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This page created April 2000 by Michael Wynne
Choice in health care is a very different
process to choice in the marketplace. Potential patients are
vulnerable to manipulation, misuse and abuse. While advocates of a
health care marketplace claim that the market provides more choice,
it is not in the interests of corporations to provide this. In
practice they have a very poor track record.
Marketplace advocates promote their solutions arguing that the "consumer" or "customer" is able to shop around for quality and cost. This assumes that the patient has the knowledge, is in a position to be sufficiently objective and has the time. In large numbers of situations, particularly those where major decisions must be made urgently it is not practical for the patient to be an effective customer.
It is not only the extent to which the market
has misused citizens but that those who have been most misused are
the most vulnerable and dependent sections of society. This is what
is so disturbing about corporate market practices. Education and
choice are exercised more effectively and much more safely in
alternate systems.
Proponents argue that patients are becoming much more knowledgeable and many are gathering large amounts of information from the internet. This is certainly so and when the patient becomes more informed about a particular disease than the doctor this can be threatening. It is more like dealing with a colleague, but this too can be very rewarding.
In most instances an informed patient is more able to be involved in the discussion of the illness and in decision making. A much better relationship can be established. The treatment of a disease is a joint venture between the doctor and the patient to which both contribute. There is a duty of care but it is not a one sided contract to provide a service. The patient has a critical role to play.
In contrast it is sometimes difficult to
establish a good relationship with the market orientated patient who
comes to buy a product. The lack of trust can make patients like this
difficult to managed when they become seriously ill. Care is far too
individual and personal to be handled effectively by the market. The
distrust fostered by the marketplace is not conducive to a good
therapeutic relationship.
Providing choice is costly. A well informed patient interested in exploring the issues in depth and making choices may take 30 to 60 minutes. A patient who simply wants advice as to the best treatment may take 5-10 minutes. Extra time has to be paid for and corporations will not want to pay for this extra time unless it generates more money for them. These patients create tensions in any system which is intended to be "efficient".
If educating and informing patients provides
an opportunity for marketing and if it recruits patients to their
hospitals then corporations will pay for time. A very important
aspect of choice is the way in which patients are educated and
informed. Are they given useful information to help them choose or
are they given information which aims to influence that choice?
Even intelligent people lose objectivity when they or a loved one become seriously ill. Tenet/NME and Sun Healthcare in particular misinformed the families of the young and elderly respectively and then capitalised on their anxiety.
To become fully informed in a particular
facet of care requires time and study and only some seriously ill
patients have the luxury of time and the ability to be objective.
Doctors should be the most discerning of health care customers. As
patients they can lose their objectivity almost as readily as others.
A caring and well structured not for profit system of cooperating
people will serve the needs of this group well. The market has not.
The health care market while claiming to provide choice has in fact more than any other system limited choice. Market systems which use competitive practices and contracts to reduce costs and increase efficiency seriously limit time for discussion. This is one of the major reasons why citizens and doctors in the USA are moving away from managed care. The model which the Australian Graeme Samuel promoted to the World Bank relies on similar competitive pressures and contracts.
An even more disturbing aspect is the way in which corporate groups have misused marketing, education and patient information for their own commercial purposes rather than to help patients make informed choices. The extent to which corporate interests misused the power given to them by their status as providers, and their dishonesty in manipulating patients for their own purposes deserves a page of its own. Marketing and corporate education programs have been used to limit choice.
CLICK HERE -- for information about marketing and misinformation.
The big attraction for corporations in countries which have had a predominantly publicly funded and provided system is the contracts with government to provide care for the public. These contracts will be competitive and profits may be limited. Governments are also now paying for less, pushing people towards private care, making waiting lists longer and talking about rationing.
Everyone is going to want the best for their relatives - a longer consultation, the more expensive but better drug, earlier admission to hospital. The potential for profits is endless and those who have these contracts will have access to the patients so can "educate them" about the additional services.
As I read between the lines the carrot which will draw corporations to contract with government at "competitive rates" may well be that they will be able to market and sell extras like special information consultations. The prospects for abusing a system like this are endless, and the track record of market listed for profit corporations in doing so is disturbing.