Sunday, August 30, 2009

The Business Model of Health Care

Twitter friend @StaticNrg, a highly empowered Cushing's Syndrome e-patient, sent an article that ends thus:


Our society has decided that provision of certain services is best left to the government and out of the marketplace. It is ridiculous to think of multiple water systems, for example, competing to bring drinking water to individual households. It is equally unthinkable to subject fire departments to the economic dictates of competition: we certainly do not want fire chiefs to be creating more demand for their work. We do not choose to divvy up national defense between competing suppliers of armed services, for obvious reasons. Alternatives to these types of public services just do not fit into the corporate model that works so well for consumer goods and services. They are either too expensive, lacking in overall benefit to the entire populace, or just plain too chaotic.

Should health care be any different? Do we want the consumer-driven marketplace to rule in such a way that untrained, vulnerable individuals can order for themselves expensive medical tests that have no proven benefit and may carry incalculable opportunity costs? Do we want entrepreneurial efforts to increase consumption of highly profitable drugs, regardless of cost and any consideration of what might be best for medical care? Do we want a system that rewards the creation of expensive and profitable services, such as NICUs, without consideration of need? Do we want to continue to witness the compromise of the integrity of basic medical research in the name of profit?

As these questions are framed, the answers are obvious. Clearly, it is necessary to overhaul our health care system so that decisions are made to improve health, not the bottom lines of corporate enterprises. Current issues in health care that politicians debate (universal health insurance, medical malpractice reform, a drug benefit for senior citizens) are important, but dealing with them will constitute mere tinkering with a system that needs more than a patch here and a stitch there. Rather, fundamental assumptions about medicine’s role in our society need to be considered. It is a wonder that we allow such a flawed system to persist. It a greater wonder that the basic question of what health care should be, a business or a social service, is not even on the national agenda.

I thought "MAN that makes sense! Who brought this into our discourse?? I sure hope people listen!"

Then I saw the publication info:
James P. Whalen is a medical doctor and a freelance medical writer living in Oak Park, Illinois. The Independent Review, v. VIII, n. 2, Fall 2003, ISSN 1086-1653, Copyright © 2003, pp. 259–270.

2003. Six years ago! Still makes sense to me.

1 comment:

  1. Those are very good points indeed. Could you see fire departments on "pay for performance". If you watch the news, here in southern California, there might be a big advantage as we have the dry fire season and are on the news all the time, but not the same in the rest of the country, a bit of satire, but making a point. This is how health care is done though, with algroithms to create the goals, etc. that need to be reached based on demograhics and statistics.

    What if police departments had to show a profit and had to report to shareholders? Well enough said there as I think the picture is clear about business models. Perhaps healthcare needs to be looked at as more of a public service and not profit driven.


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