The hospice care industry may not be profitable in the Philippines now, but it could potentially become a lucrative service. Must we be concerned?
In business, a quick profit is always attractive. Whatever industry you are in, the allure of easy money always exists. It may not always be moral or ethical at times – more often than not, a get-rich-quick-scheme has few big winners and more big losers. But if it is in the industry of health care, specifically hospice care, it could present serious issues.
Dr. Joan Teno of Brown University School of Public Health in the United States, whose work has focused on end-of-life care, is one of those practitioners who have raised red flags about paid hospice services. “I’m very concerned that you’re harming not only the dying patient, but the family whose memory will be of a loved one suffering because they didn’t get adequate care.”
Hospice is a relatively easy business to start. At present, not many health care businesses are into it, because payments are usually out-of-pocket, and all services that are covered by the health insurance system require hospital admission. Hospice care can be provided at home and using lower-cost health workers, who can work longer shifts. This may allow the entry of smaller hospices, launched with the intent of profiting within a few years. Coupled with the sale of pharmaceutical drugs and equipment, a hospice care provider can potentially have steady clients with a regular cash flow.
The scary thing, however, is that not all of those entering the hospice market have the best intentions.
An aging population is a huge market for hospice care, but this segment of the society can be prone to abuse. Even if someone has deep pockets, the constant drain on resources could render someone bankrupt sooner or later if expenses are not checked. There may be a need to enact new laws for these services to streamline the practice and discourage unscrupulous businessmen from racketeering.
This has been the case in certain countries where the government covers for hospice care. If oversight is limited and payouts become generous, there could be private services who will take advantage of the constant income stream. Reports show that some of these industries provide shoddy service and charge a premium. More hospice providers will accommodate inquiries and clients, but they might be unable to spend more time with patients if needed. A study found that patients in for-profit hospices see doctors less often presumably to cut costs. In an analysis of federal data from 2014 to 2017, it was noted that profit hospices were less likely to have received any hospice visits in the last three days of life.
For-profit hospices also enroll a different set of patients, preferring those likely to remain in hospice longer. Most costs are incurred in the first and last week of hospice care. Patients who enroll in hospice must undergo several assessments to develop a care plan and set their medications. In their final days, as the body begins to shut down, patients often need additional services or medications to stay comfortable. Thus, when profits become a priority, screening becomes more important.
In this regard, one of the profitable cases that a hospice care provider can have is dementia. These patients will not die soon, but they will need constant attention to improve quality of life. They are also prone to all kinds of abuse, as their limitations make them dependent on care providers. Unlike cancer patients whose remaining days may be numbered, dementia patients may survive for years with the same needs and medications. Thus, there is no need for a service provider to constantly go searching for patients. The system might become discriminatory when this becomes common practice.
One must understand that hospice care is not easy. It requires some emotional involvement and yet, you must not bring the stressor home with you on your day off. You must have the patience to wait for patients when they take medications, and yet most of them may not realize a cure. It goes against the messianic complex of some care providers – you cannot save your patient, and yet you must still care.
Hospice Care providers are here to stay, and with an aging population, we must find ways to strengthen this segment. It is not bad to make a profit along the way, as it is actually necessary to sustain the service. Non-profit organizations might not be enough to serve the needs of the populace. Let us all work together to learn more about hospice care so that we can all benefit once we or our relatives need it.
REFERENCE:
Hospice Medicare Margins: Analysis of Patient and Hospice Characteristics, Utilization, and Cost - By Carol Bazell, Melissa A. Caplen, William Coates, Pamela M. Pelizzari, and Bruce S. Pyenson (25 November 2019)