World Bank Reviews Health Holdings Amid Patient Detention Claims

(Bloomberg) — The World Bank is reviewing its portfolio of health care investments and bolstering its oversight procedures following a Bloomberg News investigation that found the bank had invested in for-profit hospitals that detained poor patients and turned them away in emergencies.

The Bloomberg report, published in January, found that some World Bank-funded hospitals in the Philippines and Uganda barred patients from leaving until they could pay their bills — a practice illegal in many countries — according to accounts they or their families provided, hospital documents and interviews with former employees. Some facilities denied emergency care to patients until they demonstrated an ability to pay.

“The situations that patients have described related to our clients in the Philippines and Uganda are difficult and heartbreaking,” the World Bank said in a statement on its website. “We know that we can and must do better in our oversight and supervision of client service delivery.”

The bank said it was working with its clients to understand the serious concerns raised by patients in Bloomberg’s report and to identify an “appropriate course of action.” It also said it was strengthening the supervision of its health care investments and adding additional ethical principles that its clients would be required to follow. The bank did not detail what those principles would be.

Bloomberg’s report highlighted the case of Cesar Bonales, who was admitted to a Healthway QualiMed hospital in the Philippines in 2022 with serious respiratory issues. He soon burned through his private health insurance and had to borrow from friends and family to help fund his care. When he fell behind on payments, he says the hospital cut off some of his medications.

After five weeks in the hospital, doctors said he was well enough to be discharged, his medical records show. But Bonales said that a billing officer told him he couldn’t go until he had paid off most of his bill and left post-dated checks to cover the outstanding amount. It took him another six days to borrow enough to leave the hospital.

Bloomberg spoke to five other families who said they had had a similar experience at a Healthway QualiMed facility. 

A lawyer for AC Health, the subsidiary of Ayala Corp. that owns Healthway QualiMed, didn’t immediately respond to a request for comment. The company has previously said it has never detained patients for unpaid medical bills, and declined to comment about Bonales’ case. It added that patients aren’t considered detained under Philippine law until they have received a discharge order and executed a promissory note for unpaid sums, with collateral or a guarantor, and are nonetheless restrained from leaving. AC Health previously denied insinuation of illegal, unethical or improper conduct in the rendition of its medical services.

Shortly before Bonales was admitted to the hospital, the International Finance Corp., the arm of the World Bank that invests in for-profit businesses, loaned Ayala Corp. $100 million to build a specialist cancer hospital.

Bloomberg’s report also highlighted the case of a 1-year-old who was denied emergency care last year at C-Care IHK, a hospital in Uganda, according to her mother and an eyewitness account. The baby was convulsing, her eyes were rolling back in her head and she was struggling to breathe, they said, but was left untended by a doctor in the hospital’s reception area for about 30 minutes while someone went to fetch a credit card. Two weeks later, she was well enough to be discharged, but the hospital detained her until the bill was paid, her mother said.

C-Care Uganda, which also received millions of dollars in public money from the IFC and which runs the hospital and more than 20 clinics, didn’t immediately respond to a request for comment. C-Care’s Chief Executive Officer, Azhar Sundhoo, previously told Bloomberg that staffers followed established protocols and that his company would never deny emergency care. He declined to answer additional questions about the 1-year-old’s treatment. The hospital’s priority “first is to save life, but then once it’s stabilized is to make sure they can afford it,” Sundhoo said. “In an emergency situation, you obviously haven’t got time to screen.”

The IFC told Bloomberg in December that it would tighten its appraisal and supervision process to address concerns about coercive financial practices.  

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