Service Duplication Could Force Competition

Ocean County Observer

September 12, 1977

Earlier this month, a private firm withdrew its application for a dialysis center in Toms River, rather than meet the opposition of Monmouth County hospital officials who said it would duplicate services here.

I am not sure that I understand what duplication of services means or why it is even considered important. Gas stations on every other corner (except in western Pennsylvania) represent duplicate services; liquor stores one mile or less apart represent duplicate services; cigarette machines and pay phones represent duplicate services; several movie theaters in one area represent duplicate service, but none of these cause excitement. Nor are there committees to regulate the number of such services – no A councils, no B councils, no state councils against duplication.

Only when it comes to something as important as your health does the government get exercised over duplication. If it wants exercise, it should try jogging.

There must be something si8nful about duplicate services in medicine. Otherwise, why would the government be lobbying so stridently against it? Because of government policy to prevent “duplication”, we have a shortage of nursing home beds, which causes a shortage of hospital beds, because people who should be transferred to nursing homes have to languish in hospitals and people who should be in hospitals have to “Q” up on the streets, unless they are lucky enough to catch an ambulance ride to the emergency room.

Of course, the government will interfere with anything it pays for with our money. But it is a shame to lose a dialysis center because of shortsighted government policy.

What’s the worst thing that would happen if a private firm started a dialysis center here? It might fail and go out of business. Or it might shrink the income of the one at Monmouth. Well, who said competition is bad. Maybe several centers vying for patients will find ways to improve service to patients in order to successfully compete.

Strangely, the same forces that are so concerned because there might be an extra dialysis center in this part of New Jersey, those who are fighting duplication of services, are organizing to bring more doctors into the area. Why would they want more doctors and fewer hospital beds, fewer dialysis centers, and no outpatient surgical centers, is the incongruity of the year.

The peculiar thing about the marketplace is that it is fairly up to date. The strange think about planning is that it becomes obsolete as soon as it happens. Also, as politics make strange bedfellows, so does planning.

Hospital administrators favor certificate of need for hospitals, but would like to see it abandoned for nursing homes so they could discharge nursing patients more readily.

Nursing home operators, on the other hand, would like to see certificates of need operative for nursing homes, but lifted for hospitals that feed them patients. Doctors are not unanimous in their views about these problems, but I would hazard a guess that if they would think about the problem, they would favor abolition of the certificate of need altogether. Meanwhile, we have lost a dialysis center, and many people are thereby inconvenienced.