A leading article in a recent issue of Der Spiegel (51/2016), appropriately titled ‘In the sickness factory’, rendered a graphic description of commercialised medicine.
In the words of Der Spiegel, medicine free of commercial pressure is under threat. This raises the worrying question: is this the writing on the wall for our health service?
The article describes in gruesome detail the deterioration in patient care following the privatisation of a major hospital and six clinics in Hamburg some years ago; this was described as a “failure of health policies”.
The standard of the Hamburg hospital had been that of a university clinic. It had, however, become a liability which was costing the State too much, because “it had taken its social responsibility seriously”. The takeover by a commercial company was followed by progressive “ruthless economization” of the private health care delivered by the hospitals, to the detriment of patients.
These hospitals are now managed, Der Spiegel says, as a “sausage factory”, where profit margins override the needs of patients. Sick people in need of hospital treatment are regarded as “revenue sources”, nursing staff as “cost factors” and doctors’ performance assessed in terms of profit rather than efficacy as physicians.
Hospital staff were reduced to a minimum, putting them under pressure. Staff shortages meant that many patients were being denied what they needed most: “A hand to hold as their end approached.” Medicine had become inhuman when dignity matters so much.
Matters came to a head after some ward sisters and nurses wrote a letter out of desperation to the hospital management describing how staff shortages were endangering patients and how “exhausted, overworked and drained” the staff was. They pointed out that they had to deal with sick people, not inanimate objects. Staff were so short that if two or more critically ill patients developed a problem at the same time, it was only possible to deal with one and hope that the second or third patient would be able to cope until they could be attended to.
There is a risk that our health carers will be sucked into a vortex of commercialised medicine
Because of the pressure, patients often had to wait for routine attention – to be medicated, have blood samples taken and so on. “Patients and their relatives weep, confused and disturbed patients fall out of their beds,” Der Spiegel went on to say.
To maximise profit, hospital departments and wards were closed if their financial return had not improved over the preceding years or there were insufficient severe (in other words “lucrative”) cases to make them profitable. They were also closed if the percentage of private patients was too low, resulting in an unprofitable “case-mix index” or if the patients were not as ill as foreseen by the marketing plan – therefore unlikely to assure sufficient financial return.
Departments which dealt with “bread and butter” cases as uncomplicated diabetes, especially those seen as outpatients, were considered incapable of delivering sufficient return and also closed down.
Since medical staff were now judged by their deliverables in terms of money, staff clinical meetings became primarily discussions of income matters rather than complex clinical issues and patient welfare. Debate now dwelt on how departments could earn more, how to lengthen hospital stays and achieve a more productive “case mix” with predominantly severe conditions, how to increase admissions during the summer season and so on.
If, compared to previous years, the income from a particular department was below expectations, the department medical staff were shamed for not meeting their profit target.
The situation in Hamburg bears an uncanny resemblance to what might be expected to take place in Malta. Instead of allocating more priority and funds to our national health service and refurbishing hospitals ourselves, we have handed over three hospitals to a commercial enterprise which will run a good part of our health service on a commercial basis.
This incurs the risk that our health carers will be sucked into a vortex of commercialised medicine. Disadvantaged people, who cannot afford private medical care or health insurance, may well find themselves excluded from the care that they deserve as taxpayers and get treated as second-class patients who may have to beg for treatment elsewhere because they are commercially unprofitable.
Until now Malta has enjoyed a high standard of medicine in spite of the underfunding of our health service and bed shortages.
Against these odds, our skilled health carers have performed wonderfully at every level – as witnessed by the regular letters of gratitude from patients to this and other newspapers.
This commercial company will presumably be autonomous. The report in Der Spiegel raises the worrying question: what guarantees are there that the profit motive of this company will not be to the detriment of hospital staff and patients?
George Debono is a retired doctor with a research background and a special interest in health and environment matters.