Public vs Private Healthcare
Healthcare in the public sector is beset with challenges ranging from limited resources, aging equipment, a revolving door of unmotivated staff, and an overall demotivated team. This article is written based on my own experiences in two Caribbean countries. It showcases some key differences between the behaviour of staff in public and private hospitals in the region.
Efficient Delivery
Private hospitals exist for profit and are always searching for a method of competing and reducing operating costs all while increasing profits. Much of the efficiencies sought after come with a continuous analysis of processes. This analysis may be purely derived from the need to ensure the highest levels of certifications are achieved or maintained which attracts patients to their facility.
From my observations in the public sector the need to improve the efficiency is one that is a lot more reactionary. Did someone experience a fall down these stairs? Oh no - let's ensure that patients in our care are not at risk of injury as a result of aging infrastructure. The need to improve efficiencies are never driven by a strive to compete in the sector. Public hospitals exists to only service the needs of the community and usually only worry about reducing costs in the face of budget cuts.
The contrasts in my experience are night and day - any physician operating in both worlds can support this view. A private hospital is a proactive institution while a public hospital is reactionary.
Growth requires Reinvestments
The need to increase efficiencies usually come at some costs. During the analysis phase it might be noted that the introduction of a Pyxis Pharmaceutical Dispenser may save the hospital thousands of dollars over a 5 year period and reduce the need for one on staff pharmacist. For a private hospital this is an easy sell - The Pyxis will be paying for itself easily within a few years of being introduced despite the initial high upfront cost. Private Hospitals are also not shackled to bureaucratic red tape to procure a high valued item; instead, where there is a justified spend - this can easily be approved by a board that values the need for increased operational efficiencies.
In a publicly funded hospital there is a stark difference in the approach:
Who will pay for it? Usually, public hospitals in the Caribbean are poorly funded and rely heavily on private donors to invest in infrastructure - much of what is critical to the care of patients.
Reductions in staffing. If the efficiency increases due to the introduction of a new process- in this case, a machine - then it is not likely to see a change in the staff complement. This is usually despite the fact that the new process can now be done with less. In the majority of cases, it is true that the staffing was never adequate to begin with.
Laser Focused Team
Increasing operational efficiency also leads to the development of staff that are focused on delivering quality at lower costs. This happens in every department of a private hospital, from the billing department to the clinicians and even the kitchen team. The teams are usually laser-focused on trying to keep a check on the costs while ensuring that the billable costs to the patient always result in a profit. Team members are also incentivized to ensure that their abilities to lower costs and increase profits are always rewarded. The inverse is true; underperformers are quickly reprimanded, moved or dismissed in an effort to fail quickly and take corrective actions.
A team in the public sector, based on my observation, does not need to ever focus on identifying a process that can be improved. They must operate in an environment that protects themselves and delivers healthcare with just the resources at hand, leaving a focus on the profit to the finance team upstairs. This mindset from staff results in issues with billing, unrealized costs, abuses in resources and further degradation of the quality of patient care due to unnecessarily high costs. There are a number of factors that lead to this behaviour; the bureaucracy involved in processes, the lack of incentives and a lack of involvement in efficiency management that is needed from all members of the team.
Summary
The delivery of healthcare in the Caribbean between private and public hospitals is wide and varied. The outcomes are unfortunate but can be improved. In a future article, I will look at a few suggestions to tackle the disparity and close the gap in the quality of healthcare facilities.
