There are two great ideas for improving access to healthcare.
One idea is to offer free consultation to indigent patients. The other idea is to assist the patients to access surgery by looking at their financial situation and working with what they have. Both ideas will improve healthcare delivery and improve outcomes. They also have the potential to help reduce patronage of charlatans and reverse medical tourism.
You see, one of the impediments to care in Nigeria is the cost.
Free medical consultation
Free consultation is cheap and affordable for most people. It removes a significant barrier to health care. Patients often present in large numbers to access free service. This enables the practitioner have increased contact with needy patients and provides a platform for effective management.
There are many reasons for offering free consultations. Some are simply due to honest altruism and the desire to help Nigerians. Others have a business angle to it by increasing the number of people who visit the hospital, know about its services and serve as brand advocates. In any event, costs are necessarily incurred and have to somehow be paid for – assuming the hospital and practitioner offering the services are set up as a business in pursuit of profit. Someone still pays for the service even if not the patient!
If a for profit business, free consultations may not necessarily translate to exemption from or reduced fee for tests or surgical procedures ordered following the consultation – which may be strategically planned ab initio to offset the so-called prior “free” encounter. In this regard, strategic planning and efficient business costing may enable a recoup of the consultation fees from ‘other business’, sold to the patient. These may be further consultation, blood tests and more expensive investigations required from the free consultation.
Hospitals and specialists may also offer free service as part of a medical mission or paid up by a non-governmental organization. Organisations such as the Nigerian Medical Association routinely offer the services of its members through medical missions as part of its Annual General Meeting. The same attitude applies to the Guild of Medical Directors.
While free consultation may be offered as a charity or truly gratis to all who require it, it can be disguised advertisement to popularize the available specialist knowledge and skills in the hope would later increase demand for services. The Indian hospitals have routinely employed these tactics as a way of generating patients for medical tourism to India.
Of course, it could also be set up entirely by a non-medical person as a way of giving back to the society. In this case, for example, a politician seeking electoral victory may sponsor such medical missions or free consultation and services. I hope someone is listening!
Reduced cost or free surgeries
The costs of operations can vary widely between hospitals and between the public and private sector. We often start with the premise that good surgery is not cheap and cheap surgery is not good. However, often times, the minimum costs are closely similar and the extras are charges due to specialists, instrumentation and hospital comfort (hospitality).
So, how can hospitals and specialists reduce the cost of care for indigent patients?
The idea is to work with smaller margins and reduce the cost of care through efficient patient management. The focus is on delivery of timely operations to reduce hospital morbidity and mortality. Manage the patient when the problem is still manageable. Delays often complicate the outcome.
The other plan is to work with the patient’s pocket. The charges are graded according to affordability and the hospitality requirements of the patient. For example, two patients requiring the same spine surgery may pay widely varying bills if one is the President of an organization and another, the security guard. The President, of course, may opt for a deluxe private room with all the amenities while the security chap might be in an open ward.
However, what is vitally important is that the quality of the operation, the expertise and the actual care remains the same for assurance of similar outcomes. The outcome must not be compromised based on financial resources. Quality of care must not be sacrificed on the altar of money. That will ultimately be detrimental to the whole business.
Free surgeries have been carried out routinely by many notably the Maxillo-Facial surgeon, Dr Seidu Bello. He runs the Cleft and Facial Deformity Foundation and repairs facial deformities caused by congenital defects or tumours. The operations are performed by a consortium of doctors who give up their time and expertise for free. This improves the skills of the local doctors and generates more patients for them; long after the smile train has left town.
In effect, there are ways like these to improve the lives of indigent patients as doctors and hospitals especially in the private sector increase their patient contacts and find creative ways to stay in the black.
As you know, the Nigerian patients are worth it.
NB: Dr Sam Osaghae, Urologist contributed to these thoughts.