John Salmon wrote:
> Subject: Free market economics and medicine
> There is an article in "The World In 1998" written by an American health
> care
> economist who predicts that free market forces will dictate how medicine is
> delivered, initially in the USA and subsequently in the UK. I think this is
> inappropriate for health care in the UK and will make it more expensive and
> less
> efficient. I felt compelled to write to The Economist and the letter is
> below.
>
> What do other GP-UK List subscribers think about this seemingly relentless
> march of
> free market economics ?
>
> Dear Sir,
> I was interested to read the article in your annual magazine, The World In
> 1998, by
> Regina Herzlinger called "Shopping for your doctor". This indicated that
> medical care
> in the USA and subsequently in the UK was going to succumb to free market
> forces.
> The article is in keeping with the philosophy of The Economist that the
> free market
> should apply throughout society because it induces fairness, efficiency and
> a
> reduction in costs.
>
> I am a family physician in the UK. I strongly disagree that this simple
> idea, when
> applied to a subject as complicated as health care, will have these
> desirable effects. I
> do agree that patients should be fully informed and that monopolies,
> notable in some
> areas of medicine, should be curtailed.
>
> If patient access to specialist investigation and treatment grows it will
> increase the cost of medicine. Evidence of this is already apparent.
> Patients expectations have
> risen dramatically in the last few years, encouraged by the Patients'
> Charter, and this
> has led to escalating costs.
>
> Family doctors are a moderating influence on these rising costs and they
> help patients
> make intelligent choices of investigations and treatments. If the free
> market were to
> exert an increasing influence on medicine then costs would continue to rise
> and
> become unsustainable. This could ultimately lead to the collapse of the
> National
> Health Service.
>
> Dr John Salmon
It is my belief that there is more cobblers talked by economists
about the virtues of 'market forces' as applied to provision of
health care than almost any other single topic that they turn to.
It seems to me that there is a massive misfit between the usual
applications of 'market forces', in areas such as the provision
of consumer goods, say, and the provision of health care. This
arises because the consumer elects to become a purchaser of a piece
of furniture or a TV set. There is no such element of voluntary
participation in the acquisition of health care. Most people do not
suddenly decide that it might be nice to develop an ailment, or to
have an accident. So the acquisition of health care is imposed on
the patient from without, not undertaken voluntarily. This means
that the patient does not have the option to compare the costs of one
form of provision with another, or to elect not to bother at all,
that he does in the case of a more strightforward purchase of goods
or services. (I suppose one might argue that this does not apply to
malingerers or to hypochondriacs, who elect to seek treatment; but
then one can use the normal 'market forces' approach for these
groups, and charge them a going rate)
Because the (genuine) patient is in a totally different setting from
the normal purchaser, it seems to me inevitable that to apply market
forces arguments is in essence wrong headed, and likely to lead to
some of the crass situations that have arise under the previous
administration (and that I regret to say look as if they might
persist under the present one!).
Mike Wells
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* M. Wells *
* 9 Hall Close *
* Bramhope *
* Leeds LS16 9JQ *
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