Healthcare is often perceived as a noble profession grounded in principles of compassion, ethics, and the oath of providing quality care to patients. However, an alarming trend in Kenya's healthcare system has emerged, where doctors are not only tasked with saving lives but are also given financial targets to meet. This unfortunate practice, common in both public and private health institutions, distorts the core purpose of healthcare and leads to compromised medical care. After engaging with a doctor recently, I came to understand how these financial goals affect healthcare delivery and why this practice must be legally and morally condemned.
The Rise of Financial Targets in Healthcare
Financial targets, once primarily associated with corporate sectors like sales and marketing, have increasingly made their way into healthcare settings. Hospitals and clinics, both public and private, now often impose monthly revenue targets on doctors. The objectives can include maximizing patient admissions, performing a certain number of diagnostic tests, and prescribing specific treatments or procedures, often regardless of clinical necessity. This practice is driven by the growing commercialization of healthcare services and the desire of healthcare institutions to boost revenue from insurance claims, patient fees, and out-of-pocket payments.
Doctors are thus incentivized—or sometimes forced—to shift from their original role of prioritizing patient health to meeting financial quotas. This creates a moral dilemma: should doctors prioritize quality patient care or aim to meet the financial demands set by their employers?
The Ethical Dilemma: A Breach of the Hippocratic Oath
The cornerstone of medical practice is the Hippocratic Oath, which compels doctors to do no harm and prioritize the well-being of their patients. However, financial targets put doctors in an ethically compromising position where they may have to choose between providing necessary, effective care and ensuring they meet revenue goals. For instance, to meet these targets, doctors might admit patients for longer durations than necessary, prescribe unwarranted tests and procedures, and recommend treatments or medications that may not be medically required.
These practices not only violate the ethical principles of medicine but also exploit patients who trust doctors to act in their best interest. The financial burden placed on patients through unnecessary tests, procedures, and extended hospital stays can lead to undue hardship, especially in a country like Kenya where many individuals and families already struggle with the high cost of healthcare.
The ethical implications of this are profound. Medicine, as a profession, should be centered on patient welfare rather than financial gains. The prioritization of profit over health by healthcare institutions goes against the spirit of healthcare and puts doctors in difficult situations where they must balance their duty to their patients with their financial obligations to their employers.
The Consequences of Financial Targets: Patient Exploitation and Systemic Issues
The introduction of financial targets into healthcare facilities has far-reaching consequences. Patients, who trust their doctors with their lives, are often unaware of the financial pressures driving decisions regarding their care. This lack of transparency can lead to exploitation, with patients being subjected to unnecessary tests, treatments, and prolonged hospital stays that are not only costly but may also put them at risk for further complications.
In the context of Kenya, where many citizens rely on public healthcare or out-of-pocket payments, the financial strain caused by unnecessary treatments is particularly concerning. Many patients already face difficulties in accessing affordable healthcare, and the imposition of financial targets exacerbates this challenge by increasing the cost of care without necessarily improving its quality.
Moreover, the focus on financial targets undermines the trust between patients and healthcare providers. Patients who become aware of these practices may lose faith in the medical system, leading to delayed treatments, distrust of diagnoses, and an overall reluctance to seek medical care when necessary.
The Role of Healthcare as a Commodity
This troubling trend reflects a broader global issue: the commodification of healthcare. As healthcare becomes increasingly commercialized, the focus shifts from providing quality care to maximizing profit. This commodification turns healthcare into a product to be sold rather than a fundamental human right. Institutions, particularly private ones, may argue that financial targets are necessary for sustaining operations, especially in a resource-limited country like Kenya. However, when profit becomes the primary goal, patient care inevitably suffers.
Economist Kenneth Arrow’s seminal work on healthcare markets argues that healthcare should not be treated like a traditional market commodity. Arrow suggested that the unique nature of healthcare—characterized by trust, uncertainty, and the non-fungibility of services—makes it unsuitable for market-based systems that rely solely on financial incentives. Applying traditional financial targets to healthcare distorts the decision-making process, leading to over-treatment, over-diagnosis, and the exploitation of vulnerable patients.
A Legal and Moral Call to Action
The imposition of financial targets on doctors is not just a moral issue; it is also a legal one. International human rights law recognizes the right to health as fundamental. Article 43 of Kenya’s Constitution guarantees every citizen the right to the highest attainable standard of health. The practice of assigning financial targets to doctors undermines this right by putting profits ahead of patient well-being. Therefore, there should be strict regulations prohibiting both public and private healthcare institutions from enforcing such targets.
The government and regulatory bodies, such as the Kenya Medical Practitioners and Dentists Council (KMPDC), need to step up and enact laws that ban financial target-setting in healthcare institutions. These laws should protect doctors from being forced into unethical practices while ensuring that healthcare institutions prioritize patient welfare over financial gain. Furthermore, insurance companies and healthcare providers should be held accountable for any form of malpractice that arises from financial target-driven care, as it fundamentally compromises the delivery of ethical and quality care.
Healthcare Must Prioritize Quality Over Profit
At its core, healthcare is about saving lives, alleviating suffering, and promoting well-being. Financial targets, which incentivize profit over patient care, have no place in this sacred profession. Kenya’s healthcare system must be restructured to prioritize quality care over financial gains, and doctors should be free to fulfill their oath without the undue burden of financial targets. In a nation where access to healthcare is already challenging for many, the commercialization of care exacerbates inequalities and places unnecessary financial and health burdens on patients.
As we push for healthcare reforms in Kenya, it is crucial to recognize that the commodification of health threatens the very foundation of patient care. Laws should be enacted to protect both doctors and patients, ensuring that healthcare remains a service grounded in ethics, quality, and compassion—not financial targets.
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