Central Map ..... Initial Map ..... USA Map ..... Australian Map ..... International Map ..... Corporate Practices Map

Map of Corporate Practices Pages


Much of this web site deals with individual companies or countries. Over the years I have at various time written some more general pages looking at failures or practices and putting a different point of view. I created this section to bring this theme together and provide another way of exploring the site for those who are interested in more general issues. Many of the pages also appear in other sections.

I am reflecting the perspective and responses of an ordinary person with medical experience coming to these events and examining corporate behaviour. Several of these pages were written after the chairman of Australia's national Competition Council, Graeme Samuel's speech to the world bank in 2000 - an alarming proposition by so senior and supposedly responsible person given the knowledge publicly available at the time. Several pages were written hurriedly in some revulsion and have not yet been subjected to sober reflection - others are better.

I am not an authority on value systems, ethics or professionalism so am not making claims for pages dealing with these issues. I have tried to live out my perceptions of ethics and professionalism, and what I have seen as the community's expectations in this regard. I am alarmed at the consequences of a corporate marketplace for values, ethics and professionalism. The pages reflect this. I believe that evidence, history and common sense speak for the importance of values, ethics and professionalism in health and aged care services and for their incompatibility with a share market controlled health care marketplace. A Royal Commission in Canada has affirmed their importance in health care and emphasised this incongruity.

Unfortunately there is a great deal of duplication. I have wanted to rewrite and consolidate this section for several years and integrate it better with the other pages. The recurrent fraud, the repeated threats to the Australian system, and the need to update pages about corporations have kept me from this task. Despite their obvious deficiencies I think there is much of relevance to health and corporate medicine on these pages.





























































































Corporate Practices
The Way the Health Care Market Operates


In early 2000 I collected pages dealing with corporate practices together into this section in early 2000. This page was intended to contain a broad introductory review of the whole area. At present it contains only brief outlines and links to the pages.

I am not sure when if ever I will get to rewriting and organising these pages as I struggle to update and to meet each new crisis in health care.



























General Reviews of Corporate Practices

The pages on this first section take a rather general look at the way the health care market operates.

  1. Nay Corporate Medicine
    This is a 600 page published article in which I tried to encapsulate the essence of the problem in corporate medicine.
  2. The Health Care Marketplace
    This page examines the health care marketplace in the USA and explains how it works to disadvantage those who seek care
  3. The Story of Health Care Reform
    This page looks at the way in which economic rationalist thinking has come to dominate political processes. As a consequence market thinking and processes have been introduced into health care as "reform". The response to market failure and at home control of market excesses has been to globalise and try elsewhere.
  4. Corporate Medicine in Australia
    I wrote this review of Australia's response to the application of economic rationalism in health care in 2000. It looks at what has happened in the USA and Australia and at Australia's response.
    This page examines some issues surrounding overseas ownership of health care in Australia and looks at what has happened here.
    This page looks at market failure in the USA. It examnes the great divide between the perceptions of market advocates when contrasted with the way health professionals, patients and most citizens perceive and experence the market system in health care. It goes on to list the red flags which should alert citizens and regulators to the possibility of dysfunction. I wrote this page in 2004 when Primary Health induced the University of Wollongong to take a page off the web site.
    This is a review of 141 "recent articles" which I wrote in 2001. An introduction puts the articles in context. The material looks at corporatisation of health care in Australia at that time. It looks at what was happening in managed care and nursing home care in the USA. It looks at political influence and at what was happening in Canada.
  8. The Logic of Marketplace Arguments
    This page examines the logic of some of the marketplace arguments and challenges them.
  9. Joseph Califano and the Market Revolution
    Califano was a health adviser to Reagan who subsequently went to work for Chrysler. The company was being crippled by health costs. He saw the way in which the developing health care marketplace was causing costs to spiral. Because he saw this as a marketplace problem his 1986 book proposes marketplace solutions and more market pressures. The adverse consequences are now obvious.
  10. Introducing competition in the public delivery of health care services
    This is Graeme Samuel's speech to the world bank in February 2000. He urges all countries to adopt an even more market like system of economic and regulatory levers than in the USA. I
    criticised this angrily and some of these web pages resulted.
    This page gives an overview of the way in which the pressures for profit have impacted on care in the various sectors of the US and Australian health care marketplaces.
    This page was written in 1997 when Australia was threatened by Columbia/HCA. It was the introduction to an examination of the implications of Columbia's arrival. The page examines the rise and rise of economic rationalism and its application to health care.
  13. Corporate Medicine - Hospital licenses : Revising the regulations
    In 1998 I used Columbia/HCA's own admissions and its acknowledgment of the business practices which lay at the root of its fraud and health care failures to motivate for the banning of these business practices in health care. This is my submission.
  14. THE MARKET -- MERGERS (This page is empty. It was left behind by events and has not yet been written)
    The driving force in the corporate market is growth which is accomplished by takeovers and mergers. The pressures generated are largely responsible for the fraud and the failures in care.

Pages in other sections which explore corporate behaviour more specifically
Many pages in other sections describe the way the market operates and the conduct of specific companies. Tenet Healthcare (then National Medical Enterprises - NME) gives a marvelous insight into market thinking, market practices, and the thinking of the market in Australia. It shows the relationship between corporate managers, market analysts and investors, (see the 1996 page "
THE IMPACT OF FINANCIAL PRESSURES ON CLINICAL CARE : LESSONS FROM CORPORATE MEDICINE"). Tenet's involvement in a second scandal illustrates the pervasiveness of corporate culture and the way market ideology has insulated itself from community perceptions and the consequences of market practices (See Tenet Healthcare Scandal in General Hospitals : The Second Coming 2002. For more about Tenet and NME see Tenet's main access page).

Columbia/HCA (now simply called HCA) adopted similar practices (See Columbia access page). The particular corporate practices are addressed in something I wrote after Columbia had done a mea culpa in 1997, and in a submission I made arguing that some business practices should be forbidden under hospital licensing regulations in health care. I had a year before lodged an unsuccessful objection to hospital licenses for Mayne Nickless, the Australian giant, because of its adoption of these business practices. Later Peter Smedley introduced even more aggressive business practices into Mayne Health. Doctors revolted forcing profits down, Smedley's resignation followed and all Mayne's hospitals were sold to a Citigroup subsidiary and two partners in 2003.

Aged care illustrates the same problems (see overview and the many companies involved). Sun Healthcare is particularly illustrative. A business analysis describing the companies prospects and an interview with Sun's chairman are very revealing of market thinking.

HealthSouth illustrates another manifestation of market pressures - accountancy fraud. This was essentially a co-development with the frauds in the wider marketplace on Wall Street and illustrates the profound impact financiers and their advice have on health care companies.

Corporate health care should be seen within the context of this wider corporate marketplace to which it owes its ideology and its primary allegiance - an allegiance in extreme tension with responsibility to the community and a duty to care for its sick members. The nature of the marketplace and its imperviousness to the values of the community is well illustrated by the defrauding of the community by Wall Street financial giants in recent years. The Citigroup pages explore the wider financial marketplace frauds and their hidden involvement and influence on health care (see page "The Financiers and Health Care"). Several of the pages touch on the power and influence which corporate market leaders exert and the nature of this marketplace (see "The Banking Marketplace"). Another examines the culture on Wall Street and the sort of people who succeed here (see "Citigroup Culture and People"). This page also looks at the rapidly unfolding scandal surrounding the chairman of the New York Stock Exchange who played such a vital role in resolving the financial scandal without properly punishing the financiers or making effective changes.

If we look even more widely we can see the pervasiveness of the sort of practices and processes which we have seen in health care. Examine what actually happened in the torture of prisoners in Iraq. These aspects and the processes are highlighted in the Australian ABC Four Corners Program on 7 June 2004 (look at for a transcript). On this it was disclosed that both the US army in Iraq and the CIA contracted the interrogation of prisoners out to private corporate interrogators. The companies were paid for results and everyone turned a blind eye to how the results were obtained. Torture became legitimate, acceptable and even desirable - exactly as the imprisonment of normal children in psychiatric hospitals, and coronary artery procedures on normal arteries, apparently became legitimate in some Tenet/NME hospitals.

That this marketplace, its thinking and its practices permeate throughout every facet of health care and affects each adversely is illustrated by developments in other areas such as renal dialysis, home care, managed care, clinical laboratories, and the drug market internationally. In Australia we have the Scan scam, the Pan Pharmaceuticals scandal and the pressures exerted on Australia's unique system of drug control - the PBS.


Building on Ideas

The following pages continue to explore the ideas set out in the pages on coming to grips with health care. They link to actual developments and events. Pages 2 and 3 were written in some disgust in response to Samuel's speech. Some pages are repetitive and need modification.

  1. CORPORATE PRACTICES : INTRODUCTION to Analysis and Criticism
    This is an introduction to this section. It looks again at the conflicting frames of understanding which are at the heart of the problems with market medicine. It examines the nature of social criticism. It looks at the use of our understandings in a reflective way and the difficulty in doing this in a society under pressure.
    This picks up on Samuel's advocacy of marketplace "starting points" in health care to revisit the theoretical frames I developed in the introductory pages in a slightly different way. I attempt to show how community and market starting points and so understandings differ and so have different consequences. I link starting points and understanding to identity. Samuel clearly understands these ideas. Where I have advocated a broad approach fitting starting points to context, Samuel seeks to convert others to his belief system and create tension in order to do so.
    This page follows on the previous one by looking at the world the rest of us live in when we examine the health care marketplace and contrasting it with the world health market advocates like Samuel and Wooldridge live in when they advocate market medicine. It summarises corporate conduct in health care and suggests that some of us are living in an imaginary world and it is not the rest of us.
  4. ANALYSIS OF CORPORATE CULTURE AND PRACTICES(Sun Healthcare as an example) ::::: Lessons for the Future
    This page uses Sun Healthcare and its founder Andrew Turner to explore some of the understandings developed in the theoretical section reached from the
    initial map and explored again above.
  5. Quotes and Extracts : the new corporate world of medicine
    By mid 1997 Columbia/HCA had gone but Sun Healthcare was in Australia. I had vast quantities of material and the comments of many advocates and critics. I could not circulate all this so I made a collection of quotes to send with my material. They illustrate the conflicting belief systems.
  6. Lessons for the Future
    I have written a page in which I suggest the way in which we can use these ideas to guide us in developing a health service which gets us from where we are to where we would like to be and should be. We are currently moving to a situation we should not want to be in and where we should not be.

Other pages
More pages along these lines dealing with specific companies can be accessed from the pages on
coming to grips with health care.


Words and Ideas in the Marketplace

A number of pages contrast the market's culture with that of community. They look at demand, need, quality, altruism, probity, equity and similar ideas. They often acquire different meanings in the marketplace.

  1. The Market, Demand and Value
    This page looks at the way the corporate groups use marketing and education to induce the community to value what they sell and so create demand for health care which the taxpayer may be expected to pay. The market then exploits this demand for profit. This is contrasted with what the community needs in the form of health care. An example is given to illustrate how this led to the misuse of children for profit.
    This page examines the myth that competition and market forces improve quality in health care. It suggests that "quality" is a word with associative meanings. These encourage the creation of illusions and support fuzzy logic. "Standards" is a better and more precise word - one which we seldom hear in the marketplace.
  3. Quality in the Health Care Marketplace
    This page examines how the word quality has been interpreted as meaning profitable by health care corporations. It shows how accreditation and oversight have failed to identify and address the serious problems in these company's facility.
  4. Quality, Profit and Type of Provider
    This page examines the differences in the way in which patients and doctors experience and understand the health care encounter. It looks at the issues of responsibility, pressures on doctors, and public education in relationship to the market and to professionalism. It suggests that the problems would be best addressed by cooperation between doctors and the community as contrasted with competitive market solutions.
  5. Cultural Conflicts ::: Altruism
    The page looks at altruism as an integral part of professional culture, rather than as ostentatious public donations by corporations. It looks at the impact of marketplace medicine on this.
  6. Some thoughts about Probity
    Probity is not a consideration in the US marketplace but is a repeatedly ignored requirement for licenses in health care in Australia. This web page examines probity and its importance for health and aged care.
  7. The Market and Equity
    This page examines the failure to maintain equity in market systems and when using contracts.
    This page examines equity in the USA and in other countries. It examines the impracticality of ensuring equity through regulation or by contracts and looks at alternatives. Prof Stephen Leeder gave an excellent address on equity to the Australian summit on health care. This is published in the Autumn 2004 edition of New Doctor. He refers to the difference between US (i.e. market) ideas about equity and those in Australia.
  9. Access to care and the Marketplace
    This page looks at Samuel's claim that the market improves access because of increased efficiency. The evidence shows that it reduces access under a capitation or managed care system and increases it under an item of service system resulting in under or over servicing. Many don't get what they need and others get care they don't need.


Trust, Professionalism and the Attack on Professionalism

Professionals control the treatment given and so the utilisation of health services. Corporate profits flow from their signatures. The response ranges from an attack on professionalism to attempts to secure their compliance with corporate programmes using marketing, incentivisation, coercion and simple bribery (various legal and illegal forms of kickbacks). Non-compliance by individuals is often viewed as disruptive. Marginalisation, social isolation and punitive action often follow. Professionalism has bent before these pressures and there have been serious failures.

  1. Trust : The Market and Professionalism
    This page examines the the importance of trust and trustworthiness for success in health care and in professionalism, contrasting it with the importance of distrust for the success of the market. It examines the failures of professionalism to meet that trust and the role of the market in this.
  2. Professionalism - response to economists criticisms
    This page looks at the impact of market forces on professionals and indicates that professionalism has buckled under market forces. Given the way humans behave this is what we should have expected. The page argues that market forces are extrinsic to health and professionalism. They were developed elsewhere and are essentially destructive of professionalism. Professional values and ethics are intrinsic to professionalism and health care. They are sound but need reaffirmation and social support to survive.
  3. Quality, Health Professions, Patients and the Market
    This looks at the different way in which each of these groups sees and experiences health care and quality of care. It looks at the issue of responsibility for the market and for doctors. It examines the impact of the market on public education and preventive medicine.
  4. Professional Independence
    This page looks at the role of professional independence as a thorn in the side of ideologies. It compares doctors under economic rationalism to those under apartheid. There are problems with professional independence and these are acknowledged. They are not explored on this page.
    This looks at the misuse of consumers and the perspective of the profession and of the marketplace. It looks at professional responsibility and the allegation that care is organised for the benefit of doctors rather than patients.
  6. Professionalism and Regulation
    Professionalism is built around and driven by intrinsic values and ethics directed to care and the community. There is consequently pressure towards self correction when it responds to external pressure and goes off the rails. The market in contrast is profit driven and external regulation is essential to make it work for society. The pressures are away from care and so not self correcting.
    This is the text of a message initiated by the "Ad Hoc Committee to Defend Health Care" and circulated to health care professionals in the USA in late 1997. It resulted in the publication of an article in the JAMA signed by thousands and in the formation of
    Physicians for a National Health Program (PNHP) which is now a powerful force in US politics. It calls for universal health insurance in the USA holding Canada up as an example.
  8. Controlling the Utilisation of Health Care
    This page addresses the question of who controls the utilisation of health care services in the marketplace. Investigation and treatment is approved and is signed for by doctors. Those who control the pens of the doctors succeed, those who don't fail.
  9. The Market, Teaching and Research
    This page explores the relationship between the market, universities, research and education.


Accountability, Regulation, Surveillance, Retribution and Accreditation

A host of costly government and community structures seek to exert control over this marketplace to ensure that patients and the community are not short changed. They have simply pushed up costs and failed to protect citizens. The issues are explored.

  1. Accountability
    This page documents the failure of internal corporate structures , external oversight bodies and disciplinary processes to hold health care corporations accountable for their conduct.
    This looks at governments ineffectiveness in controlling the corporate marketplace and the indebtedness of many politicians to corporations, particularly those health and aged care, for campaign funds. The two are linked.
  3. Surveys fail to Protect Nursing Home Residents from Abuse
    This is a 2001 article reproduced from a Wisconsin web site which examines the failure of regulatory authorities to address failures in the care of the aged.
  4. Why Regulation Fails
    This page looks briefly at why oversight and regulation are so ineffective in health care.
  5. Government Oversight : Regulation and Surveillance
    This is another page examining the repeated failure of government regulation and oversight of the health and aged care marketplaces.
  6. The Collection of Data
    This page looks at the difficulty of obtaining data and the paucity of data from the competitive corporate marketplace. It looks at how data can be obtained and at how most of the material on this web site was obtained.
  7. Monitoring Developments in the Healthcare Marketplace
    This is another page looking at the collection and interpretation of data more generally in the health care marketplace. It looks at what might be accomplished in an integrated cooperating not for profit system.
  8. Regulation in the USA
    This page examines the failure of regulation in the USA and gives a number of examples.
  9. Regulation in Australia
    This page examines the way in which regulations which protect citizens from unsuitable, even criminal corporate health care corporations have been undermined in the corporate interest.
    This page looks at the track record of accreditation and why it fails as it has in the USA.


Structural Aspects

These pages look at the need for a stable health system and at structural aspects. They examine choice, not for profit care, efficiency and integration

  1. A Stable Health System
    This page examines the stability of the corporate health system in the context of affordability. What is likely to happen to a corporatised health system when health care is no longer profitable or when money is short and there is less to spend on care.
  2. The Corporate Marketplace and Choice
    Choice in health care is a very different process to choice in the marketplace. Potential patients are vulnerable to manipulation, misuse and abuse. While advocates of a health care marketplace claim that the market provides more choice, it is not in the interests of corporations to provide this. In practice they have a very poor track record.
  3. Not for Profit Health Care and The Market
    This page examines the behaviour of not for profit community services when they are placed in a competitive marketplace and have to compete with groups whose primary focus is competition and market dominance.
  4. Structure of the Health System
    Health care in Australia is currently structured along lines of funding. Graeme Samuel in his speech to the world bank has suggest it be structured in terms of an economic theory. I suggest that it be structured along the lines of the services provided so that these can be brought to patients balancing efficiency against need and service.
  5. The Cost of Efficiency
    Efficiency in the corporate marketplace is used to rationalise and justify substandard care. Decisions are made in board rooms in order to enhance profits. This is contrasted with the opportunities presented for efficiencies and humane care by those at the coal face trying to stretch resources for maximum benefit.
  6. Competition and the "efficiency dividend"
    This page examines the claim that competition results in efficiency. It examines the difference in efficiency originating in the board room and efficiency originating at the bedside.
    This page looks at integration for profit by the large corporations, at the use of flagship hospitals as the hub of an integrated system, and at gate keeping in managed care.


The Consumer

Some pages examine the plight and role of the patient and the community. This is fashionably called the consumer so as to hide their vulnerability and suggest the power of a market customer without claiming it.

    Marketing and education have been used by corporate health care companies to build the bottom line. They have misinformed, deceived and even restricted information. Instead of facilitating and encouraging choice they have restricted it.
  2. Declining Community Satisfaction
    Market advocates claim that patients, now called consumers are dissatisfied with the health system and that the market solves this problem. The former is partly correct. The latter is not supported by the evidence. The page examines dissatisfaction under different systems.
  3. Health Care and Empowerment
    This page explains how paternalism has given way to an ethic of empowerment. It looks at the benefits and problems in empowering and shows how difficult this is in a market place context.
  4. The Consumer in Samuel's Model
    This page examines the lack of power of the marketplace health care customer (or patient), and the ruthlessness of the market when large sums of money are involved.



The link between the market and politicians is a close one. Many believe it is the reason why health care corporations have been so successful in resisting reform and have been treated so leniently. The relationship is cemented by the vast sums spent on political donations and lobbying

Politics, Markets, Health and Democracy
This page is a 2004 rewrite of three previous pages. It examines the way we conceptualise the nature of democracy. It suggests that the inappropriate relationship between corporate interests is the consequence of a democracy which emphasises the right of all individuals to pursue their own self-interest. This is contrasted with a democracy which emphasises the responsibility of citizens for society and the well being of all. The financial relationships which cement the links between the market and politicians are documented. These largely disenfranchise citizens. The roles of politicians in the USA and Australia are examined. The importance of this for health care is illustrated by many examples. Many links are provided.

Other pages
There are sections on the individual pages describing political links, donations and lobbying.
The Banking Marketplace looks at the power of the large market institutions. There is more about Citigroup lobbying. The Frist family running Columbia/HCA was a political dynasty. Bruce Lumsford (Vencor 's founder) was close to state governemnt. His attempt to run for governor was torpetoed by his track record in aged care. Integrated Health Services (IHS) was notorious for its political dealings. The intense lobbying as nursing home chains sought to block the damaging litigation in Florida is representative of what happened in most major health care crisis. Managed care groups and pharmacy giants have been particularly active.


Whistleblowing and Dissent

The vast majority of corporate prosecutions have arisen from whistleblower initiated actions and not from regulation or oversight. Without them most would go undetected.

  1. Whistleblowing in Health Care
    I have always wanted to write about whistle blowing in health care. I got as far as writing some initial thoughts in 2000 and became lost in conjecture. I never got back to it but hope to do so. It badly needs rewriting. Whistle blowing has succeeded in the USA where regulation has failed.
    1. Olivieri empty page
      This page is still empty. Dr. Olivieri blew the whistle on a drug company in Canada. Her experiences are illuminating.

Other pages
My own efforts at whistle blowing can be accessed from the
Initial Map. There are accounts of whistle blowing on some of the corporate pages. James Alderton and others for examole blew the whistle on Columbia/HCA. In Tenet/NME in 1991 and in 2002 it was patients who realised what was happening and acted. In Vencor it was patients and staff.


Miscellaneous and Obsolete

A number of blanks or short outlines of planned pages were put on the site to temporarily receive links and are still there. When I will get to write them I don't know. Most will go in time. They are here so that I don't lose them.

This page was written in outline only in 2000. I never got to complete it.

Organisation (still to write)
Outline for a planned page in about 1997 -- never written

The Processes at Work - This page written in 2000 simply supplies links to other pages. I planned to summarise the psychological, sociological and political processes at work in the corporate marketplace but this is probably irrelevant now.

MARKET REFORM : Cognitive Processes and Change
This page describes social, psychological and political aspects to the process of change. These create pitfalls and challenges which are seldom confronted. The manner in which marketplace ideology has been imposed in health care illustrates many of the problems and the unfortunate consequences.

Linking Funding to Care
This is another April 2000 page started after Samuel's speech which got lost and was never finished. It contrasts market and professional ethics and then comments on capitation and fee for service. It needs fixing or scrapping.

Corporate Medicine Site : (alternate entry page)
This is a redundant out of date page and will be removed.

Further Developments in 1997 Overview
This page is simply a set of links to material I wrote during 1997 as details of Columbia/HCA's many unsavoury practices became public in the USA.

Central Map ..... Initial Map ..... USA Map ..... Australian Map ..... International Map ..... Corporate Practices Map
This page created June 2004 by Michael Wynne
Modified September 2004