Conclusion for Business research only

 

Table of Contents

Abstract 2

Introduction. 2

  1. Review of literature. 2
  2. Method. 4
  3. Result and analysis. 5
  4. Discussion. 10
  5. Conclusion. 11

 

 

 

 

Does the public or private healthcare produce better results for the cost?

Abstract

we conduct our research to study people’s or patients’ viewpoints about how hospitals use their health insurance and are there any differences between public and private insurance. Our primary research questions: How does the patient feel about the hospital’s utilization of the insurance company? What does the patient do with the unneeded treatment or the extra drugs? Will the patient report this problem if he sees it, and why? Will this affect the patients; trust or loyalty to the hospitals? We chose these questions to gather critical information regarding how patients feel about the hospital’s utilization of insurance companies. Do they notice a difference in treatment between the two types? (Private, public) We answered these questions by interviewing 12 participants, 6 of them have private insurance, and the others have public insurance.

Introduction

When you go to the hospital, the first and most important question they will ask you is whether you have health insurance or at the government’s expense or your account. Your answer may change everything as, unfortunately, private insurance patients may suffer from unnecessary procedures because of the doctors’ greed to increase expenses on the insurance company, but the victim here is the patient. Imagine with me when you go to the hospital for a usual reason such as headache or seasonal fever, then you are surprised by so many painful procedures that have nothing to do with your main problem; otherwise there is a loss of time and money. Our main and important goal in this research is to uncover the problems of insurance patients and try to reduce or end their suffering, our research will include several solutions to ensure the patient’s rights.

 

1.      Review of literature

Hospitals were first built in 331 CE by the Roman emperor. Back then, people who get a disease would be isolated from the home and family, so he came up with the idea of having a place for treating patients. Years past, hospitals are becoming bigger buildings and more effective, have modern technology , many drugs in the pharmacy, more skilled doctors, nurses etc. People who have illnesses, mental issues, and even patients who need surgery will be getting treatment there (By The Editors Of Encyclopaedia Britannica, inc. 1998).As a result of the continuous development of hospitals (healthcare systems), it has been divided into two different systems. They are the public and private healthcare systems. Both are trying their best to make the patients satisfied because he is the most important part of the entire system; by increasing their awareness of what should and should not do to everyone in their hands, they kind of competing together, which makes both of them have to develop their system, workers, machines, and the way they process payment methods. Having a different level of people requires different payment methods, that is why private healthcare provides insurance, which decreases the medicine costs (Rao, G. N. 2002). The insurance is useful for saving money, but not everyone will own one. Some organizations provide it for the employees, but it is not the same percentage for all of them. Of course, it will be low for one group and high to another, but is there any negative sides in the insurance? The first question to the patient is (Do you have insurance?) when he enters a private hospital, which makes this approach more important. Unfortunately, private hospitals are coming to increase their own benefits, not the patient’s. It has been defined that they sometimes assign unnecessary treatment and medical procedures to the patient. Sometimes the insurance will be harmful to the patient and will be manipulative to him, like the case of a patient who was in a private hospital and had insurance, he had many blood tests, slept in the hospital for some days, had medicare and medicine with insurance that covers all the amount he must pay, but the hospital and the insurance company had much complexity, the hospital increased the patient bills just because he has insurance, and eventually the patient had to pay a large amount of the cost instead of the insurance company (Reliance General Insurance Home Page).  In such a big problem in the healthcare system, it is important to compare the two approaches together, the public and private provision. To achieve realistic results, a study has been examining the public and private hospitals in Europe. More than 5500 hospitals showed that the public hospital systems are the most staffing to the patients by saving their time and money and by treating older people and care about them, rather than the private hospital system do, the claim by saying the private hospitals is insurance hungry and they dose not care much about the patients being happy or not. This difference might be because of the leadership in the organization itself based on lack of balance between the needs and the objectives they must achieve, which makes the public hospitals more efficient (Liina-Kaisa Tynkkynen, Karsten Vrangbaek 2018). Hospital employees including doctors, may manipulate the patients’ bills, but no one will know how many times they actually did it , and if the insurance company and the patient noticed it. They might over-diagnose the patient or even change the bills’ information, but even more shocking is that the doctors themselves claim that ” system manipulation” is necessary to ensure the service’s effectiveness nowadays and satisfy the patient. Some doctors are manipulating because they want their patients to get the necessary treatment, such as blood tests, X-rays, and medicine, but if they continue doing their play, it will harm the people with insurance. The way they unethical behave will make the relationship between them and the patient full of mistrust, pressure, and danger. Suppose anyone notices that he has to deal with an unethical hospital or insurance company that plays with his money, time, personal information, and things in his health or one of his family’s health. In that case, he will quit dealing with them “if he can,” with a high possibility that he will be warning the people he knows, family, friends, and coworkers about his experience, which will make the guilty unit have a terrible reputation ( Matthew K. Wynia, M. D. 2000).

Research Questions:

  • How does the patient feel about the hospital’s utilization of the insurance company?
  • What does the patient do with the unneeded treatment or the different drugs?
  • Will the patient report this problem if he sees it and why?
  • Will this affect the patients ; trust or loyalty to the hospitals?

 

2.      Method

2.1.      Research Design:

We decided to do our research paper about Hospital exploitation, specifically if Dose hospitals take advantage of the insurance company? And we want to explore it.

We used qualitative data collected by the group research itself Through interviews. It’s the most suitable approach for our study because we want to know who is dealing with the hospitals, what is precisely happening with them, and their opinions.

 

2.2.      Sample:

The research includes 12 participants from KSA. There are four college students, three government employees, And six employees in the private sector. The private sector employees’ income ranged from 9,000 to 10,000 SAR; For government employees, their income ranged from 9,000 to 14,000 SAR،. Finally, college students’ income ranged from 900 to 1500 SAR. The age range is from 20 to 60, and the number of Females is 8, and the number of males is 4. To Comprehend various points of view and assertions, this research asks six people with insurance in the hospital they attend and another six who attend hospitals without insurance. Six attended public hospitals, and 6 attended private hospitals. Furthermore, this research interview contains 13 critical questions, and the 12 participants will be interviewed individually in a structured way.

Ethical issues: Collecting data from study respondents kept their identities anonymous.

3.      Result and analysis

  • How do you feel about your hospital’s usage of your insurance, do you think it’s fair or not?

Mariam said, “I don’t have insurance, but if I have one, I will feel bad when going to the hospital because I know they care about the insurance, not their patients, which will affect the way they treat their patients,” Khaled said “It seems to be unfair. Personally, I will lose my trust in the hospital that take advantages from my insurance, because I would feel they do not have integrity in their work”, Nora said “I have heard of  it before and I do not  like it at all, me being patient, I only want the hospital to take good care of me without feeling they want to use my insurance”, Lana said “I don’t have insurance, but it is so bad to know the hospital will do it to the people who trust them and go to them to get treatment”, Asma said “I don’t have insurance at the hospital that I go to; I go to a governmental hospital”, Ahmad said “I am not an expert on these issues because I go to a government hospital, so most of the treatments are free”, Shahad said “I really don’t like these situations, although I don’t think I would notice if it happened”, Shatha said “No, I feel that the hospital took an advantage from the insurance, and I noticed that the treatment is disbursed in exaggerated amounts”, Reem said “Not fair because you take another price if you have insurance”, Fatema said “I think it is fair enough because the public hospitals are free so they will not take any advantage if you have insurance”, Mohammed said “I don’t mind as long as it doesn’t affect me or the treatment I want”, Badr said “Yes, fair, but sometimes there is a big delay in the appointments, which makes me have to go to a private hospital”.

 

  • Do you think that the hospital’s actions depend on whether you have insurance or not?

Mariam said “Yes, I am the only one who does not have insurance in my house, and I noticed the kind of treatment my family gets when they go to the hospital, like faster appointments, more medicine and even extra sessions like massage”, Khaled said “Yes, I noticed that when I booked an appointment, it took days only, but when my friend who does not have insurance booked for appointment it took him a week or two”, Nora said “No, back to the days when I did not have insurance, the government and the private hospitals treated me the same way they treats me now”, Lana said “Yes, my mother has insurance and her appointments are faster than mine, and they really cares about her heath like when she went to the hospital with a weird acne in her hand they literally gave her about five creams and two bills”, Asma said “I did not notice any mistreatment in the hospital I go to”, Ahmad said “I believe that because I go to a government hospital, I did not see mistreatment”, Shahad said “Yes”, Shatha said “Yes, the hospital treats me in a special way because of the medical insurance”, Reem said “Often yes, some doctors do unnecessary things”, Fatema said ” Yes, in private hospitals the best or the higher insurance you have, the fastest you get the medical service, while if you do not have you will wait for maybe double the time the person who has an insurance so that is why I prefer to go to a public hospital”, Mohammed said “Yes”, Badr  said “Yes”.

 

  • In your view, what was the most Trustworthy hospital you have dealt with, government or private, with mentioning the reasons?

Mariam said, “Government hospitals, I had an appointment one day in a private hospital for a blood test, and I found out that I needed some vitamins and the doctor gave me a list of 5 medicines to buy them, but after a week I went to a government hospital and I did the blood test again, the doctor gave me a name of 2 medicines to buy and told me I need to eat more fruits and vegetables”, Khaled said “Private hospitals, their system is more organized and quicker than the government. They make me feel more comfortable because they have almost everything the patients want,” Nora said. “Private hospitals are easier to deal with, and I feel they care about the patient himself. Every time I go to them, they would give me more medicines than the government hospitals do, and even the doctors booked me another appointment to check up on me for a while to make sure my health is great”, Lana said. “I only go to the government one, and they are nice, but they need to have some equipment like an X-Ray,” Asma said. “I once went to a dermatologist. In my opinion, I don’t think she examined me well. The appointment-only took five minutes. Then she wrote me the medicine on paper and finished the appointment quickly. And the medicine was about 700 SAR, not to mention the appointment cost,” Ahmad said, “I once went to a private dental clinic that my friend recommended. In my opinion, the government hospital that I used to go to is better. Also, I don’t think I can afford to pay 600 riyals each time I go to the dentist”, Shahad said.

“I have tried both the government and private hospitals, and although I pay in the private hospital, the government hospital’s dealing and treatment are much better than the private. But in the government hospital, the appointment takes 1 – 3 months, which I hate in the government hospitals”, Shatha said. “Government hospital, Royal Commission Hospital because the performance and quality are monitored,” Reem said. “Gov, Because they gave me the medicines I needed and did the necessary tests, no more,” Fatema said. “Government hospitals do not care about how much they will receive from anything they will do, and also, in my opinion, their doctors have more years of experience,” Mohammed said. “It took me a long time to find the best hospital for me, it may be a little expensive since it is a private hospital, but I learned how to know if I need the medicine or if I can find something cheaper in the pharmacy,” Badr said, “it was Almana hospital I like the service; they were deal with the patient perfect.”

 

  • If you go to a government hospital (you do not pay for it), have you faced such a problem before? (Overuse of giving the medication)

Mariam said, “Yes, I remember one day I had an appointment at 2:30 p.m. When I was waiting to join the room, the doctor told me to wait for 15 more minutes because he did not finish with his patient yet, and that made me so angry because I did not have all day I need to go home to do my homework’s”, Khaled said “I have struggled a lot with the appointments because it takes so long. Before I had my insurance, I went to a government hospital because I had a bad pain in my shoulder, the doctor told me I needed to get an X-Ray appointment, and it will be after three weeks. I could not handle the pain, so I went to a private hospital. I did what I needed within four days”, Nora said, “No,” Lana said, “No,” Asma said, “I go to a government hospital. I have never faced this problem ever,” Ahmad said. “Luckily, I have never faced it,” Shahad said. “Not, I have not,” Shatha said. “No have never had such problems,” Reem said “yes, the line is so long. The service is not good enough for me,” Fatema said. “I have never faced such a problem like this; I do not think that government hospitals may contain such a problem because it would be a waste of the state budget,” Mohammed said. “I don’t think so,” Badr said, “No, They give the required drug without increasing or decreasing.

  • What would you do if the hospital gave you unnecessary treatment or unneeded drugs?

Mariam said ” I will take them but most probably I will not use them, because I do not like to use too much medicines, I would rather only use the necessary medicine and heal myself with vegetables”, Khaled said “I will not use them. It happened to me before, they gave me three drops of medicine for my ear and I only used one of them, the other two were unnecessary to me”, Nora said “It happened to me a month ago. They gave me extra panadol (three boxes) and I only needed one, so I told the pharmacist that I will not take them, and I took only one”, Lana said “One day, I went to check up on my health and I did a blood test. My health was good but the doctor gave me a list of medicines. I did not take them, they were so unnecessary”, Asma said “I have never faced such a thing. I think I will keep it in case I need it at another time”, Ahmad said “I think I will confront the doctor or pharmacist why would I need this amount of medicine and I know I don’t need it”, Shahad said “I will confront the doctor or pharmacist”, Shatha said “I do not prefer to use any extra doses of medicines”, Reem said “I will return it”, Fatema said “I will give it back to the hospitals”, Badr said “I will not take it, specially if I have it in my home”.

 

  • Do you think it is the patient’s job to report it?

Mariam said, ” Not really; if the patient is willing and has time to deal with the situation by making a report, then fine; if the patient does not want to make a report, it is up to him,” Khaled said “Yes, the hospital is for patients. When the patients get the kind of treatment they dislike, it is their responsibility to report it to make sure it will not happen to them or others”, Nora said “Yes, when the hospital does not care about the patients, the patients must take it seriously and report it because everyone deserves to have the best treatment without manipulating them, Lana said, ” I think it depends on the patient himself. If the patient wants to report it, it is OK; if they do not want to, that is also OK”, Asma said. “No, I don’t think so,” Ahmad said, “I think if the patient report this, it will be easier for the hospital to solve the issue, but it’s not the patient’s job to do so,” Shahad said, “I think that as a good citizen, I should report if I saw this problem,” Shatha said “Yes, it is better to communicate and inform the competent authorities, because it harms the patient and wastes medicines,” Reem said “yes if he did not report it who will do it ?”, Fatema said “Yes, if it has happened more than once where the treatment or drugs was a lot,” Badr said “Yes.”

  • If this case happened to you, would you report it? And why?

Mariam said, “Yes, to make sure it will not happen again to another person or me.” Khaled said, “Yes, it is my responsibility to make sure they will not do it again,” Nora said, “Yes, I don’t want it to happen to me again in the future,” Lana said, “Yes, I don’t like the situation, and it will make me feel so uncomfortable,” Shatha said “Yes, I will inform the relevant authority and stay informed,” Reem said “For sure, I don’t this happen to other people,” Fatema said “Yes, because I do not want to waste the drugs that I will never use,” Badr said, “No, I wouldn’t if I don’t take the medication.”

 

  • Do you think that the hospital’s utilization of the insurance company is a problem for the hospital or the doctors themselves?

Mariam said, ” Both, I think the hospital probably has a poor system, this kind of treatment is unacceptable, and the doctor should be aware and make the patient satisfaction in the first place,” Khaled said, “From the hospital, they need to check how the patients are being treated and making sure they are satisfied,” Nora said “Both, the hospital must have a strong system to manage their work and treat their patients in the best way, and they need to observe the way doctors are dealing with patients as well, to minimize any negative impact on the patients,” Lana said “The hospital, In my point of view, the hospital should consider what the patients are feeling about their experience, if it was a bad one they should work on the reason that caused the negative experience,” Asma said, “I think it’s from the doctor since he or she is the one responsible for giving it to the patient,” Ahmad said, “I think it’s from hospital management, they need to look after their employees. Otherwise, the managers allowed this to happen”, Shahad said. “I think it is bad management from the hospital, and the doctor took advantage of it,” Shatha said. “Both of them because they start with the doctor and end with the medication,” Reem said. “Both the doctors sometimes need to be accurate of his medication,” Fatema said. “I think the doctors and governmental hospitals will not benefit from it,” Badr said. “Both, but the hospital has the more responsibility because they need to make sure that all hospital employees work organized.”

 

 

 

  • Will this affect the patient’s trust or loyalty to the hospitals?

Mariam said, “Yes, I don’t like to go to a private hospital because I feel they do not care about the patient. “Khaled said, “Yes, for sure, one of my colleagues told me that he had a bad experience with a particular hospital. I took his experience seriously and I did not go there, I do not want to go to them at all, because maybe I will have a similar experience my colleague had”, Nora said “Yes , I will not go to a hospital that does not have a clear way to manage the work, especially when the hospital has a bad reputation”, Lana said “Yes for sure, my brother faced a problem one year ago with a pharmacist in a hospital that we have been going to since we were children, and neither me or him went to that hospital again because of that conflict”, Asma said “Yes”, Ahmad said “Yes since some of the doctors’ opinions will be based on the insurance company and what it’s capable of spend”, Shahad said “Yes, because a mistake by the doctor may make the patient refuse the entire hospital”, Shatha said “Yes, it affects the patient’s confidence in the hospital, and the patient will not feel the credibility and sincerity of the doctor’s diagnosis of the disease”, Reem said “Yes if he suffer”, Fatema said “Yes, it will affect the trust of the patient”, Badr said ” Yes, however if the patient goes to a trusted hospital, whether governmental or private, and finds the  good treatment, then he will continue to deal with this hospital, so if the hospital wants to gain the trust of their patients, they should avoid these problem”.

 

4.      Discussion

  • How does the patient feel about the hospital’s utilization of the insurance company?

In order to answer this question (i.e., How does the patient feel about the hospital’s utilization of the insurance company?), we wanted to approximate the feelings of all types of patients, not only employees but also students and retirees, and what we discovered is that 85% of the participants have insurance in the hospital they visit. They believe that it is unfair for the insurance company to exploit the hospital. Also, 15% of the participants think it is appropriate or expected for the insurance company to take advantage of the hospital. Finally, all those who go to a government hospital (they have no insurance) and the students did not notice any exploitation. We discover that some of the participants are unaware of these situations, so people should understand that exploiting the hospital is not a simple thing, as this may affect both the patient and the hospital. Hence, people need to be familiarized with this situation and its occurrence.

 

  • What does the patient do with the unneeded treatment or the extra drugs? & Will the patient report this problem if he sees it and why?

For the second and third research questions that aimed to know the patient’s behavior in these situations, our research explained that the patient’s behavior changes according to his personality, not whether he has insurance. 80% of patients said they would not agree to take medicines they do not need. Furthermore, 20% said they would take the extra medicine without using it. Moreover, we also discovered through this research that most people think that the patient should report this issue to the hospital if this issue occurs. 5% of the participants said that it is not the patient’s job to report this problem to the hospital and that the hospital should solve it without being notified.

We discover from this research that this extra care is not necessarily harmless. Unnecessary drugs, examinations, and procedures do not provide any usefulness. The hospital will try to justify the cause for this in defensive language, but in essence, everything they do is causing harm. To reduce this problem. We can educate the public about this issue and its financial and health damages.

 

  • Will this affect the patients; trust or loyalty to the hospitals?

The last research question that must be addressed is (Will this affect patients’ trust or loyalty to hospitals?), We found that all participants shared one answer: the utilization of the insurer’s companies affects the trust between the patient and the hospital. Most of them said that government hospitals are better than private hospitals in terms of dealing and management in general. Also, to understand this question, we had to ask the participants whom they think is the main reason for this utilization. 50% said it was from the doctor and the hospital, 30% said it was from the hospital administration alone, and finally, 20% said the leading cause was the doctor.

Some doctors have a direct financial conflict of interest in deciding what patients should receive. Doctors who own surgical, laboratory, or radiological centers receive extra compensation for the services they advocate for their patients. This research found that more than 50% of doctors are more possibly to perform unneeded procedures when they profit from them.

 

5.      Conclusion

 

 

 

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