1st NU12 Paper – New Attitude:
Thinking PRIVATE in a GOVERNMENT hospital
Pseudonym: thebluetiger
December 13, 2012
MBAH – 10B
Entrepreneurship – Class H04
Submitted to: Prof. Jorge Saguinsin
For decades, the Philippine Government hospitals have been serving the poorest of the poor sector. They have delivered health care services for a minimal fee, if not entirely for free. This has led to the influx of numerous patients daily, especially in tertiary government hospitals like the one I am connected with. Day in and day out, throngs of patients line up to get their much needed medical attention in our out patient and emergency departments.
However, the massive number of patients is markedly disproportionate to the limited resources the hospital has. The annual budget is limited, the hospital income is low, the backlog of collectibles is high and usage of supplies is increasing due to increasing number of patients. This has usually led to out-of-stock supplies which directly affects health service delivery, complaints of poor service, long waiting times, inadequate facilities and the list just goes on.
This makes me compare the hospital with private medical institutions, where they boast of excellent service, world-class standards, and efficient customer/patient relations. Why can't a government hospital be run efficiently like a private one? Why can't we do what they do?
Although the idea is not entirely new and some government hospitals have already undertaken the path towards privatization/ corporatization, there is still much resistance against taking such steps, both externally (patients, law makers, etc.) and internally (hospital management, staff etc.). "We are here to serve the poorest of the poor…" they say, "where will the poor patients go if we privatize and start charging for services?" As John Harvey, contributor in www.forbes.com said "…not everything that is profitable is of social value and not everything of social value is profitable." Currently, most people's mind set is that a government hospital is a social service, that it should provide services for free while relying mostly from government budget and not from income.
That old concept is no longer acceptable. No, we will not charge poor patients for health services. We will charge patients who can pay in their own capacity, maximize and bring in patients who can pay for health services, and use these funds to subsidize for the indigent ones. For not all patients who line up in the out-patient are indigent patients, as evidenced by their newly loaded cell phones which they use while waiting on queue. Not all patients are indigent patients that totally cannot pay for their bill, they can pay 75%, or 50% or even 25%. We need to change our mind set.
A change in mind set in a hospital such as ours is not an easy task to do. For years, the more senior hospital staff have been accustomed to the current set-up and believes it should remain as is. A former suggestion of collecting a minimal fee of Php 20.00 for out-patient services drew violent reactions immediately and never reached the bargaining table.
To implement this change in thinking, the following initial steps are suggested:
1. Scout for hospital staff who share and believe in the new paradigm, to be part of a core team. Staff both from the upper management and rank and file are important.
2. Create a presentation addressed to hospital staff why there is a need to change. Stress the fact that charging fees will not deprive patients of health services but on the contrary, will be the means by which better and more efficient health services to them will be rendered.
3. Discuss this presentation to various sections and departments, concurrently asking for their take and suggestions regarding the matter. Give them a sense of "ownership" for their ideas to be implemented in their respective areas.
4. Summarize the recommendations and submit to the Medical Director for approval.
Getting the "new" mind set accepted is one thing, rolling out processes to back up this new thinking is another. Once the staff have embraced the need to change in the manner of thinking, they are expected to be more cooperative in subsequent activities; e.g. workshops on quality improvement, implementation of a hospital information system, computing and designing updated hospital fees and charges, increase in the number of private beds, improvement in facilities, cost-cutting measures, increased collection efficiency measures, increase in philhealth claims and creating business plans per area/ department.
Rolling out these improvements will definitely have a positive effect on the staff's attitude towards work, which will translate into better patient care, which will bring in more private patients to the hospital, which will enable the hospital to provide better health care to more indigent patients. It's expected to be a positive feedback cycle which will lead to continuous quality improvement. 4
TDG
MEDICAL SPECIALIST III
TRAINING AND RESEARCH OFFICE
JOSE R. REYES MEMORIAL MEDICAL CENTER
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