WITTEN-HERDECKE (NNA) - Is the acquisition of profits ranked above the welfare of patients by private clinics? This is the question posed in a new publication by Professor Matthias Kettner, a specialist in medical ethics at the University of Witten/Herdecke (UWH) in Germany, and a number of other contributors. His thesis: this issue puts an additional severe strain on the professional responsibility of the caring professions on top of those to which they are already subject.

Through their need, patients are dependant upon carers and helpers who should not exploit their situation for their own financial or other gain. This ethical principle is opposed by the necessity of private hospitals to generate a return. And so there exist understandable incentives to put the main focus on financial profit.               

Private hospital owners who do not possess charitable status must operate a profit-oriented business and use business tools with this end in mind. The latter include such things as incentive systems that inform the actions and decisions of doctors and carers in line with the company goals. This creates an ethical problem if these incentives essentially appeal to self-interest, as we are dealing with the health of people here, Kettner sums up his argument.

For him there is currently no clear evidence that private hospitals are really less expensive when offering an equal level of patient care or that they indeed improve care, as the proponents of hospital privatisation like to claim. It was also true, of course, that data and measurement methods were inadequate. Furthermore, it was difficult to exclude the effect of flat rate cases (DRGs) from the calculation of the impact of privatisation.

DRGs are "Diagnosis Related Groups" and designate an economic and medical classification system for the services offered to patients.

For Kettner there is also an abundance of evidence that both nurses and doctors experience the introduction of DRGs, that affect all hospitals, as well as the privatisation process, which concerns an ever increasing number of hospitals, as a serious threat to their professional identity.

Doctors and carers had to remain sufficiently independent from the profit motivation of the companies running the private hospitals, the specialist in medical ethics demanded. That did not mean that everything medically desirable had to be made available to everyone.

But there had to be institutional assurance that there was a transparent balance between what is medically necessary and the need to make financial profit, while ensuring that the patient did not draw the short straw.

For Kettner, that transparency does not currently exist. Health politicians, doctors’ organisations and nurses’ representatives had a moral responsibility to ensure that change was able to take place in this respect.

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References: Heubel, Friedrich / Kettner, Matthias / Manzeschke, Arne (eds.). “Die Privatisierung von Krankenhäusern: Ethische Perspektiven”, ISBN: 978-3-531-17256-9

Item: 111031-01EN Date: 31 October 2011

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