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The Health | january-February , 2021
| Column |
The primary role of government in healthcare is ensuring safe housing , clear drinking water , proper sanitation and a reliable food supply chain to ensure nutritious food . The provision of electricity does make things easier to ensure all the above . This is usually a national initiative on a national level as it cannot usually be provided by non-government entities .
Provision of free childhood vaccines is also an important component . While most childhood diseases are not lethal in an otherwise healthy child , significant family distress can ensue due to hospitalization , infection of smaller children , disruption to child ’ s education and parent ’ s job . So , a quick and safe jab for the eligible child can go a long way in maintaining family peace and equilibrium ! This would come under public health initiatives of local governments .
Next would be the provision of clinical health to the public , which is the topic of this essay . In Malaysia , we have a variety of hospital structures . We have the wholly-government funded Ministry of Health ( MoH ) hospitals and we also have the “ subsidised ” hospitals such as the university hospitals . We also have wholly private hospitals .
The main difference that is pertinent to patients is the “ waiting time ” and “ seniority ” of the attending doctor .
In most private hospitals , one can straight away see a specialist within a short time so long as one knows which sub-specialty services one requires . On the other hand , if one is not sure , one could see an experienced General Practitioner who will write a referral letter to the appropriate specialist .
In a government hospital on the other hand , one has to typically wait for longer periods and will likely be seen by trainee general practitioners or trainee specialists first before being referred to a more senior person . So , to many , this ‘ time ” and “ seniority ” advantage of a private hospital cannot be disputed .
A conflict of interest ?
In terms of infrastructure , both government and private hospitals may have the best and latest equipment at varying times . For example , if the CT scanner in a government district hospital were to irreparably break down , that district hospital would then likely get the latest CT scanner on the market as replacement !
The difference is probably that private hospitals would buy an extra CT scanner if the patient load demands it and it is profitable to do so , thus cutting waiting time . Here , the issue of “ time ” is linked to infrastructure . And very often , private hospitals provide this advantage .
Do private hospitals “ poach ” staff from government hospitals ? Not really . Many , if not most senior doctors , after a while , prefer to run their own clinical practice according to their own standards .
A “ group ” practice like in government hospitals are forced to adhere to “ common standards ”. In clinical practice , so long as the “ standards ” being used are equal to or exceed those regarded as “ best practices ”, doctors should be free to run their practices as they see fit .
Will doctors going into private practice “ deplete ” government hospitals and disrupt training programmes and patient care ? Yes , to some extent . However , this should be addressed by increasing doctors ’ salary and improving working conditions
Should govt be in private healthcare ?
The debate on the pros and cons of government involvement in private hospitals continues
Bare Facts
BY DR MANIMALAR SELVI NAICKER in government hospitals .
So , should governments run private hospitals ? The answer to that would be , why not ? So , long as the physical infrastructure and staff are entirely separate , this would pose no problems .
In fact , income from a private hospital could be used to subsidise the free government hospital and increase the salary of government doctors to prevent them from leaving .
This would also keep general taxes low . To the individual doctor , it would not make much difference whether the “ owner ” of the hospital is the government or a private corporation as the terms of appointment would likely be similar . It would not matter to patients either as the standard of care would be the same .
Regulating ethical lapses
The real problem occurs when government hospitals have “ private wings ”. These are areas within an existing government hospital “ reserved / blocked-off ” for paying patients .
Here , a lot of undesirable activities can take place . Senior doctors might “ disappear ” too often leaving their nonpaying government patients to be taken care of by trainees and junior doctors while they attend to their paying private patients , thus depriving non-paying patients of their expertise .
Infrastructure like CT scanners which can be used for longer periods on nonpaying government patients will now have slots “ reserved / blocked-off ” for paying private patients , thus depriving non-paying patients of their use . The “ disappearing ” senior doctors will also cause congestion in the non-paying government clinics as fewer and more junior doctors are forced to handle the same number of patients . Patient care standards will also likely deteriorate . These ethical lapses will be very difficult for the hospital management to regulate since they will have to stand up to their own doctors and colleagues . Something hospital managements are often reluctant to do as these are friendships and relationships built over a long period of time .
It is seen as “ disturbing ” the rice-bowl of their colleagues and may be regarded as an “ unfriendly ” act .
Hence , while the government operating a private hospital as a separate physical entity with a separate set of staff poses no moral , ethical or logistical problems , operating a “ private wing ” within a government hospital can pose significant problems .
However , my essay does not address the larger question of “ Should governments go into private industry of any sort ?” or “ Should government be in direct competition with its citizens in the business arena ?”
The answer to these questions I leave to my learned colleagues who have specialized in the field of economics and finance . — The Health
Dr Manimalar is Consultant Histopathologist & Statistician ( Gstat ).