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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
are you listening gordon?
- Bob Bury (15 February 2008)
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Patients will never be "customers"
- Stefan Diez (18 February 2008)
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Are markets evil?
- stephen black (22 February 2008)
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Bob Bury, Consultant Radiologist Leeds General Infirmary LS1 3EX
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It would be nice to think that Gordon Brown and Alan Johnson will read this and think twice about their current headlong rush to sell off the NHS to the private sector. But I won't be holding my breath. Competing interests: None declared |
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Stefan Diez, Consultant Neurologist 75365 Calw, Germany
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I donīt understand why many European politicians promote market mechanisms that do more harm than good in health care. I know of a case of paying US-$ 20000.- for inadequate assessment of frequent panic attacks. The patient did not at all enjoy "a leisurely consultation time" but ended up with a big hole in the wallet. Competing interests: None declared |
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stephen black, management consulting london sw1w 9sr
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There is a subtle difference in what the article says and its headline that allows the argument "its always bad to have commercial organisations deliver healthcare" to persist. American healthcare is not, in parts, an embarrasment to a civilised country because commercial firms run most of it: it is a mess because the government has allowed (and protected) market structures that contain the most perverse incentives for participants. Those americans who have insurance are frequently overtreated to the point of injury (as a glance at the evidence on www.dartmouthatlas.org would show). Many are uninsured because the easiest way for an insurer to make money is not to incentivise providers to do the right thing efficiently, but to avoid insuring high risk patients. Most countires with private insurance systems don't allow risk selection by insurers and often have a government safety net for the poor ensuring universal coverage. These systems are sometimes not much worse in efficiency or fairness than the NHS despite the use of commercial insurers. There is also nothing wrong with markets among providers as long as the structural incentives are right. Providers need to be incentivised to provide improving quality and efficiency. Systems that reward more activity with no constraint will promote overtreatment. Centrally planned systems are not notably good at improving the quality or efficiency of hospitals, which is why NHS productivity is a lot lower than it was 10 years ago. The right question isn't whether we should use markets or not, it's how we should structure them so the participants have the right incentives. Competing interests: None declared |
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