Thursday, September 16, 2010
Should Poor People Pay for things?
Bonjour equipe-- I have been thinking about something recently due to a spate of really poor mothers that I have met on PMI trips. Should poor people have to pay for medical care at all? It kills me when a mother says that she cannot afford the 2000 CFA (about 4 dollars) for a consultation and medicine on the PMI trips. There have been some extremely sick kids that we have not seen because of the barrier enacted by the consultation fee. It makes me feel like we should see everyone for free. But when I offered this idea to the PMI nurses, they were vehemently against it because they said it would overwhelm the system and it would cause mothers to prioritize/value health less because they would be able to get it for free. Although this idea is a bit unpleasant, there are studies (even put out by the World Health Organization) to support the idea that there should be small fees associated with health care. For the time being, I wish that I could give things for free to all my patients but I recognize that I have to respect the rules of the system that I am working in. Otherwise, if it is only me who gives things away that will only disequilibrate the hospital and community health services of the hospital even more.
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HI, Sophie,
ReplyDeleteI was interested, as always, in your latest blog, and particularly in the question of having to deny care to those who cannot pay. This was a recurring theme at the Schweitzer Hospital in Haiti, and I thought I'd give you a brief outline of how we dealt with it in the 1970's. Dr. and Mrs.Mellon had run the hospital since the 1950's, and a lot of thought had been put into the system of payment.
First of all, there was a "zone hopital," a district of 100,000 population that was supposed to be the focus of all our programs. In reality, patients came from a much wider area (Haiti had about 8 million at the time), as medical facilities in other parts of the country were either limited to the monied elite or were relatively poorly equipped (I estimated that at HAS we were able to provide adequate treatment, somewhere close to first-world standards, for about 95 percent of cases.) All patients were screened by an RN in the courtyard outside the hospital's front door; those that were "moun zone hopital" were allowed to enter and asked to pay a fee of 10 gourdes ($2 US), which covered all outpatient treatment including lab, Xrays, and prescriptions. Those who didn't have the money had to wait until the payers were admitted, unless their condition was deemed urgent. Nobody from the district was denied care.
Patients from outside the district were admitted only if further screening by one of the physicians determined that their condition could not be treated elsewhere in Haiti. There were instances of Haitians driving up in private cars and changing into rags to get into the system. These "outdistrict" patients, in addition to the fee at he door, also had to provide "deux mouns pou bay sang", 2 blood donors. This was one way of keeping our blood bank stocked.
The cost of a hospital bed was determined by that of a funeral! The average in-house stay was six days, and the average funeral cost $30 US, so the rate was $5/day. Nobody was asked to come up with the money upfront, but the people at the admissions desk (which on most clinic days included Ms. Mellon herself) kept track of who owed and who had the wherewithal to pay, and collected in drips and drabs on subsequent clinic visits. The bulk of the hospital's running costs came from outside donations. There was no formal relationship between HAS and the Haitian government.
No additional fee was charged for surgical procedures, but I once calculated that the total cost of a major surgical procedure (we had excellent OR's, nurses, and equipment) came to about $35.
I wish you the very best for the rest of your stay in Lambarene and your medical career!
Mike Hammar
HI, Sophie,
ReplyDeleteI was interested, as always, in your latest blog, and particularly in the question of having to deny care to those who cannot pay. This was a recurring theme at the Schweitzer Hospital in Haiti, and I thought I'd give you a brief outline of how we dealt with it in the 1970's. Dr. and Mrs.Mellon had run the hospital since the 1950's, and a lot of thought had been put into the system of payment.
First of all, there was a "zone hopital," a district of 100,000 population that was supposed to be the focus of all our programs. In reality, patients came from a much wider area (Haiti had about 8 million at the time), as medical facilities in other parts of the country were either limited to the monied elite or were relatively poorly equipped (I estimated that at HAS we were able to provide adequate treatment, somewhere close to first-world standards, for about 95 percent of cases.) All patients were screened by an RN in the courtyard outside the hospital's front door; those that were "moun zone hopital" were allowed to enter and asked to pay a fee of 10 gourdes ($2 US), which covered all outpatient treatment including lab, Xrays, and prescriptions. Those who didn't have the money had to wait until the payers were admitted, unless their condition was deemed urgent. Nobody from the district was denied care.
Patients from outside the district were admitted only if further screening by one of the physicians determined that their condition could not be treated elsewhere in Haiti. There were instances of Haitians driving up in private cars and changing into rags to get into the system. These "outdistrict" patients, in addition to the fee at he door, also had to provide "deux mouns pou bay sang", 2 blood donors. This was one way of keeping our blood bank stocked.
The cost of a hospital bed was determined by that of a funeral! The average in-house stay was six days, and the average funeral cost $30 US, so the rate was $5/day. Nobody was asked to come up with the money upfront, but the people at the admissions desk (which on most clinic days included Ms. Mellon herself) kept track of who owed and who had the wherewithal to pay, and collected in drips and drabs on subsequent clinic visits. The bulk of the hospital's running costs came from outside donations. There was no formal relationship between HAS and the Haitian government.
No additional fee was charged for surgical procedures, but I once calculated that the total cost of a major surgical procedure (we had excellent OR's, nurses, and equipment) came to about $35.
I wish you the very best for the rest of your stay in Lambarene and your medical career!
Mike Hammar
Hi Sophie,
ReplyDeleteYour posts are so very interesting, and I look forward to more. As for the issue of cost as it relates to healthcare, it is my firm belief that people, especially children, need access to healthcare wherever they are, whatever their circumstances. The world needs to recognize basic human needs if we are ever to crawl our way up to a livable society. Aunt Nancy