The Notion of ‘Free’ Care

By F. Bruce Cohen
Chief Financial Officer, United Therapies
Co-Founder, Knock Foundation, Inc.

(Previous post: Publicizing the Development Work Leads to Great Demand)

Many of the patients had not only been suffering for months but in many instances years and this provided them with a welcome opportunity to be treated by a specialist (some still had catheters that had been inserted months earlier).

As they saw patients, the doctors wrote into the patient’s booklet, which is carried by the patient and not maintained by the hospital, the diagnosis and the proposed treatment. We were never quite sure how a patient that was to have surgery was to be scheduled and, in some respects, assumed that when the doctors showed up to perform surgery on one of the following days, the patients on the schedule would not be there.

To say that we did not understand NPGH’s processes is a bit of an understatement and, from an American’s perspective, it appeared more like organized chaos than anything else. Yet as the day passed our confidence in the nurses convinced us that not only would patients be scheduled as directed but that prescriptions would be filled and tests would be taken.

As in any hospital, it seems as though the nurses are most responsible for the “efficient” running of the institution and its processes and somehow, despite all appearances to the contrary, get the job done. Just the same, we were still pleasantly surprised when the patients that were scheduled for surgery did in fact show up.

I would be remiss if I didn’t discuss the notion of “free” medical care. At the beginning of the screenings, there was a great deal of displeasure voiced by many patients. Indeed, a mini riot was brewing. I soon discovered that the radio advertisements informed the patients that care would be free; in fact, this was not the case. Even though this was a provincial hospital serving all comers (those with money or insurance would likely go to a private hospital with more modern amenities and equipment), nothing was free.

Indeed, patients scheduled for surgery were required to bring the disposables used in surgery. For example, if a procedure called for 100 liters of fluid and sutures, the patient would have to show up with cases of saline solution and a box of sutures the day prior to the surgery. NPGH staff would carefully check off all the items the patient brought and if they were satisfied the patient would have the procedure the next day as originally scheduled.

Moreover, the patient would have to pay operating room costs – about 5,000 Kenyan Shillings, equivalent to about $65.

Once I found out about this I made it clear to the patients that the doctors were providing their services free of charge and NPGH agreed to waive all operating room costs (although not supplies) as long as our doctors were doing the surgeries. Although not fully placated this seemed to calm every down. As an aside, because of time and equipment constraints, we were not able to perform scheduled surgeries on about 12 patients that had originally been scheduled which meant that, if they were subsequently operated on by a local surgeon, they would be responsible for the operating room fees which many could not afford.

Feeling an ethical responsibility to these patients that we screened, scheduled for surgery and most of whom had bought their supplies (which they had to take home and could not store at NPGH lest they disappear), we agreed to pay the operating fees when they scheduled the subsequent surgeries.

I believe this brought us even more goodwill from already grateful NPGH staff and patients alike.