Market proponents like Australia's Graeme Samuel and Dr Wooldridge promote marketplace medicine. They claim credibility for their model on the basis that countries are increasingly adopting market principles to reform health care. They distance themselves from the USA.
It is certainly true that this policy is being promoted by corporate groups, particularly those in the USA. This is because they want a slice of the vast amounts of money which governments across the world spend on health care. This is money intended for the care of their citizens. The majority are US multinationals seeking to expand into international markets and the United States is supporting them through the World Trade Organisation. Pressure is being applied to the World Bank. This makes it all very credible. With such powerful support it is not surprising that some governments are tinkering with the system.
Gullible ministers struggling to fund their health care systems are vulnerable to corporate conmen selling snake oil. They readily enter into golden handshake agreements which soon become golden handcuffs.
Samuel points to Australia and the United Kingdom as countries which have followed this direction. The facts do not support him.
Australia: - In Australia the experiment has been singularly unsuccessful. There has been little community support. The government had to bribe and threaten citizens to induce them to take out private insurance.
All of the multinationals which the government has sought to bring into Australia have subsequently been shown to be thoroughly unsavoury groups. To allow unsavoury groups to continue to care for Australian citizens our licensing regulations have been subverted. Probity provisions have been ignored and in our most vulnerable sector, aged care they have been removed.
Corporate Hospital providers have not won the support of Australian doctors. They have not been successful financially and there have already been bankruptcies. Where the care of public patients has been contracted to corporatiions this has subsequently been heavily criticised by independent assessors. The bribe used to boost private health insurance has been shown to be the most expensive way of meeting the needs of the community.
There is much to suggest that competition policy in health care has more to do with ideology than with health care. The government were not under pressure from the community whose prime concern was the preservation of medicare and adequate funding for the public hospital system. Data from around the world reveals that this is the more cost effective model. The World Health Organisation has recently confirmed this. One can hardly call competition policy "reform".
Other countries are already moving away from the market model. The United Kingdom has abandoned the gatekeeper/fund holding system introduced during the Thatcher years as it did not work.
New Zealand: - New Zealand which Samuel ignores, has been a leader in the market "reform" of health care. A community backlash was a major factor in a recent change of government. The new government has now introduced legislation which "seeks to remove the competitive model and address the distancing of communities from decision-making". The government lists its objectives as follows
Speaking to the bill in parliament the new minister indicated that he "was saddened and dismayed by what happened, I was still staggered by the level of disillusionment and the lack of morale I discovered right across the health sector."
The health system will have a will have a "population focus". The organisational structure is to be decentralised, the community is to have a large representation and board meetings will be public. The new boards "will not be companies". The health system will be protected from the competitive marketplace. I quote "In order to minimise concern that this may be precluded by the Commerce Act, the Bill will apply the exemption in the Commerce Act that applies to commonly-owned organisations".
How strange that these are exactly the sort of changes which I have been hinting at for some time!
(The New Zealand Public Health And Disability Bill 2 August 2000, 10:06 am. --- Press Release: New Zealand Government) -- CLICK HERE -- for the full text
Canada: - Samuel does not mention Canada where the public are rallying strongly to preserve a cooperative community health system which has served them well.
CLICK HERE -- to go to the section on Canada
Graham Samuel mentions Netherlands, Belgium and Austria. I do not have information about these countries.