30 August 2008

The folly of competition in medicine

If you argue against competition in healthcare you will be seen either as a Luddite or, more likely, protecting your own interests. Our political masters, goaded by the likes of Branson the profiteer with a benevolent veneer, are incapable of believing that it might actually be in the best interests of patients and taxpayers alike not to have much in the way of healthcare competition.

As it happens one of the Grumble family has just had quite major surgery. Did he shop around? No. He had it done at the nearest hospital. Was that important? Yes. He's still not fully mobile and needs physiotherapy. Did the expert Grumble family know who was the best surgeon for the job? No. Even we don't know. Would iwantgreatcare.org have helped? Definitely not. We don't actually care that much about the surgeon's bedside manner. We just want the job done well.

Dr Grumble has been through all this before. Shopping around for hospital care does not actually make a great deal of sense. Is this just doctors protecting themselves? No. The patients agree. Ill people do not make great shoppers. It's a shame our government does not realise this.

As for general practice, what has competition got to offer the sick and the elderly in the community? If you introduce the likes of Virgin do you think there will be more or less healthcare spending? What do you think Richard Branson would like? More, of course. In contrast, traditional GPs, like NHS doctors, have seen as their duty the need to look after the patient and get each patient what they really need while also protecting the taxpayer by not requesting unnecessary tests, doing useless operations or doling out costly medicines when cheap ones would do the job just as well. So what effect would competion have on spending? Don't rely on Dr Grumble's answer. Here's what the Physician Executive has to say on the topic:

.....competition in health care frequently leads to increased consumption. Price transparency has the potential to paradoxically lead to rising prices, rather than price competition. (“Have we got a sale on brain surgery this week!”) The fact that a third party pays for the services completely distorts consumer behavior.

You can see how the Branson family will capitalise on that. The task for young Dr Holly, (whom Dr G met many years ago when she was something of a tomboy) will be to maximise and not minimise spending on health. She will focus on the young healthy rich and not the elderly frail poor. She will focus on milking the taxpayer and maximising the amount spent on healthcare but not on keeping the lid on healthcare spending . In contrast, the NHS has always focussed on minimising expenditure. The taxpayer likes that. And the patient also likes that provided they get what they really need (and not what they want or might think they need). The current arrangement is a good one. But with the present government in charge how long can it last?

1 comment:

No One said...

youre wrong so wrong

yes good regulation is needed

but giving the end consumer the buying decisions is the only way to save us from this mess