Revenue targets, management staff making doctors pawns in corporate hospitals: Study

‘Corporate hospitals have reduced patients to factories’

By DTE Staff
Published: Monday 24 February 2020

The increasing trend of doctors opting for a job with corporate hospitals, instead of starting their own ventures, is changing the paradigm of the profession’s malpractices, a recent paper by the BMJ has said.

The paper has been authored by Shweta Marathe of Pune-based non-profit ‘SATHI’ and researchers at King’s College London.

“Because of targets, (diagnostic) machines require 1,000 patients or investigations per month. So, it definitely involves a lot of unnecessary investigations,” the paper quoted a Maharashtra-based ophthalmologist to show the extent of ‘targets’ being given to doctors working in corporate hospitals.

A doctor who missed targets for two consecutive months, received a verbal or written memo, and a warning that his or her contract could be terminated. “At the time of contract renewal, the commercial value of the doctor is assessed on the revenue they have generated for the hospital,” the paper read.  

The success rate of converting outpatients to inpatients by recommending an unnecessary procedure had become significant for meeting targets in big hospitals.

The authors quoted a doctor as saying that if the inpatient revenue was less than outpatient revenue, doctors were asked, Why is it so? Were you not convincing enough?”

Insurance came into play too. “This situation is compounded by growing use of private insurance to pay for healthcare and attitudes that see this insurance as legitimising irrational provision of care,” the paper said. 

The trend of referrals from single-doctor clinics to other hospitals fetched them a commission had been commonplace in Maharashtra, the authors noted. But now, it was not just about the commission but its scale. The paper quoted a gynaecologist as saying since the bills of corporate hospitals were much bigger the crumbs were bigger too. 

The big hospitals were hiring management graduates to maximise their profits and the doctors lamented that they had no say in front of them.

“Respondents felt these staff prioritised financial concerns over the realities of healthcare — in ways that left one urologist comparing such hospitals to patient ‘factories’. The comment from a retired state health official that ‘doctors are pawns, they are supposed to be the conduit to earn money’, reflects a commonly voiced cynicism about the healthcare industry and its ways of working,” the paper read. 

But hospitals did not always have an upper hand. There were ‘star doctors’ who did not enter into full-time contracts with any single hospital but rather worked with multiple hospitals as they cashed in on their reputation.

“Respondents noted that hospitals will charge higher fees from patients in order to accommodate the increased cost of employing star doctors,” the paper said, adding one such ‘star doctor’ was even made trustee of a hospital so that he did not leave it. 

The ambition to make more and more money was also leading to wastage of resources. The central government had been stressing on increasing MBBS seats and producing more doctors so that their shortage can be mitigated.

However, the paper said that after completing MBBS, they took a master’s degree in business administration, law or hospital management and pursued careers in related industries like pharmaceuticals, health insurance or the medical devices industry to make more money.

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