Thursday, May 10, 2012

Conversion rate

This heading should not lead you to think that I have suddenly become an economist and have started thinking about conversion rate of rupee against the dollar or have become an evangelist counting number of heathens I have managed to convert. I am writing about what a doctor friend told me about conversion rates related to a corporate hospital.
My friend is one of those rare birds who tries to follow medical ethics. His hospital outpatient work is fairly busy as he is good in his job and in his approach to the patients. He and I have become friends over years and he occasionally confides in me and seeks counsel.
Recently his hospital’s chief called him over for a chat and during the course of the talk gently reminded him of his conversion rates! He had a chart in front of him which gave him the year’s figures of the number of patients he has seen as out patients and the number of admissions he has made. Compared to the previous year the admission rate had come down and this from his point of view is not good and my friend was gently reminded to improve his admission rate.
I have grown old watching the changing medical scenario in urban India. Thirty odd years ago it was doctors who were hospital chiefs which were the beginning years of corporatization of health. Now it is the finance mangers with MBA qualification who become hospital chiefs and their method of management is how much profit a particular input shows at the end of year. The input may be a respected physician or a Sonography machine. The hospital chief is likely to be a much younger person than the doctor who is responsible for patient care. If I were in his position I would congratulate the doctor for having reduced the admissions while seeing more number of outpatients.
Hospitals are not factories which produce consumer products. These are institutions that mange sick patients and if a sick patient can be managed as outpatient at much less cost it is a service to the patient and indirectly to the community. If the same patient were to be admitted and treated when he could have been managed without admitting him, it may be beneficial to the hospital but it is very unethical.
 This is not an uncommon practice and there have been many occasions when I have given contrary advice to that of the hospital consultant who had advised intervention and very rarely such advice has been proved wrong.
What should doctors, who are at the mercy of the hospital owners to do in such a situation? Many are forced to compromise values and stay on, as quitting the job often means a major drop in the income.
What did my friend do?
He quit.