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This page created April 2000 by Michael Wynne
Share market listed corpoations have held
managers accountable for profit and not care. External bodies
responsible to citizens for ensuring that corporations were
accountable have failed to do so.
The story of medicine in the marketplace is
the story of the failure to hold managers responsible for anything
other than profits. This has been the only thing measured. This has
extended across the whole spectrum of the for profit US health care
system.
Tenet/NME devised the concept of plan based on measures which impacted on the bottom line. It specified the number of admissions, duration of stay, payer mix, and profits per patient day. Plans for each service were made centrally. bonuses and career were both dependant on "meeting plan". The care provided to patients was never measured. Quality Assurance Committees never met. I received a long lecture about the latest in Quality Assurance from a Tenet/NME administrator.
Care in these hospitals was monitored by
insurers, accreditation bodies, and state oversight processes. It was
parents who objected to the kidnapping of family members, followed by
patients and staff who spoke out about what was happening to care.
Two Senators were persuaded and a dreadful situation was exposed.
In spite of many articles in the press after the specialty hospital scandal and claims that patient care issues were to be part of the monitoring and incentive system Columbia/HCA behaved very like Tenet/NME. It used a system of financial report cards to monitor and reward its staff. They were not held accountable for care. Bonuses were based on the card and those who did badly were personally interviewed and reprimanded by Richard Scott.
Columbia/HCA did well in its accreditation
and its hospitals were accepted by state regulators. Substandard
performance when compared with not for profit hospitals was
identified by an independent investigator, not the oversight bodies.
It was whistle blowers, the New York Times and critics like Robert
Kuttner writing in the New England Journal of medicine in August 1996
who exposed what was happening. It was not the state and federal
regulators. At no stage had Columbia/HCA been held accountable for
its disturbing business practices by any formally constituted body.
It is quite clear that in aged care
management took no interest and accepted no responsibility for what
was happening in the nursing homes. Decisions made by management
seriously compromised care and many allege that this was deliberate.
Numerous complaints were made by relatives to state authorities. Many
of these were not investigated and even when serious deficiencies
were identified little was done about it. When fines were imposed
they were not enforced.
While there is a great deal of rhetoric about accountability in the health care marketplace this is all it is. This deception is facilitated by the use of words like "quality" rather than "standards".
Profit discourages accountability and the pressures of the market do not support the process. There is more form than substance. In practice formal accountability processes provide no assurances that people will not be misused or short changed in the care they receive. The USA has the most costly and sophisticated accreditation and oversight programs in the world. None of them held health care corporations accountable for their actions.
CLICK HERE -- for more information about the word "quality" and its relationship to accountability.