| Two decades ago, the World Bank decided the massive health-care challenges across the world couldn't be solved by government programs alone. They needed the participation of business to help plug the gap. So its investment arm, the International Finance Corp., began searching for opportunities to take equity stakes in or provide loans to for-profit providers. My colleagues and I have spent the past few months working to understand the impact of that $9 billion investment initiative on those most in need. We began hearing stories of abuse from patients across the world, from the Philippines to Uganda. On a trip to the Philippines last summer, I met Cesar Bonales. The public relations consultant checked into a Healthway QualiMed facility in Santa Rosa in early 2022 because he was struggling to breathe. Over lunch in Manila, he told me that he expected to be in the hospital for only a few days. But doctors found that one of his lungs had collapsed, and he had a host of other ailments. He spent the next five weeks in the hospital. Bonales had private insurance that was soon maxed out, he said. He hustled to borrow money from friends and family to cover the rest and used social media to appeal for financial assistance from strangers. It wasn't enough. As his bill ballooned, Bonales said the hospital cut off his access to expensive antibiotics because he couldn't pay. He managed to recover. But when Bonales was well enough to be discharged, a billing officer said he couldn't leave until he had settled his bill, which had grown to more than 700,000 pesos, the equivalent of about $12,000. It took him another six days to borrow enough money to pay his bill and leave. The hospital Bonales was detained in is part of a company that received a $100 million loan from the World Bank in 2022, just a few weeks before he checked in. Bonales' case wasn't an isolated one. The IFC declined to say how many hospital companies it currently funds. But Bloomberg identified more than 20 from the Philippines to Uganda to Kenya. At least four barred patients from leaving until they could pay their bills – a practice illegal in most countries – according to accounts they or their families provided, hospital documents and interviews with former employees. Some families said that corpses of relatives were held at IFC-backed hospitals or they were denied life-saving care altogether until they could pull together sufficient funds. Although such abuses are well-known in many countries, the IFC acknowledged in a statement that it didn't screen for them before it invested. In the statement, the IFC said it conducts extensive due diligence before making an investment. After Bloomberg asked about Bonales' treatment, IFC said it was tightening its appraisal and supervision process to address concerns about coercive financial practices. Ayala, the company that owns the hospital Bonales was treated in, said it investigated the cases highlighted by Bloomberg and "strongly refutes any suggestion that we unlawfully or unethically treated individuals under our care." For his part, Bonales says he had every intention of paying his bills. He says he's not a criminal and didn't deserve to be treated like one. Bloomberg's Investigations team is digging into hospitals funded by the World Bank's investment arm as part of an ongoing series. We'd love to hear from you if there are issues you think we should be reporting on. You can reach me at gfinch@bloomberg.net. – Gavin Finch | 
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