Commodification of healthcare
The entry of big business and tax accounting into healthcare
has become very significant for many reasons.
One, patients have become customers. And that carries the
slogan “the customer is always right,” an absolutely weird and completely
erroneous phrase that many customers seem to rally around. What if the customer
does not want to pay? And in the realm of healthcare, what if the customer is wrong?
Fueled by the vast amount of misinformation in the world wide web, how do you
handle a patient-customer who refuses a therapy, like vaccination for example,
because some porn star claims that particular therapy damaged her child (she’s
since been disproven).
Two, the end-goal has moved from cure to profit. Not too long
ago, ordering lab workups were based primarily on indication and what was
needed in the care of the sick. But with the advent of defensive medicine
(welcome ambulance chasing lawyers) and big business into healthcare,
physicians are now more trigger-happy with labs than ever. Say you present at
the hospital with a Complete Blood Count (CBC) done in another institution. Doctors
can question the reliability of labs done outside, and order another CBC. Especially
if the hospital is keeping score on how many labs you’re ordering (some really
do).
Three, physicians have become entrepreneurs. With the entry
of big business into healthcare, starting a practice is no different from
putting up a business, with its attendant capex and opex computations, ebitda
and amortizations. In Metro Manila most especially, the typical clinic in the
major hospitals will set you back at least 3-4M, and that’s not counting
renovation expenses. There’s CUSA (common use services area), staff costs
(secretaries and stuff), utilities (water, electricity and communication), etc.
And with the taxman breathing down the physician’s neck, there’s a lot of
accounting happening now. Who’s going to foot the bill?
It has gotten so bad, some physicians in the major private
hospitals have resorted to bribery. Commonly, it’s the person in the concierge
or the info booth, who tend to direct walk-in foot traffic towards certain
doctors. Alternatively, some doctors get secretaries who are related to the
info girl instead. There’s this story about a general surgeon who saw his
patient in the floors one afternoon. The patient called him out and asked,
“Doc, andito pala kayo? Nagpa-opera na ako sa ibang doctor. Sabi kasi ng tao sa
info, out of the country daw kayo.” Classic.
