present anywhere in the world. These are modern times and our health care machinery has to move out of that era, as every patient has a hand held computer researching their problem before they appear to the doctor.

The private sector aspect of medical care provides a perfect “rescue” to the public sector by providing medical care for which the patient pays. This is done with cash or in directly through private insurance. Group insurance is a practical way of financing private insurance through employment institutions like the credit unions and the National Insurance Service. Persons who are not employed could be financed through the public purse, paying for care with a mechanism to ensure accountability. In this system, the patient pays for what they receive and they can use their own choice of physician, as opposed to who is available at the public clinic.

Every time a patient uses a private clinic, it takes a burden off the public machinery. Whenever a surgical procedure is performed privately, it opens up the space for someone in the public sector. The latter is true and must be promoted and endorsed by the policy makers. Private clinics and doctors can take a significant load of responsibility off the public facilities, which are presently bursting at their seams. It is also true to say that generally private physicians take more time with their patients and give service that would encourage that patient to return when needed, thus patient satisfaction scores higher.

The issue here is not that there is no need for the public sector, but that there is a greater role for the private sector. I personally believe that the public sector has to strengthen its role in “public health” and move away from delivering general clinic care. There must be a greater role in communicable diseases like tuberculosis, HIV, preventable vaccinations et cetera and foster private sector management of chronic disease and general health. The public machinery should emphasize more management of the system, as opposed to delivery of the service. To me it would make more sense to set standards and monitor it rather than trying to deliver it. Under our present system, there seems to be no management of quality of care and I question the existence of calculation of a cost to benefit ratio. It would not be unusual to realize that some district clinics are simply places to collect medications. The drive to establish “poly-clinics” is good in theory, but delivery is where judgment tales place. I would recommend incentives for practitioners who go solely into private practice or investors into private hospitals. It is a perfect situation because private facilities employ personnel (nurses, receptionists, cleaners, doctors et cetera) and they provide a service that would have been provided by the public purse.

The machinery of health care delivery cannot be used as an employment agency, but evidence based statistical results must be presented for the monies invested. Better management of resources and service delivery based on satisfaction is the hallmark of private facilities. With our present system, you simply have no choice, because, like most old established systems of public service, it thrives on its status as a “central service” and mass bargaining. The latter serves the employees well, but not the recipient of the service they offer. Our present system of health care is based on the British system, which itself has undergone significant changes.

This is nothing new nor am I trying to re-invent the wheel, but rather highlighting a system that exists in many countries and could be exploited to our advantage. With a growing population and the limit to public delivery of health care, private sector medical service is a practical solution.