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Accountability

Share market listed corpoations have held managers accountable for profit and not care. External bodies responsible to citizens for ensuring that corporations were accountable have failed to do so.


Internal failure

The story of medicine in the marketplace is the story of the failure to hold managers responsible for anything other than profits. This has been the only thing measured. This has extended across the whole spectrum of the for profit US health care system.


Tenet/NME -- (to Tenet/NME pages)

Tenet/NME devised the concept of plan based on measures which impacted on the bottom line. It specified the number of admissions, duration of stay, payer mix, and profits per patient day. Plans for each service were made centrally. bonuses and career were both dependant on "meeting plan". The care provided to patients was never measured. Quality Assurance Committees never met. I received a long lecture about the latest in Quality Assurance from a Tenet/NME administrator.

Care in these hospitals was monitored by insurers, accreditation bodies, and state oversight processes. It was parents who objected to the kidnapping of family members, followed by patients and staff who spoke out about what was happening to care. Two Senators were persuaded and a dreadful situation was exposed.


Columbia/HCA -- (to Columbia/HCA pages)

In spite of many articles in the press after the specialty hospital scandal and claims that patient care issues were to be part of the monitoring and incentive system Columbia/HCA behaved very like Tenet/NME. It used a system of financial report cards to monitor and reward its staff. They were not held accountable for care. Bonuses were based on the card and those who did badly were personally interviewed and reprimanded by Richard Scott.

Columbia/HCA did well in its accreditation and its hospitals were accepted by state regulators. Substandard performance when compared with not for profit hospitals was identified by an independent investigator, not the oversight bodies. It was whistle blowers, the New York Times and critics like Robert Kuttner writing in the New England Journal of medicine in August 1996 who exposed what was happening. It was not the state and federal regulators. At no stage had Columbia/HCA been held accountable for its disturbing business practices by any formally constituted body.


Aged Care -- (to Aged Care pages)

It is quite clear that in aged care management took no interest and accepted no responsibility for what was happening in the nursing homes. Decisions made by management seriously compromised care and many allege that this was deliberate. Numerous complaints were made by relatives to state authorities. Many of these were not investigated and even when serious deficiencies were identified little was done about it. When fines were imposed they were not enforced.


There is No Accountability in the Market System

While there is a great deal of rhetoric about accountability in the health care marketplace this is all it is. This deception is facilitated by the use of words like "quality" rather than "standards".

Profit discourages accountability and the pressures of the market do not support the process. There is more form than substance. In practice formal accountability processes provide no assurances that people will not be misused or short changed in the care they receive. The USA has the most costly and sophisticated accreditation and oversight programs in the world. None of them held health care corporations accountable for their actions.

CLICK HERE -- for more information about the word "quality" and its relationship to accountability.


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This page created April 2000 by Michael Wynne