There was much talk about health care
rationing and this is a response to an editorial in the Medical
Journal of Australia (MJA). This letter, making points about the
corporate threat, was published in the MJA in June 1998.
Note that this material is copyright (MJA) and is reproduced here as fair use in the public interest and to stimulate discussion. It should not be published in any other way.
J Michael Wynne
Senior Lecturer in Surgery, Mater Hospital, South Brisbane, QLD 4101
Baume's editorial in the 19 January issue of the journal fails to address the most critical issue in the fair and equitable rationing of healthcare.1 The major threat is not that care will be rationed but that corporate commercial forces will dictate the process of rationing. The government is committed to a corporate managed care system of health care for Australia. While community discussion and guidance as advocated by the author is desirable, it will have little impact when corporate profit priorities are involved.
According to Boyd et al ".... corporate executives are employed by shareholders, not patients. Ultimately the laws of the market demand allegiance to profit over health, and the laws of the land require corporate officers to maximise shareholders returns. Should such organisational imperatives govern health care?"2
Williams warned in 1992 that our politicians would see United States megacorporations as the solution to the problems in our health system.3 National Medical Enterprises (NME) (now renamed Tenet Healthcare) and Columbia/HCA have both been welcomed by our politicians.4 NME has since paid almost US $1 billion to settle fraud related actions. US $135 million was paid to compensate the patients, many of them children, who were exploited for profit.5 In July 1997, United States federal agents swooped on Columbia/HCA hospitals across the USA, seizing truck loads of documents as the first step in a massive investigation of fraud by corporate medicine.5 The FBI operation "Labscam", has already netted US$800 million from 10 large corporate pathology groups. The managed care group Kaiser has been the subject of intense criticism and government investigation.5
In August 1997 the treasury overruled the New South Wales government's objection and allowed Sun Healthcare into Australia. Sun, which has expanded from eight to nearly 500 health care facilities in less than 10 years, is currently the subject of a fraud investigation by the US department of Justice. It has reached a US $24 million out of court settlement with shareholders who claim that they were harmed as a consequence of corporate misinformation.5
In the United States, contracts, hidden arrangements, incentives and coercion have bound the medical profession to the corporate profit mission. Healthcare is rationed to increase the incentives offered to managers and the profits for shareholders and to fund corporate expansion. The real danger is that rationing of care in Australia will follow the same model?
1 Baume P. Rationing in Australian health care services [editorial] Med J Aust 1998; 168:52-53
2 Boyd JW. Himmelstein DU. Woolhandler S. The tobacco/health-insurance connection. Lancet 1995; 346:64
3 Williams R. Remission Impossible. Brisbane: Jacaranda Press, Queensland. 1992
4 Wynne JM. The Impact of financial pressures on clinical care: Lessons from corporate medicine. In Donnelly PK. Wadhwa L. editors. Access to Surgery: A National Symposium on the Planning and Management of Health Care Programs under Medicare. 1996 May 23-24: Townsville, Queensland. Brisbane. University of Queensland Press, 1996
5 Wynne JM Corporate medicine site <http://www.uow.edu.au/~bmartin/dissent/documents/health> Dated 31 March 1998. Accessed 20 April 1998
Published MJA Vol 168 page 581 (1 June 1998)