Follow the China model, build hospitals for Covid-19 patients

 

The government is reaching its limits in managing Covid-19 cases solely in government hospitals and it has declared a nationwide state of emergency to better handle the situation.

A record high of 4,029 Covid-19 cases were reported on Jan 16. Active cases, deaths and Covid-19 patients with severe conditions are rising.

RM17 billion in Covid-19 funds were approved in the 2021 budget for the complete and comprehensive implementation of the 3Ts – screening, detection and treatment.

If these procedures are not strictly adhered to, there will be more cases surfacing.

Now, the government, after nearly a year of directing all Covid-19 cases to be sent to government hospitals, is telling private hospitals they have to start managing their own cases. This sounds fair, until the pros and cons are looked into.

Allocate funds for this purpose

Understandably, the existing public hospitals are now facing constraints as there is a shortage of intensive care units and normal beds for Covid-19 patients in public Covid-19 hospitals.

Private hospitals and doctors will favourably share this burden if they are treated as equal partners and their views are taken into serious consideration.

However, resorting to private hospitals to resolve the problem may not be enough as not all private hospitals can accommodate the increasing number of Covid patients as they themselves do have their own cohort of non-Covid patients and other limitations.

Private hospitals basically run on fees paid by patients whereas government hospitals are run on taxpayers’ money. And not all private hospitals are making profits. In the case of
admitting Covid-19 patients in private hospitals, the government has no choice but to allocate funds for this purpose.

There are only a limited number of doctors in every private hospital in the country as compared to government hospitals. Unlike public hospitals, the majority of specialist-consultants in private hospitals do not have medical officers (MOs), registrars or housemen to back them.

This is unlike the specialists in government Covid-19 hospitals who are mostly of a younger age group. They have a chain of clinical specialists, registrars, MOs and housemen to assist them with the regular ward rounds and procedures.

It’s important to note that doctors in private hospitals are mostly senior ageing specialists in various fields and are not trained to attend to Covid-19 patients.

If the health ministry insists on private hospitals handling these patients, then government specialists, MOs and housemen should be seconded to these hospitals, on the government’s payroll.

The government should also be ready to provide added medical facilities, if requested, to handle the patients.

Insurance companies should not opt out

Private hospitals have their own rules and formalities as far as patients are concerned. Patients will have to pay for room and board, nursing, medication and doctors’ fees, among others. These can add up very quickly, especially if patients need oxygen or ventilation.

The obvious solution would be to send insured patients to private hospitals, while those paying out of their own pocket should be allowed to go to government hospitals if they choose, unless they are able to foot the bills (at a reasonably reduced price).

Unfortunately, it seems the insurance companies are saying that their policies exclude pandemics. A diagnosis of Covid-19, therefore, will lead to a denial of payment by the insurance company and the patient will be responsible for all charges.

Now, if a state of emergency is imposed, shouldn’t it apply to everyone? The citizens must follow standard operating procedures strictly to avoid infection. The doctors and nurses must treat Covid-19 patients without discrimination.

Are insurance companies going to be allowed to opt out of this crisis? Are they too big, powerful and rich to be coerced into enlisting Covid-19 patients to be covered? If they insist not to, will the government step in and pay a negotiated (reduced but reasonable) fee to the private hospitals to handle these patients?

Besides this problem, Covid-19 patients might flood private hospitals if someone else foots the bill – thus driving other patients away. The government must meet with the private hospitals and agree with them on exactly how many beds each must set aside for Covid-19 patients.

This should depend on the capacity of the hospital, the number of doctors and nurses available and its ability to provide ICU care for these patients.

Complexities to consider

Another issue, as mentioned, is that in the private sector, each specialist works alone. He is responsible for his patient at all times. In government hospitals, house officers, medical officers, registrars and junior specialists form a buffer for the specialists. This is not the case in private hospitals.

Stress and burnout will quickly set in when private hospitals are understaffed. Let’s not overlook the fact that most private sector specialists are getting on a bit in age. A majority of the anaesthesiologists, intensivists, pulmonologists, and infectious disease physicians in private hospitals are in the high-risk categories age-wise and might also have co-morbidities.

Should such individuals be excused from managing Covid-19 patients? But then, this would increase the burden on the younger doctors and those without other illnesses – stressing
them even more.

Another point is that private sector specialists have almost no experience in managing Covid-19 patients. Of course, theoretically, through their reading and learning, they are aware of the possible cures and useful drugs to combat Covid-19, but this is no substitute for practical experience.

During the learning curve there will be inevitable adverse outcomes. Will the government then, using its emergency powers, grant doctors immunity from liability for such outcomes?

There are many issues and complexities to consider, and that the health ministry’s knowledge of how the private sector works is rather vague, to put it kindly. It may not be easy, but before compelling the private sector to treat Covid-19 patients, there must be a comprehensive and open discussion concerning these many issues.

Trying to force the issue will end up causing more harm to the patients, the private hospitals and eventually to the government hospitals.

Build more hospitals

Having private hospitals to share the burden is not going to resolve the problems faced by public hospitals in the country. Centralising all Covid-19 patients in specifically built public hospitals in every state is a much better option as far as supervision is concerned rather than distributing these patients to many other venues such as private hospitals or hotels to accommodate them.

In an emergency like this, the government has to trim down all the budget allocations to other insignificant sectors and channel the money to the healthcare sector to immediately build hospitals in every state to house Covid-19 patients as what has been done in China, for instance.

Distributing Covid-19 patients to flood the hybrid hospitals and private hospitals, will only create phobia among the general population who would want to seek treatment for other illnesses. This would adversely impact the management of other non-Covid-19 illnesses.

The government should recruit more medical staff and expertise even if they need to come from other countries. Building new hospitals will not be a waste of public funds as they can still be utilised even after the Covid-19 pandemic is over.

Moaz Nair is an FMT reader.

The views expressed are those of the writer and do not necessarily reflect those of MMKtT.