Here are five questions all should ponder about what it means when ownership status changes from nonprofit to for-profit.
First, should the money that comes to Maine for dialysis services leave Maine? When health care facilities are locally owned, Medicare reimburses them for the cost of providing care to people in their communities. The money that comes to Maine stays in Maine.
When multinational corporations own clinics, some of that money leaves the community. Where does it go? It goes to corporate headquarters and is used to pay company stockholders. It pays the salaries of company executives who are working to build more business, not benefit the people of Maine. The salaries are likely to be much higher than the salaries most Mainers receive. In today’s economy, should the money that comes to Maine stay in Maine and benefit local businesses?
Second, do communities want health care businesses they cannot control? Health care facilities such as Eastern Maine Medical Center are nonprofit and tax-exempt. They are required by law to have a governing board whose responsibility is to ensure the institution serves the community and is accountable to it. When a multinational company takes ownership of clinics and hospitals, its fiduciary responsibility is to the people who own the company, not the community. There is no local board to whom the company is accountable. Communities lose control of the health care facilities when they are sold to multinational companies.
Third, do communities want a health care business that is not accountable to the people of Maine when they become patients? If a person undergoing dialysis has a problem with the treatment, who is accountable? Where does the buck stop? With a manager in a regional office? That employee is accountable to his or her supervisor, not to the community or a board that represents the public’s interest.
Fourth, do communities want doctors with divided loyalties? Health care companies have a variety of compensation schemes for doctors who refer patients to dialysis and for medical directors of the facilities. The doctors may own stock in the company or have other types of financial arrangements unique to for-profit companies. While these arrangements may be legal, it doesn’t lessen the reality of conflicts of interest. A doctor’s loyalty is divided between the interest of the patient and the interest of the company. Where do you want your doctor’s loyalty to reside?
Finally, will a multinational company headquartered far away take better care of the people in Maine than people who live in the state? Corporate executives who work in offices that are located long distances away will establish and carry out policies that affect the health and well-being of people in Maine. How can they do a better job than the people who call Maine home? Many investor-owned companies can add specialized knowledge and value to health care. What is the company doing that Mainers could learn to do just as well under local ownership?
An unanswered question is why EMMC is selling its clinics. Is it because a large dialysis company can drive out smaller providers because it has negotiating clout with a manufacturer of a drug used in dialysis treatment?
Health care is personal and all the more reason that Mainers should know the facts before deciding whether to invite a company into the house.
Rosemary Gibson led national health care initiatives at the Robert Wood Johnson Foundation, where she worked with Mainers on ways to improve health care. She is the author of “The Battle Over Health Care” on Wall Street’s impact on the future of health care.