Commercialization of Medicine-An email from my cousin

Dear Hoosu,

    Thank you for your emails about your work and the commercialization of medicine, the book
    ‘A First Rate Madness’ and your picture with friend Jayesh. I hope everyone is as well as
    possible.

    It seems that in India people see private commercial hospitals as having more advanced
    technology, lower waiting times and being cleaner and more hygienic than government
    hospitals. I also understand that government hospitals provide lower charges or are free. To
    some extent private medicine has provided more private hospitals for the country in general,
    some with up to date technology, but the problem remains that the poorer cannot afford it.

    Some deals have been done between private hospitals and government like the government
    giving cheaper subsidized land to the private sector in return for the private sector giving
    cheaper or free treatment medical treatment to the poor. The poor can be defined as those
    with an income below a certain amount, per month or year. Whether such deals work is not
    clear though the concept can be taken further, with the government offering to some extent
    what it has control of e.g. tax concessions for treating the poor.

    There are examples of things being made cheaper and more affordable in the commercial
    world e.g. food, clothes etc being made more affordable by bulk buying and bulk large scale
    selling as in large supermarkets and department stores. Such commercial principles in
    medicine could mean treatments being provided in larger streamlined amounts when the
    treatments are in demand and are needed in large amounts, and so provided more cheaply.

    I also understand that the Indian government has made pharmaceuticals free in hospitals,
    and the bulk buying principle could also be used to make medicines cheaper. Another thing
    that sometimes makes things cheaper in developed countries is when the merchandise is
    made with more advanced technology or cheaper labor costs. It should however be noted
    that the way of thinking that if there are profits to be made more people will be attracted to
    the business or profession, can also mean that when there are too many businesses with the
    same products, and can lead to less profits for each business and in the medical area can
    lead to over servicing of patients.

    Arguments or points in favour of commercialization include mainly for less developed
    countries:

    -offering better resources and better equipment which would enable a hospital to run in a
    better way
    -advanced technology coming into the picture means more chances of survival e.g. for
    operations and cancer
    -there can be a huge difference in less developed countries between facilities provided by
    private hospitals that those available in government hospitals. In many so called developed
    countries there is not much difference between private and government hospitals.
    -commercialization could result in advancement of healthcare raising the level of care.
    -in less developed countries commercialization brings in hygienic ways which government
    hospitals may fail to show
    -it promotes competition and therefore possibly efficiency and better service standards
    -it ensures doctors are well rewarded for their efforts
    -government can adjust costs by commercializing some medical areas that would reduce
    costs if commercialized.
    -less queues and so less delays in getting treatment and finding treatment givers

    Arguments against commercialization include:

    -medical care is a basic necessity, it should be free or subsidized as far as possible.
    -a high percentage of the population in many countries being economically weak cannot
    afford to pay the expenses of a private hospital, except possibly through insurance.
    -the benefit given to the poor is negligible as richer people become the major beneficiaries of
    commercialization
    -commercialization of private companies is possibly another way of filling some people’s
    pockets and generating revenue
    -the worth of ones life can be ignored as medical staff may care more about their own
    betterment and profits
    -it can give rise to corruption as in countries like India, medical officers do tend to sell the
    medicines of public hospitals in their private clinics
    -poor are not always able to take benefit of advanced medical technology and hospitals as
    they are out of their reach financially and otherwise
    -it even hurts the middle class as the doctors and hospitals may try to make more money
    when they see the patient can afford much more
    -it can get duplicate drugs in the market. Many times drugs which are banned in other
    countries are sold in third world less developed countries.
    -the motive of economic gain, places the well being of patients in danger and undermines
    the trust so essential to a doctor-patient relationship
    -private hospitals have to make profits to survive and so can charge higher than non-profit or
    government funded hospitals for services. Healthcare should be provided at affordable
    prices for as many as possible, business should not be made out of it at too great an extent.
    -when doctors think of themselves as being primarily in business, professional values can
    recede and the practice of medicine can change.
    -the focus on money making and attraction of financial rewards could have changed the
    climate of USA medical practice at the expense of professionals seeking the welfare of
    others and the moral commitment to patients
    -endangers the ethical foundation of medicine, including the commitment of doctors to put
     the needs of patients ahead of personal gains, to deal with patients honestly, competently,
    compassionately, and to avoid conflicts of interest that could undermine the public trust in
    the altruism of medicine.
    -medical treatments and counselling lacking profit potential, however effective may be
    discouraged.
    -exploitation for profit purposes of the patients trust of doctors
    -monopolies could be created where one company becomes too big and takes over the
    market and then charges what it wants as customers may not have other choices through
    lack of competition in a monopoly.

    As you may recall in developed countries commercialization does not appear to do as well,
    since in more privatized medicine as in the USA, the health outcomes per dollar spent are
    not as good as in government run medicine that exists in other developed countries.

    Some moral values hospitals should keep in mind are:

    -treat patients with humanity, cure patients with care and positive behaviour

    -they should provide emotional support to family members, their motive should be welfare of
    people not being profit orientated, have concessions for poorer people
    -partiality should be avoided, hospitalization is a service not a business.

    To prevent exploitation of poorer people or any people, governments can bond with private
    hospitals, have strict rules, give subsidies for poor people, health insurance for poor people,  
    control over corruption, have structure improvement by tie up with private hospitals.

     Medicine is a profession and like many professions, is one of the choices society has for
     controlling and organizing work. Other choices are the free market and management by
     organizations such as governments or private businesses. A profession is highly specialized
     and grounded in a body of knowledge or skills that give it special status in the labour force,
     its members are certified through a formal educational program controlled by the profession,
     and qualified members are granted exclusive jurisdiction and a sheltered position in the
     labour market.

    Perhaps more important, professions have an ideology that assigns a higher priority to doing
    useful and needed work, than to economic rewards, and ideology that focuses more on the
    quality and social benefits of work than its profitability. However money is needed for a
    comfortable life and a situation where professionals earn much less than others should not
    exist.

    The alternative to a full time formal educational program, is working and training as in trade
    apprenticeships and this system could be used where suitable in professions .However a
    situation could exist where there may be too many apprenticeship trainees in a profession
    and not enough employers to train them. Somehow society usually manages to train enough
    people and give them a comfortable or other pay, to serve others in most professions and
    trade employee situations.

    If people were not earning enough in a profession or trade employee situation they may
    have to do alternative jobs or employment that pays more in society. In general economic
    terms it is possible that when there is a high demand and low supply for a profession or
    service they get paid more and increase in number, due to more employees being attracted
    to the higher pay that employers can offer due to the high demand, low supply situation, and
    when there is a high supply and low demand for a profession or service, the service
    providers may get paid less, and decrease in number, as less people may be attracted to the
    low pay that employers can offer due to the high supply, low demand situation .In effect if
    society had less need for a profession or service, the profession or service would earn less,
    and so less people might be attracted to work in the profession or service givers.

    Similarly if society had more need for a profession or service, the profession or service may
    earn more, and so more people may be attracted to work in the profession. They do however
    say that people are attracted to a professional subject out of interest, rather than how much
    it pays.

    Though surveys are not always trustworthy a survey found that in countries like India, the
    number of people visiting private institutions for healthcare was higher in urban areas at
    79%, than just 72% in rural India. Many people are turning to private health providers that
    have mushroomed across the country because of poor infrastructure at often overcrowded
    government run hospitals. Some data showed that people opted for private sector treatment
    even though it cost about four times as much as treatment in government institutions. About
    one fourth of patients are getting pushed into poverty because of high out of pocket health
    expenses. With cost of treatment almost doubling in India in the past decade, and insurance
    cover still less than 15%, 68% of people in rural areas and 75% of people in urban areas use
    their savings for treatment. Since drugs constitute the bulk out of pocket expenditure, the
   government has intensified efforts for provision of free essential drugs in Public Health
   Facilities.

    It is possible that you have heard these arguments for and against commercialization of 
    medicine before.

Bye for now, Best Wishes,
Husaini Sadikot