A Medical Financial System
Dr. Henderson is a family physician in Riverside, California. Dr. Byrne is chairman of Pediatrics at St. Vincent's Medical Center in Bridgeport, Connecticut
1. The primary purpose of this discussion is not to criticize or condemn any member of the body of Christ; but while speaking the truth in love, showing that the Christian physician needs to evaluate the manner in which he practices medicine in our society by applying scriptural principles.
2. To determine basic scriptural principles of finance which are applicable to a medical practice and in the establishment of a non-secular billing and collection system.
3. To compare the most common secular approach to finances with these scriptural principles.
4. To apply these principles, offering some possible alternatives.
In post-Christian, American society of the late twentieth century, we have returned to the values of our grandparents as they sought to avoid another great depression - fear, greed, and a survivalist mentality.` In so doing, many in the body of Christ have adopted the insidious philosophy of secular humanism, thereby incorporating into the worship and lifestyle an ancient and dangerous heresy capable of destruction and delusion. Evidence of this can be found in both mainline denominations and in the "so-called" faith and prosperity movements. This philosophy has its roots in ancient Hinduism and suggests that man has become or can become a god through an evolutionary process by mastering natural forces.' Thus, the center of its worship is mankind, where self is enthroned in the place of worship, rather than God (I Thessalonians 2:4).
Herbert Schlossberg remarks about this philosophy:
"Exalting mankind to the status of deity therefore dates from the furthest reaches of antiquity, but its development into an ideology embracing the masses is a characteristic of modernity.",
In depth exploration of this philosophy is beyond the scope of this discussion, save to mention its presence and influence on the body of Christ, as exhibited by those signs listed in Tables 1 and 2.
Throughout history, the church has given religious instruction via a question and answer format known as the catechism, which is based on scripture. The very first question in the Westminister shorter catechism asks, "What is man's chief end?" The answer. "Man's chief end is to glorify God and to enjoy Him forever.'"
This is supported in scripture. Psalm 16:8 states: "I have set the Lord always before Me . . ." The psalmist goes on in verse 9 to say, "Therefore, my heart is glad, and my glory rejoices. . ." He found great joy in God, as he kept the Lord as his focus. Psalm 73:25 states, "Whom have I in heaven but Thee, I desire nothing on earth." So man's chief end is to glorify God, which results in eternal joy.' If this is true of our personal lives, then we may deduce that our businesses should, likewise, glorify Him whom our souls adore. (How do we glorify God? See Figure 3.)
But do we? Specifically, as Christian physicians who are servants of Almighty God, do our practices reflect scriptural principles in regard to setting charges and collecting fees? It has been our observation over the past ten plus years, working with physicians practicing in different regions of this country, that many times there is very little difference between Christian and non-Christian physicians in the area of billing and collections. Is this due to a lack of knowledge of God's principles, a lack of insight, or an act of neglect or disobedience?
One particular professional interviewed in the course of research for this article, revealed he was unaware of his reason for accepting bad debts he just did it. If he was unaware of Biblical financial principles, being a leader of his church, how could he communicate the Biblical principle of stewardship to those under his authority?
There are at least 700 scriptures in which God deals with finances and principles of finances.' Ron Blue quotes John MacArthur, Pastor of Grace Community Church, Panorama City, CA from his tape series "Mastering of Materialism" stating,
"Sixteen out of 38 of Christ's parables deal with money; more is said in the New Testament about money than heaven and hell combined; five times more is said about money than prayer; and while there are 500 plus verses on both prayer and faith, there are over 2,000 verses dealing with money and possessions.'
Jesus said, "Don't lay up for yourselves treasures upon earth, where moth and rust destroy and where thieves break in and steal. But lay up for yourselves treasures in heaven, where neither moth nor rust destroy, and where thieves do not break in or steal; for where your treasure is, there will your heart be also" (Matthew 6:19-21). Additionally, in the parable of the talents (Matthew 25:14-30), the master's response to each servant indicates that God has a lot to say about finances, and also about how our spiritual maturity is effectively gauged by the handling of our personal and business affairs.
What, then are some scriptural principles which can aid us in our billing and collection system? First, is the realization that God owns everything (Matthew 25:14; Proverbs 3:46). There are three implications to this principle. The first implication is that God has the right to whatever He wants, whenever He wants it. This removes from us all ideas of personal wealth of possessions. The only position left to the individual believer is one of being a steward or manager of what God has entrusted to him. Stewardship may be defined as the use of God given resources for the accomplishment of God given goals $ Believing this frees us to give generously of God's resources to God's purposes and people. The second implication of God's universal ownership is not just that my giving is a spiritual decision, but every spending decision is a spiritual decision as well. Why? Because God owns it all! The third implication is that one cannot fake stewardship for everything will come to the light when the Master examines the individual believer's use of His resources.
The second principle is an extension of the first. If God owns everything, if man is a steward of God's possessions, and if man's chief end is to glorify God, then everything we have is for God's glory. This is supported by Proverbs 16:4 when Solomon states, "The Lord hath made all things for himself." (KJV)
The third principle involves establishing the tithe from the increase in our finances. Since the tithe is God's mark of ownership on believers (Genesis 14:20; Malachi 3:8-10), we may deduce that our businesses are extensions of ourselves and are possessions in the steward's hands. Therefore, we should establish the tithe in our businesses (Deuteronomy 14:22-29; Matthew 25:44-45 ). Once the tithe is established, we need to support God's work and give to the poor including widows, ministering brethren and unbelievers (I Corinthians 9:9, III John 6-7; I Timothy 5:3).
We must remember the material wealth that God graciously provides as a result of our businesses (or income) is to be shared for His work and for doing good (Psalm 49:10-11; Revelation 3:18; 1 John 3:17-18; James 2:14-16; 11 Corinthians 8:11-12). For those who have an abundance, it is their responsibility to share with those in need. In so doing, the Lord will utilize these funds to meet the needs of other, provide direction in their lives, unite believers through many shared blessings (I1 Corinthians 8:14), and demonstrate His power over the world. By our willingness to share with each other and with non-believers, we are a testimony to God's love, power, and ownership in this world (Matthew 5:42; Matthew 10:42; Luke 12:33). It is crucial to remember, "He who gives to a poor man, lends to the Lord, and He will repay him for his good deed" (Proverbs 19:17; Proverbs 14:31).
How, then, do we evaluate a person to be a recipient of charity? Some questions to consider are: 1) Is this person willing to work) 2) Is he able to work? 3) Should we aid him in establishing a budget and assist him accordingly? This subject will be considered later in the discussion.
The fourth principle is that debt is to be avoided. Debt may be defined as the inability to meet agreed upon obligation."' Romans 13:8 states that we should owe no man anything except for the debt of love. In Proverbs 22:7, the writer states, "The borrower becomes the lender's slave." Greed is likewise to be avoided (Luke 12:15; Matthew 6:19-34; Luke 3:10-14).
Why is this important? God assumes the responsibility of providing the basic necessities for everyone trusting Him (Matthew 6:19-34; Matthew 7:11; Philippians 4:19). He will use money to strengthen trust in Him (Matthew 6:22-23). Therefore, debt is to be avoided since it presumes upon the future, reducing a believer's trust in God by depending on himself, rather than in Almighty God's ability to care for his children (Proverbs 22:7; Luke 22:15).
In light of maintaining God's testimony, not only should we avoid debt, but we should also make provision to pay all bills on a regular basis (Psalm 37:21; otherwise our effectiveness as God's witnesses is reduced. God will provide. our needs, but not necessarily our lusts nor our greed (Proverbs 28:8). If we, as the body of Christ, do not heed God's principles, then it follows that we will experience a lack of commitment to His work (Proverbs 3:910), display an arrogant attitude toward the less fortunate, and resentment toward God (John 6:16; Romans 13:8; and Psalm 37:21).
The fifth principle suggests it would be better to forgive a debt than to sue. In I Corinthians 6:1-11, believers are specifically prohibited by Paul from taking a fellow believer to court for financial indebtedness. Why is this? By taking a brother to court - thus indicating an inability in the body of Christ to handle its own affairs - the name of Christ is defamed.
In the Sermon on the Mount, Jesus talks about this very subject. In Matthew 5:13-16, He states that we are salt and light in this world. Therefore, we should let the world see out good works so that God may be glorified. In verses 38-42, He states that in the event someone should sue us (anyone, no differentiation between Jew or Gentile), we should give him our coat also. "Give to him who asks of you, and do not turn away from him who wants to borrow from you" (5:42). This suggests that lawsuits are undesirable at any time.
In summary, the five basic principles of finances are:
1. Acknowledgement of God's ownership daily. (Proverbs
In addition, there are principles for financial decision making. They are as follows:
1. Avoid speculation. (Proverbs 28:22)
Table 4 compares the secular and scriptural models for finance.
A commonly utilized billing and collection system today is the peg board system, described in Medical Economics' Encyclopedia of Practice and Financial Management. The reason for its success is that it does apply the following scriptural principle: "Let everything be done decently and in an orderly manner." (I Corinthians 14:40) In short, the peg board system allows detailed records of income and outlay. It has a counter check built in with the comparison of the day sheet. This also allows an audit trail with the "end of the month" tally." It is good for a small practice, assuming that adequate personnel are available for efficient utilization, but may be unwieldy for larger groups of multi-specialty practices. At this point, an automated system or computer super-billing system could keep overhead down more efficiently, since they, too, are "decent and orderly." Certainly, in the daily minutiae, almost any system will work as long as it is tailored around the personality of the physician and the type of practice, in order to promote efficiency and therefore better stewardship.
The bottom line is, just how can these principles be applied to a practice setting? If the Christian physician's practice is for God's glory (and is, therefore, a ministry or outreach to the world), then it makes sense that God's mark of ownership should be on the business. In other words, the tithe needs to be given from the abundance of the practice. Other considerations are: What provision will be made for the poor? What about debt and collections? What do we do with "bad" debts?
From the beginning, one can determine to tithe from the office by setting aside one half clinic day per week (10% of the total practice time) which would be used for indigent health care at no charge. For the nonindigent patient needing health care that day, the individual would be fit in as the schedule permitted, at the regular charge, with the understanding that the clinic day was primarily designed for the indigent, so no offense would be taken.
The indigent patient needing care at times other than the specified day could be worked into the schedule as time permitted during regular hours. (N.B. Patient needs and physician availability cannot be clearly separated without two separate locations: one for the indigent, and one for the non-indigent. This is not only unfeasible financially, but also suggests favoritism and violates scriptural principles. (James 2:1-13) Based on proof of inability to pay (W-4 or IRS 1040), which would be obtained by a financial manager or counselor ,a sliding scale system based on a 10% gradient (0-100%) as noted in Table 5 would be instituted and the remainder forgiven. This concept has worked extremely well at Velore Christian Medical College. Administrators recognized that the poor valued their health care only if held accountable for paying some minimal charge. An alternative to this would consist of a sliding scale for all patients with no special day set aside for the poor. Therefore, while the fee would remain constant, the indigent would be provided health care at minimal or no charge.
What about billing? Quite simply, this could be taken care of by cash at the time of service, with the insurance claim submitted by the patient thereafter. For the patient unable or having difficulty submitting the forms, this function could be performed by the office manager for a nominal fee. This would minimize necessary cost and supplies.
What about the patient who forgot his checkbook? This patient could return home for his checkbook, then either return to the office for payment or mail his check to the office within twenty-four hours. If a patient did this repeatedly, then his bill would be reconciled only on a cash basis.
In view of the credit card economy we live in, what provision would be made for credit cards? In light of scriptural principles to avoid indebtedness, we have the responsibility to be examples to our patients. Therefore, to prevent financial irresponsibility and a further indebtedness in our patients, credit cards would be discouraged. A financial counselor would be available to assist the patient in establishing the financial priorities. (This is being done successfully by at least one professional interviewed by one of the authors.)
What about the patient with a true emergency, who needs service, but is unable to pay at that time, or later refuses? For this situation, no one would be refused. If the patient were truly unable to pay, a weekly or monthly payment schedule could be arranged. An alternative would allow the patient to pay what he could and then write off the rest. If the patient then refused to pay his bill or to make appropriate arrangements within 120 days, the bill would be forgiven. At this point, the patient would be considered financially irresponsible and instructed by the physician at that time to find a different health care provider by the end of thirty days. [N.B. The assumption here is that since the human person was created by God and is special, therefore, providing medical care to the needy patient has precedence over financial considerations.]
It must be emphasized that the physician would not take a person to court: a believer, because of scriptural prohibition and an unbeliever because of the testimony of the gospel. When in doubt, it is better to forgive a debt and move on. The most important consideration is God's reputation.
In summary, the principle purpose of this discussion was to show the need for a rethinking of practice principles, which need to be scripturally based if we are to glorify God before the watching world. Secondly, by applying scriptural principles to a practice setting, this discussion can assist the Christian physician in developing a financial system consistent with scripture. Third, the comparison of the secular with the scriptural approach to finances is important for the Christian physician in order to view the common pitfalls that may be undertaken unintentionally.
Fourth, the application of these scriptural principles are offered as an encouragement to Christian physicians, exhorting us to "do all for the glory of God." Finally, these guidelines are offered as an alternative to the current practice of medical collections.
Over one hundred years ago, an English physician identified with the Chinese population in language, in dress and in customs. Hudson Taylor, this same English physician, uttered the principle which he used to provide for his ministry then, and which is even more applicable today:
God's Work Done in God's Way Will NOT Lack
Bibliography for a Medical Financial System Based on Biblical Principles
1. Schaeffer. Francis, The Church at the End of the Twentieth Century, InterVarsity Press. 1969.
2. Hunt. Dave, The Seduction of Christianity, Harvest House Publishers, 1985, pp- 88-90
3. Schlossberg, Herbert, Idols for Destruction, Thomas Nelson, 1983, p. 40.
4. MacArthur, John, Keys to Spiritual Growth, Fleming H. Revell Company, 1976, pp. 21-54.
6. Burkett, Larry, Your Finances in Changing Times, Moody Press, Chicago, Illinois, 1975.
7. Blue, Ron, Master Your Money, Thomas Nelson Publishers, 1986.
9. Gothard, Bill, Men's Manual, Volume II, Institute in Basic Youth Conflicts, Inc. Oak Brook, Illinois, 1983.
10. Blue, Ron, Ibid.
11. Farber, Lawrence, Encyclopedia of Practice and Financial Management, Medical Economics Company, Inc., Oradell, New Jersey, 1985.
12. Byrne, Paul A., et al. "The Physician's Responsibility Toward Sacred Human Life,. Linacre Quarterly, November, 1986.
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