Monitoring Favours For-Profit Health Care

A new study by the Health Care Compliance Association (HCCA) in the United States found that non-profit health care institutions are audited by Medicare more often than their for-profit counterparts: 6 times per year compared to 4 for the for-profit facilities.  47% of non-profits were also audited by more than one government agency compared to only 27% of the for-profits.

No explanation was given for these findings, but the authors found the results “surprising”. They are correct: it makes no sense.  Media headlines in the last year include many reports of fraud by major drug companies, hundreds of millions of dollars in fines paid by private laboratory corporations and for-profit hospital chains that have been penalized for a variety of legal indiscretions.

Also, most peer-reviewed studies comparing quality in the two sectors find that you live longer and have fewer complications in non-profit hospitals and that for-profit nursing homes violate regulations more often.

One of the arguments made in support of more private profit in health care is that monitoring will increase.  The corporations will “row” and the state will “steer”.  In the country that invented this metaphor, that clearly is not the case.  The corporations steer, the state pays and it is not clear to many who need health care that anyone is rowing.

Canada also has a playing field tilted towards private firms. For-profit corporations are sheltered by privacy laws while public institutions often have their quality ratings published on web sites. Private corporations use surpluses, derived from public payments, to lobby the government, speak publicly about the value of private health care and fund more private firms.

The HCCA findings add another dimension to our understanding of the negative impact of mixed economies in the provision of essential services.  The uneven monitoring adds extra cost to the public non-profit sector and decreases pressure on corporations most likely to cause a problem.  The promise of monitoring safeguards becomes more than a cover for expanded private provision; it becomes a lever pushing in that direction.

Follow this link to read the full HCCA report:

http://www.hcca-info.org/Resources/View/ArticleId/817/Auditing-the-Auditors.aspx

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