A Ray of Hope on Health Care from an Unlikely Source

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Health care professionals in Egypt conduct a stakeholder analysis to help spell out governance principles for Egyptian hospitals.

A hip replacement in the United States, paid for out-of-pocket (i.e., without health insurance), would cost anywhere from $11,000 to $125,000, depending on what hospital you go to, according to a 2013 survey of 100 hospitals featured on National Public Radio.  And that was among the hospitals that, when asked, could actually produce a quote – 40 of the 100 hospitals surveyed couldn’t quote a price at all.

Those fortunate enough to have insurance don’t need to worry about price-shopping.  When I go to my primary care physician, I pay a $20 co-pay.  (Under our previous insurance, provided by my wife’s former employer, it was $10.  Why the difference?  Who knows?)  I have no idea how much my insurance company pays the doctor.  I suppose I could find out, but… honestly?  There’s really no compelling reason for me to do so.  It’s $20 no matter who I see.

And it turns out that, even if there were more incentive for me to price-shop, more expensive hospitals aren’t necessarily better hospitals, according to a 2014 study.

It’s no wonder that the point of the greatest consensus in the debate over health care reform – the need to control costs – is also the point of perhaps the greatest frustration.  Anyone who’s ever had the misfortune of having to move a futon mattress (Where the heck do I grab this thing to get any leverage?!?) has some idea of what it’s like to try to get a handle on controlling health care costs, whether here in the United States or in just about any country you could name.

It’s a complex system, lacking in transparency, and with lines of accountability that are… convoluted, at best.

And it touches the life of every single citizen.

Recently, a ray of hope has emerged from an unlikely source, in the form of Dr. Mostafa Hunter of Egypt, Chairman of the Healthcare Governance and Transparency Association (HeGTA).

With the support of CIPE, HeGTA set out to apply the principles of corporate governance (emphasizing transparency, accountability, fairness, and responsibility) to the governance of Egyptian hospitals, in an effort to “create autonomous, accountable and well-governed hospitals capable of taking decisions independently and competent enough to operate in a rapidly changing sector, while positively interacting in a complex stakeholder environment.”

Recognizing that hospitals do not provide care in a vacuum, HeGTA sought to include in its effort a wide-ranging set of stakeholders, including doctors, nurses, insurance companies, pharmaceutical representatives, public and private hospitals, government officials, corporate governance experts, representatives from the financial sector, business associations, and others.

Following a lengthy and comprehensive consultative process with corporate governance experts and with stakeholders throughout Egypt, on March 30, CIPE and HeGTA released Principles & Guidelines for Governance in Hospitals in both Arabic and English, the first guide to governance of its kind for the healthcare sector.

The guide spells out principles for healthcare governance in five interrelated domains: corporate governance and clinical governance; board excellence; control, audit and risk frameworks; sustainability and inclusiveness; and transparency and disclosure.

Since the launch, HeGTA has begun working with a newly-formed health governance committee within the Ministry of Health and Population to implement the guide in select hospitals as a pilot project.  Dr. Hunter was invited by the Ministry to be on the board of the committee.

The guide has also earned international attention.  On Tuesday, May 13, at 9am EDT, the guide and its lead author, Dr. Hunter, will be featured in a World Bank webinar entitled Introduction to Principles and Guidelines for Better Governance in Hospitals.  In the webinar, which is open to the public, Dr. Hunter will give an overview of the guide, its application, and how implementation of sound governance principles can lead to more effective and efficient delivery of healthcare services.

If you have the time, tune in.  You will learn a lot.  I sat down with Dr. Hunter on a recent trip to Cairo where, in about 30 minutes on three landscape-oriented pieces of A4 paper joined end-to-end, he mapped for me the byzantine organizational hierarchy of the Egyptian health care system (public, private, and not-for-profit). The scope of this herculean task, and the deceptive ease with which Hunter laid it all out, left me blinking and open-mouthed in amazement.

I was thinking we should keep him here for a while, and see if he can help us get a handle on the real cost of a hip replacement.

Greg Simpson is Deputy Regional Director for the Middle East & North Africa.

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