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.

The repercussions to healthcare is massive. Referrals to other physicians are based on how that other physician will affect my practice, instead of how much better it can impact patient care. Choosing prescription medicines too. And doctors are dispensing medicines, test kits, and any other value-added service, if it would mean an extra peso in sales. The paradigm is shifting, from patient care above all, to patient care in the background of improving the bottomline.