Myrton Smith | Docs not to blame
The Gleaner byline on Wednesday, November 2, 2016 titled 'Docs bleed the State' is misleading and erroneous in its implication. The statements made in the article suggest a lack of knowledge and/or understanding of the Government's private practice guidelines.
Under the current guidelines, certain categories of medical doctors, namely consultants, are allowed to admit private patients in the public health facilities for medical or surgical care. In these instances, the consultant MUST indicate to the registration staff that the patient is private. Alternatively, if a patient goes on his/her own volition to seek care at a public health facility, he/she can indicate to the nursing or administrative staff his/her desire to be treated privately. Even after patients are admitted as public patients, they may indicate at any time that they wish to become a private patient. The patient indicates his/her physician of choice or the consultant on call is contacted to determine whether they will accept the patient for private care.
No doctor should initiate the transfer of a public patient to private care. In any case, the patient is registered as a private patient of the hospital with the chart or the front sheet clearly labelled as 'PRIVATE' for all to see.
At the end of their stay (or at intervals during a long stay), the hospital's billing officers will present a bill to the patient for the use of the hospital facilities which includes room and board, drugs and miscellaneous disposable items, payment for private nursing care, and use of theatre (if required). The doctor is NOT responsible for paying the hospital. It is the responsibility of the hospital to collect from the patient in this arrangement.
The Government and its agents recognised the need to put measures in place to prevent abuse of the system, and so several strategies are employed. At the University Hospital of the West Indies (UHWI), for example, a completely separate facility (the Tony Thwaites' Wing) was established as the place to admit private patients. The guidelines also limit the proportion of time that can be allocated to private patients versus public patients. For example, for surgical cases, for every three public patients that are operated on, each consultant may operate on one private patient.
Another mechanism is to construct a separate operating theatre with separate staff dedicated to private patients, such as has occurred at the UHWI. At other hospitals, private surgical procedures are done outside of normal working hours, such as evenings and weekends. These measures minimise the competition between public and private patients for services and resources.
MONITORING THE PROCESS
The system also has built-in measures to monitor the practice. The hospital CEOs, senior medical officers and parish managers have a duty to monitor the system and to ensure that all doctors and other members of staff are aware of the guidelines through internal memos and other methods. The institutions also have a patient complaint mechanism to allow patients or their relatives to highlight suspected breaches.
Where hospital administrators obtain allegations of breaches by doctors, they are usually investigated and action taken. This includes holding disciplinary hearings and imposing sanctions in keeping with the Public Sector Staff Orders.
The tone of the comments captured in the article would give the impression that private practice in public hospitals is bad for the public health system. In fact, this is a practice that is maintained right across the world because it offers several benefits.
1. In a system such as ours where the health sector is woefully underfunded, the fees collected from private patients can significantly offset the cost associated with treating public patients, including those who cannot pay. This has even greater potential impact in an environment where there are no user fees. The additional income helps to purchase much-needed equipment and supplies.
2. The policy allows ANY patient to have the opportunity to choose private care if they so desire.
3. The policy allows patients to be able to choose which physician will treat them, giving those patients greater comfort and peace of mind.
4. Allowing specialist medical practitioners to engage in private practice has been used as an important recruitment tool to ensure that the public health system attracts and retains the services of a highly skilled medical workforce. This is practised not only in Jamaica and other Commonwealth countries, but all over the world.
In reality, the practice with its potential benefits has been hampered by several limitations. These include the state of disrepair of the public facilities. The backlog in certain laboratory services affects private patients in the public hospitals as well. Many facilities are impacted by the reduced availability of drugs and other sundries to be used on private patients. These factors will always impact on private care because in the public ealth facilities, the priority remains the treatment of public patients. Many private patients, therefore, opt to go to private health-care facilities.
It is difficult to see how doctors could be blamed for bleeding the State, the implication being that the private practice of doctors is responsible for the diminished resources within these facilities. The practice is designed to benefit the public sector, not hurt it.
- Myrton Smith is consultant ENT and head and neck surgeon, associate lecturer, and former president of the Medical Association of Jamaica. Email feedback to firstname.lastname@example.org and email@example.com.