Are private patients in public hospitals a problem?


File 20170629 16083 1jl1bey
A new report has claimed public patients are worse off with increased numbers of private patients in public hospitals.
from http://www.shutterstock.com.au

Peter Sivey, RMIT University and Terence Cheng, University of Adelaide

Recently, hospital and aged care provider Catholic Health Australia (CHA) released a report sounding an alarm bell at recent increases in the number of patients in public hospitals being urged to “go private”.

Public hospitals may encourage their patients to “go private” because it allows them to bill the patient’s health insurance and Medicare for costs incurred, rather than having to dip into their own limited budgets. Patients may be persuaded to use their private health insurance after being assured by the public hospital of no out-of-pocket costs, or being promised added extras such as a private room.

The report argued this trend may harm the private hospital sector by affecting profitability and investment decisions. It may also harm the interests of public patients if public hospitals discriminate in favour of treating private patients.

While aspects of these concerns may be valid, there may also be some benefits to public hospitals treating more private patients.

A look at the figures

The report is correct that the numbers of private patients in public hospitals are increasing, at an average of 10.5% per year since 2011-12. Public patients in public hospitals and private patients in private hospitals have also been increasing, but at slower rates of only 2.7% and 4.5% per year respectively since 2011-12.

But percentage rates of change can be misleading. In raw numbers, the increase in public patients in public hospitals (527,467) and private patients in private hospitals (576,135) has actually outstripped the raw increase in private patients in public hospitals (287,473). This is because public patient numbers are increasing from a much larger base (over five million) than private patients in public hospitals (less than one million).

Concerns with this trend

The CHA report notes several concerns with the trend of increasing private patients in public hospitals. They note anecdotal evidence of public patients being pressured to “go private” with incentives including drinks vouchers, better food options and free parking. While these reports may seem concerning, it’s hard to base any change of policy on anecdotal reports.

More worrying is the suggestion that publicly-admitted patients in public hospitals are being discriminated against, for example by being made to wait longer for treatment. The CHA report cites data from an Australian Institute of Health and Welfare report, which shows waiting times on public hospital waiting lists for public patients (at 42 days) was more than twice that of private patients in public hospitals (20 days).

But this difference is hard to interpret. There may be many differences in diagnosis and disease severity between public and private patients, which may explain the waiting time gap. So we can’t conclude this is evidence of any form of “discrimination” against patients without private health insurance in the public hospital system from these figures.

More robust evidence from public hospitals in NSW in 2004-05 does show private patients were prioritised over public patients. In this study, waiting times for elective surgery were found to be considerably shorter for private patients, despite having similar clinical needs as public patients.

Differences in waiting times between public and private patients were found to be largest for patients assigned to the lowest two urgency levels. In these cases, waiting times for public patients were more than twice as long as for private patients.

There is further evidence, also from NSW public hospitals, that public and private patients may be treated differently when they are assigned to an urgency category for waiting lists for elective surgery. The study suggested private patients were more likely to be assigned into more urgent admission categories, which corresponds with a shorter maximum wait for admission into hospital.

This study also found private patients were likely to receive more medical procedures while in hospital, but found no difference for length of hospital stay or, importantly, for mortality rates.

Potential benefits

One claim of the CHA report is that there has been relatively “stagnant” growth of activity of private patients in private hospitals, potentially affecting their profitability and investment decisions.

First, the figures don’t seem to back this up. The increase in numbers of private patients in private hospitals is actually higher than the increase in numbers of private patients in public hospitals.

Second, even if private hospitals were losing business to public hospitals, it could be a welcome demonstration of competition in the health care market. The trend may be explained through public hospitals providing better amenities, higher quality, or lower costs than private hospitals.

There are some arguments to support continuing the practice of public hospitals admitting private patients. There can be efficiency gains to the health system given that the fees and charges for private patients in public hospitals are usually lower than those in private hospitals. So this form of competition could lower the costs in the health system as a whole.

Additional revenue raised by public hospitals could also support the continual provision of services and programs for public patients, which may have been curtailed due to budget cuts to the public hospital system.

The public hospital system is often seen as unfairly treated by the private sector in how it bears costs for training junior doctors (which takes place overwhelmingly in the public system), and treating the most severely ill patients. From this perspective, it seems only fair to allow public hospitals to take their “share” of the more profitable private patients.

Why we need better data

It’s important to figure out whether private patients are receiving preferential treatment at the expense of public patients. One study found abolishing preferential access for private patients and admitting patients according to when they were listed for an elective procedure would only lead to a small improvement in waiting times for public patients.

This is because long waiting times for public patients are primarily due to budget constraints in public hospitals, and not because private patients are skipping the queue.

The available robust evidence on the treatment of private patients in public hospitals is from more than a decade ago, and it’s unclear if the disparities between how public and private patients are treated have improved or worsened.

The ConversationOne reason for the lack of high quality research on this topic is the restriction on access to detailed hospital data in Australia, which we need for robust studies. If we had access to more detailed data, we could better understand what’s happening now, and ensure timely access to high quality hospital care for both public and private patients.

Peter Sivey, Associate Professor, School of Economics, Finance and Marketing, RMIT University and Terence Cheng, Senior Lecturer, School of Economics, University of Adelaide

This article was originally published on The Conversation. Read the original article.

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Motive for Aid Worker Killings in Afghanistan Still Uncertain


Taliban takes responsibility, but medical organization unsure of killers’ identity.

ISTANBUL, August 12 (CDN) — The killing of a team of eye medics, including eight Christian aid workers, in a remote area of Afghanistan last week was likely the work of opportunistic gunmen whose motives are not yet clear, the head of the medical organization said today.

On Friday (Aug. 6), 10 medical workers were found shot dead next to their bullet-ridden Land Rovers. The team of two Afghan helpers and eight Christian foreigners worked for the International Assistance Mission (IAM). They were on their way back to Kabul after having provided medical care to Afghans in one of the country’s remotest areas.

Afghan authorities have not been conclusive about who is responsible for the deaths nor the motivation behind the killings. In initial statements last week the commissioner of Badakhshan, where the killings took place, said it was an act of robbers. In the following days, the Taliban took responsibility for the deaths.

The Associated Press reported that a Taliban spokesman said they had killed them because they were spies and “preaching Christianity.” Another Taliban statement claimed that they were carrying Dari-language Bibles, according to the news agency. Initially the attack was reported as a robbery, which IAM Executive Director Dirk Frans said was not true.

“There are all these conflicting reports, and basically our conclusion is that none of them are true,” Frans told Compass. “This was an opportunistic attack where fighters had been displaced from a neighboring district, and they just happened to know about the team. I think this was an opportunistic chance for them to get some attention.”

A new wave of tribal insurgents seeking territory, mineral wealth and smuggling routes has arisen that, taken together, far outnumber Taliban rebels, according to recent U.S. intelligence reports.

Frans added that he is expecting more clarity as authorities continue their investigations.

He has denied the allegation that the members of their medical team were proselytizing.

“IAM is a Christian organization – we have never hidden this,” Frans told journalists in Kabul on Monday (Aug. 9). “Indeed, we are registered as such with the Afghan government. Our faith motivates and inspires us – but we do not proselytize. We abide by the laws of Afghanistan.”

IAM has been registered as a non-profit Christian organization in Afghanistan since 1966.

Dr. Abdullah Abdullah, a former political candidate, dismissed the Taliban’s claims that team members were proselytizing or spying, according to the BBC.

“These were dedicated people,” Abdullah said according to the BBC report. “Tom Little used to work in Afghanistan with his heart – he dedicated half of his life to service the people of Afghanistan.”

Abdullah had trained as an eye surgeon under Tom Little, 62, an optometrist who led the team that was killed last week. Little and his family had lived in Afghanistan for more than 30 years with IAM providing eye care.

IAM has provided eye care and medical help in Afghanistan since 1966. In the last 44 years, Frans estimates they have provided eye care to more than 5 million Afghans.

Frans said he doesn’t think that Christian aid workers are particularly targeted, since every day there are many Afghan casualties, and the insurgents themselves realize they need the relief efforts.

“We feel that large parts of the population are very much in favor of what we do,” he said. “The people I met were shocked [by the murders]; they knew the members of the eye care team, and they were shocked that selfless individuals who are going out of their way to actually help the Afghan people … they are devastated.”

The team had set up a temporary medical and eye-treatment camp in the area of Nuristan for two and a half weeks, despite heavy rains and flooding affecting the area that borders with Pakistan.

Nuristan communities had invited the IAM medical team. Afghans of the area travelled from the surrounding areas to receive treatment in the pouring rain, said Little’s wife in a CNN interview earlier this week, as she recalled a conversation with her husband days before he was shot.

Little called his wife twice a day and told her that even though it was pouring “sheets of rain,” hundreds of drenched people were gathering from the surrounding areas desperate to get medical treatment.

 

The Long Path Home

The team left Nuristan following a difficult path north into Badakhshan that was considered safer than others for reaching Kabul. Frans said the trek took two days in harsh weather, and the team had to cross a mountain range that was 5,000 meters high.

“South of Nuristan there is a road that leads into the valley where we had been asked to come and treat the eye patients, and a very easy route would have been through the city of Jalalabad and then up north to Parun, where we had planned the eye camp,” Frans told Compass. “However, that area of Nuristan is very unsafe.”

When the team ended their trek and boarded their vehicles, the armed group attacked them and killed all but one Afghan member of the team. Authorities and IAM believe the team members were killed between Aug. 4 and 5. Frans said he last spoke with Little on Aug. 4.

IAM plans eye camps in remote areas every two years due to the difficulty of preparing for the work and putting a team together that is qualified and can endure the harsh travel conditions, he said.

“We have actually lost our capacity to do camps like this in remote areas because we lost two of our veteran people as well as others we were training to take over these kinds of trips,” Frans said.

The team of experts who lost their lives was composed of two Afghan Muslims, Mahram Ali and another identified only as Jawed; British citizen Karen Woo, German Daniela Beyer, and U.S. citizens Little, Cheryl Beckett, Brian Carderelli, Tom Grams, Glenn Lapp and Dan Terry.

“I know that the foreign workers of IAM were all committed Christians, and they felt this was the place where they needed to live out their life in practice by working with and for people who have very little access to anything we would call normal facilities,” said Frans. “The others were motivated by humanitarian motives. All of them in fact were one way or another committed to the Afghan people.”

The two Afghans were buried earlier this week. Little and Terry, who both had lived in the war-torn country for decades, will be buried in Afghanistan.

Despite the brutal murders, Frans said that as long as the Afghans and their government continue to welcome them, IAM will stay.

“We are here for the people, and as long as they want us to be here and the government in power gives us the opportunity to work here, we are their guests and we’ll stay, God willing,” he said.

 

Memorial

On Sunday (Aug. 8), at his home church in Loudonville, New York, Dr. Tom Hale, a medical relief worker himself, praised the courage and sacrifice of the eight Christians who dedicated their lives to helping Afghans.

“Though this loss has been enormous, I want to state my conviction that this loss is not senseless; it is not a waste,” said Hale. “Remember this: those eight martyrs in Afghanistan did not lose their lives, they gave up their lives.”

Days before the team was found dead, Little’s wife wrote about their family’s motivation to stay in Afghanistan through “miserable” times. Libby Little described how in the 1970s during a citizens’ uprising they chose not to take shelter with other foreigners but to remain in their neighborhood.

“As the fighting worsened and streets were abandoned, our neighbors fed us fresh bread and sweet milk,” she wrote. “Some took turns guarding our gate, motioning angry mobs to ‘pass by’ our home. When the fighting ended, they referred to us as ‘the people who stayed.’

“May the fruitful door of opportunity to embrace suffering in service, or at least embrace those who are suffering, remain open for the sake of God’s kingdom,” she concluded.

 

Concern for Afghan Christians

Afghanistan’s population is estimated at 28 million. Among them are very few Christians. Afghan converts are not accepted by the predominantly Muslim society. In recent months experts have expressed concern over political threats against local Christians.

At the end of May, private Afghan TV station Noorin showed images of Afghan Christians being baptized and praying. Within days the subject of Afghans leaving Islam for Christianity became national news and ignited a heated debate in the Parliament and Senate. The government conducted formal investigations into activities of Christian aid agencies. In June IAM successfully passed an inspection by the Afghan Ministry of Economy.

In early June the deputy secretary of the Afghan Parliament, Abdul Sattar Khawasi, called for the execution of converts, according to Agence France-Presse (AFP).

“Those Afghans that appeared on this video film should be executed in public,” he said, according to the AFP. “The house should order the attorney general and the NDS (intelligence agency) to arrest these Afghans and execute them.”

Small protests against Christians ensued in Kabul and other towns, and two foreign aid groups were accused of proselytizing and their activities were suspended, news sources reported.

A source working with the Afghan church who requested anonymity said she was concerned that the murders of IAM workers last week might negatively affect Afghan Christians and Christian aid workers.

“The deaths have the potential to shake the local and foreign Christians and deeply intimidate them even further,” said the source. “Let’s pray that it will be an impact that strengthens the church there but that might take awhile.”

Report from Compass Direct News

Recent Incidents of Persecution


Karnataka, India, January 7 (CDN) — Police led by Hindu extremists accused a pastor without basis of forceful conversion, reprimanded him for praying without government permission and stopped the Sunday worship of his India People Ministry church on Dec. 27 in Koppa. The Global Council of Indian Christians reported that police further warned Pastor D.M. Kumar that he would be arrested if he conducted future worship services.

Karnataka – Members of the Hindu extremist Bajrang Dal accused Christian nurses at Pandapura government hospital of forceful conversion for conducting a small Christmas program on Dec. 25 in Mandhya. The Global Council of Indian Christians reported that at about 2 p.m., Sophia Parinamala Rani and two others identified only as Philomina and Bajamma organized a small, customary Christmas meeting for staff members and patients, inviting a guest to speak about Christ. Some 20 Hindu extremists reached the hospital and, manhandling the speaker, accused the nurses of forceful conversion. Pandapura police forcefully obtained an apology letter from the nurses, who received a show-cause notice ordering them to explain the meeting to hospital authorities.

Andhra Pradesh – A Hindu extremist roughed up two Christians at a worship meeting on Dec. 23 in Mahabubnagar. The All India Christian Council reported that a pastor identified only as Prabudas and a doctor identified only as Nehemiah were on their way to a service when a Hindu hardliner and karate master, Satya Narayana, pushed and punched them, threatening to file a case of forceful conversion against them. He threatened them with more violence if they continued Christian activities in the area. Local Christian leaders were taking steps to protect the two men at press time.

New Delhi – Hindu extremists assaulted Christians attending a Christmas program of the Full Gospel Church of God on Dec. 22 at Nagafgarh. A source reported that the Hindu hardliners threatened pastors Benny Stephen, K. Cherian and Stephen Joseph, claiming that the program they were attending aimed to convert people by force, and then attacked them. Pastor Joseph suffered injuries to his left leg and back, Pastor Benny to his back and face and Pastor Cherian to his head. Pastor Joseph told Compass that no police complaint was filed as the Christians forgave the attackers.

Tamil Nadu – Hindu extremists attacked a group of Christians on Dec. 20 in Mangalam, Nagercoil. The Global Council of Indian Christians reported that Hindu extremists objected to a digital sign Christians put up stating details of an impending Christmas celebration and warned them to remove it. When the Christians refused, the extremists beat them, and some of them received hospital treatment for their injuries. A police complaint was filed, but no arrests had been made at press time. 

Andhra Pradesh – Police arrested Pastor P. Benjamin after a Hindu extremist filed a complaint against him of forceful conversion on Dec. 20 in Hyderabad. The Global Council of Indian Christians reported that Pastor Benjamin, of Holy Spirit Church, spoke of Christ with about 200 children at a Christmas program organized by a nearby area’s Christian youth leader. As Pastor Benjamin reached his home, local Christian leaders informed him that police had filed charges of forcible conversion against him under Section 295/A of the Indian Penal Code. Applications for bail were twice rejected. Area Christian leaders were taking an appeal to a higher court, and the pastor’s family was relocated as a security precaution.

Maharashtra – Hindu extremists from the Bajrang Dal on Dec. 20 attacked members of Christian ministry Operation Mobilization in Manchar and took their film equipment. The All India Christian Council (AICC) reported that about 100 extremists attacked the organization’s screening of a Christian film, organized by the area pastor with the permission of the village head. As the movie ended, the Hindu hardliners rushed in, verbally abused the Christians for their faith and took a film projector and DVD player. Moses Vatipalli of the AICC told Compass that area leaders of Hindu extremist groups were planning to meet with Christian leaders to settle the matter.

Andhra Pradesh – Hindu extremists in Karimnagar on Dec. 15 beat 65-year-old Pastor S. Devavaram and other Christians, accusing them of forceful conversion. The Global Council of Indian Christians reported that Pastor Devavaram and five youths were distributing Christmas literature after obtaining permission from the deputy superintendent of police. At about 9 a.m. a mob of 20 Hindu extremists stopped their vehicle, dragged the pastor out and accused him of forceful conversion. They beat the pastor, tied his hands and locked him and the other Christians in a room till 5 p.m. On learning that the pastor and the other five had been abducted, 10 Christians reported it to police. Officers arrived at the site of the assault and took the Christians to the police station, where the extremists filed a complaint of forcible conversion against the pastor and his team. Police took written statements from the Christians and released them without charges at 6 p.m.