Healthcare Issues - Organization Structure
While competition is well and good, it also promotes “non-corporation”
While competitiveness may be good for the development of a new commercial product, we are here talking about “Health of the Individual”. Do we really want “profits” to be the determinate of health care?
Competition "should be" based on creating the "Best Healthcare for the Population".
While competition may create the best hospital…it does not mean that
the hospital will promulgate those best practices to others. The assumption is
that everyone will compete in producing the “best solutions" creates an environment where no one wants to share
information...and what may happen is that one organization produces the “best
practices” and runs all others out of business...thus creating a monopoly!
Completion creates more choices when the organizations are similar in size and resources, but this is generally not the case. Hospitals varies in size and resources and the "little guy" doesn't have a chance. The one way he can compete is by reducing price and to do that he must reduce services and the quality of those services.
This is definitely happening now in trying to get healthcare professionals to share individual patient data.... "I am not going to give my data to anyone" is a very common attitude. It has nothing to do with "privacy rights".
Also a "Profit" based system is all about making money! A business does not have to be the "best" in order to make money. Many business finds niches for themselves that is far from producing the best care and still make money.
“Competition leads to a decline in information-sharing and technical assistance between public health agencies with negative consequences for disease surveillance and training opportunities for lower-level staff. The need to generate revenues leads to an under provision (surveillance, health education, preventive services) of public goods and a bias toward high-revenue services such as fee-based health inspections; reduced efficiency by causing duplicate inspections from public health agencies at different levels—each of them motivated by the need to generate revenues—and a general overprovision of inspections; and have negative equity effects because of agencies’ tendency to focus on profitable enterprises rather than carrying out inspections across the board. The most significant finding is a fall in the provision of public preventive services that cannot be charged” (Khaleghian and Gupta, 2004)
All branches of science are grappling with commercialization and its effects
on discovery, academic discourse, and publication. While there are many pros in
the commercialization of Healthcare, InHCc believes that the Commercialization
should be limited to promoting health...not selling a "little green pill."
The most prevalent “business strategy” in healthcare is the use of “advance technology ”. It is the consumer that drives the demand for newer technology and the healthcare organization complies with this demand. It is the “billboards” that advertise this new technology. It is the physician that promotes the technology….even if it is no better than what already exists...and we know that it costs a lot more money!
Large Healthcare organizations control their markets by making it extremely costly for new competition to enter. This race for “the best technology (even if it has not been proven to be more beneficial) is driving up cost of care.
Payers – public or private health plans, employers, and governments – often incentivize poor quality care because they are unable to get
anymore information from the providers...
Since there is very little good "Quality of Care" data, the payers pay whatever is sent into their office...therefore "volume" becomes an incentive for the provider.
Until now the Health Care System has been separated, grouped, or classified into various "types of health care"; for example: nutrition, material and child health, or family planning. Health care must be viewed as a whole. Unless an integrated approach is taken, unless relationships are understood then effective solutions are not going to be able to implemented.
The recent trend in decentralization has put a great burden on Health Care Systems. While the decentralization process has taken place (to some extend), the training of managers has not taken place. While, at least, before decentralization, there were people trained to "do things"...today, with each change of administration a new group of new individuals come into the system with no professional knowledge.
Many developing countries are responsible for the
comprehensive health care of their citizens. These countries have very few private health organizations
and therefore must rely on their own resources and those of donor organizations to care for those in need.
Because of this, developing countries and also countries with "Socialized Medicine" can be viewed and analyzed as a "Integrated Delivery System (IDS)" and/or "Managed Care." These systems of health care must provide a continuum of health care across time and locations.
To manage these systems requires a very comprehensive integrated information system. Health Care expenditures are also generally not driven by market forces but rather by the individual agendas of politicians and donor countries.
The theory held by most international donor organizations is that since many governments were so corrupt or inefficient (probably correct) that the best way to help individuals was to give the money to Non-Governmental Organizations (NGO's) and let them do the work thus be-passing government bureaucracy completely.
Impact on Healthcare
- Supply (funds) driven
- Priorities not set by organization
- Accounting procedures set by Donor
- Politically driven
One often hears "we only do it because that is what the donor wants." In many cases,
the organization does not even fully understand why the donors require such processes.
Separation of “Project” from the overall operation of the “Organization” makes it extremely difficult to create team spirit and to do things for "the good of the organization."
For example – Each project manager wants to run his or her own project as his own even at the determent of the organization as a whole.
Funding may be predicated on the party in political power. Example Organization hiring political "correct" personnel only to find that at the next "election," these people are a liability.
Organization intrigue and turf wars are bane of any organization. Especially where organizations are project driven (funded projects), the director and his staff usually think of any asset not as a corporate strategic asset but rather as a personal one. It is the haves against the have-nots. The researchers that "have" engage in “Empire building.”
When it was found that there were three doctors and 3 nurses sitting at the table in a study ward doing nothing and having no patients, it was said to me they were doing that because they had no “subjects.” When asked why they couldn’t go somewhere else to work and help out it was then said that “they are being paid by that research grant and should not be assigned somewhere else.”
NGOs may be as much a “for profit” organization as any other. While it is
true that the organization cannot distribute profits, there is nothing that
prevents it from "increasing the salaries of the owners"...or of "paying" to
subsidiaries the profit through increase charges.
Where donations are made to them based on a "budget", most NGOs lack a clear incentive to save money (operate more efficiently). Projects are generally rigidly budgeted (by the donor organization) that leaves little incentive for the NGO to operate more effectively or efficiently processes and if they do not spend all the money given to them...then they may not get it the next time!
In many cases, if NGO's cannot get the money that they need to run their organization, they start cutting services. This often lead to poor services and a further decline in "sales".
It is believed by InHCc that if NGO's had greater flexibility in managing their projects, with the possibility of making a profit, more NGO's would be attached into the service area and efficiencies would increase.
Issues may be the following: By creating "separate" NGO's it may be possible to raise more money because people would rather give to an organization that they relate... however, mergers of NGO's may enable the NGO to operate more efficiently
In every case of "any project" data is needed to prove to the donors that they "need the money" or they need to change to budget, or how well they are doing.
Donors have their own agenda. All donor organizations have (or should) Global
objectives...although these objectives may not be very clear to the recipient organization.
Donor organizations often fail to initiate their projects as an integrated, coherent whole with the national health system program. This has led to duplication (Guatemala at one time had over 200 programs all doing what seem to be the same thing) and a complete waste of resources.
Not only has it not provided for "overall" better care, in most cases, it has hindered national health systems from development.