Say no to the market
BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7557.0-f (Published 29 June 2006) Cite this as: BMJ 2006;333:0-fAll rapid responses
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We all have to agree that UK has the world class environment for
provision of good quality health and the health care providers are well
motivated and adopted to deliver ground breaking new medicines and
treatments. Through generations this has been the tradition of UK health
care system and it should not be clouded by market strategies or a
business minded minority.
The health care system in any nation whether it be UK,USA,China,India
or Sri Lanka should be a kind representative of the whole society and is
bound to care the whole general population and it should be publicly
funded and freely available. This will make sure that everybody in the
society will have a chance to enjoy the cutting edge, innovative medical
therapies. Any health care service whether it be NHS or any other similar
authority should be funded on a population basis or in other words general
taxation (1). Each and every individual then have the rights to enjoy the
facilities in an appropriate manner. Sadly the patient’s responsibility
towards the health care system tends to be diminished due to free
accessibility of leading edge service and due to ignorance. It is quiet
clear that the public must be bold enough not to overuse valuable
resources and “the doctor shopping” (2) has to be thoroughly discouraged.
Unfortunately this is quite common in Sri Lanka where almost all the
health care facilities are free of charge and sometimes it is not uncommon
to find a patient with a handful of same type of investigation reports
performed at several hospitals. This needs a radical shake up of the way
things have been done up to now and patients have to be well stressed on
their duties and responsibilities when enjoying a service which is funded
by population based taxation.
Moreover the patients should be encouraged to participate in clinical
trials, teaching sessions to medical students and junior doctors which
will enhance the health of the population in long run. Collectively these
efforts would make any health care authority a forefront in service,
clinical research and teaching. This would create immense benefits to
present and future citizens of a country and economic development when
fully implemented. At the end of the day it is not the ‘market’ but the
humanity that the patients love to see from us.
References.
(1)Fiona Godlee. Say no to the market BMJ 2006; 333(1 July)
(2)Olsen DM.Medical care as a commodity: an exploration of the
shopping behavior of patients.J community health 1976 winter; 2(2):85-91.
Competing interests:
None declared
Competing interests: No competing interests
your article makes no attempt to define 'market', but exhorts us all
to say no to it ..
Get real ! The market - a recognition that services , providers,
consumers will all interact, and usually at a price - is as unavoidable as
weather. The NHS buys drugs largely from private companies, at
considerable cost. NHS Hospitals are built with public money by private
building firms. Nurses, doctors, cleaners, and patient managers all look
at alternative employment options outside the NHS. The BMA attempts to
exert a trade-union pressure to exact a price for doctor's labour. Medical
schools train generations of doctors, who may or may not find work in the
UK. Even the BMJ comes at a price.
Having recognised the pointlessness of 'saying no to the market', it
is worthwhile agreeing these principles of the NHS:-
1. Free at the point of use ( in Wales - no prescription charge)
2. Funded entirely from general taxation ( with extra taxes on
smokers and drinkers ! )
3. Universal in its cover ( everybody can have anything, but may have
to wait a very long time.. )
Nowhere is there a law that says NHS contracts for cataracts cannot
be given to Private Ophthalmologists. Bring on the Tariff, I say - and
let's get 'competitive' in our service quality and delivery ! Indeed , we
GPs have had mixed fortunes over fifty+ years, varying this form of
private-provider public-payment contract, whilst Dentists have largely
given up on it. But did patients have their needs met as best the country
could afford ?
Competing interests:
I am 'INDEPENDENT' GP working under contract to the NHS
Competing interests: No competing interests
Editor,
In your leading article, you criticise the US healthcare system and write
"No other developed country has adopted such as system."
As far as I am aware, no other democracy has provided health care by
imitating the NHS system, all following some sort of mixed social and
private insurance model.
Yours sincerely,
Competing interests:
None declared
Competing interests: No competing interests
One cannot nowadays read an assessment of the US healthcare system
without hearing about the "familiar spectacle of inefficient and
fragmented care, spiralling costs, and growing inequities of access" and
as Fiona Godlee adds, "there's now evidence that quality of care is patchy
and worse overall than in other developed nations".
It is worth asking first if 'good health' is a universal or indeed
human right.
If it is indeed so, it is worth asking if it is entirely the
government's responsibility to deliver it with little, if any, individual
responsibility attached for one's own health.
Even if it is agreed that it is the responsibility of the government
to deliver a uniform standard of healthcare - an oxymoron in terms because
population-wide levels of health and individual propensities vary so much
that it is nigh impossible to deliver on this metric - does that allow the
primary delivery organisation to operate inefficiently or worse,
ineffectively?
I think the outright rejection of the market model - however that may
be defined, because for the large part NHS remain publicly funded - is at
least as ideologically driven as Labour's NHS reform programmes being
decried by the BMA.
A debate this ideologically entrenched, no matter how long it goes
on, may not help improve the quality of patient care which should be the
main goal of both the government and the caregivers.
PS: My doctoral research explores various dimensions of health policy
formulation in a UK/ US comparison.
Competing interests:
None declared
Competing interests: No competing interests
Dear Editor,
In "say no to the Market" you argue that performance and quality are
key to developing our vision for future a healthcare system. I agree that
quality and performance measures are vital but disagree with your
editorial and the BMA, because if we are serious about performance and
quality then my view is that the Market is a necessity.
In an NHS monopoly, providers can deliver good or bad services safe
in the knowledge that commissioners cannot go elsewhere for their
services. In a Market, organisations have to stand up and account for what
they have done with funding and what they propose to do in the future not
in isolation but in competition with other providers - thus commissioners
can actively base choices on quality and performance thus making these
factors prime drivers for change.
We all know excellent NHS services, sadly we also know of poorly
performing services, the monopoly NHS inadvertently provides safety and
security for both types of service. The Market provides a way for
comparison of services and choice for commissioners that is most worrying
for people working in poorly performing services. A commissioner seeking
quality who also has a choice of providers can ensure that the people who
stand to profit the most from the Market - are the patients. Say yes to
quality, say yes to the market.
yours
Dr. G. M. Knox
Medical Director
Pain Solutions Limited
Competing interests:
I am a director of a company that offers the NHS an alternative provider for pain services
Competing interests: No competing interests
Editor
It has been an enduring puzzle to me that the profession can be in
large measures of agreement over the folly of successive government's
policies but the option of direct political action is almost never
discussed.
Much of that which is happening to the NHS is almost wholly condemned
by those who work in it but the BMA response is routinely nicely
measured, delivered with restrained eloquence and characterised by a
remorseless reasonableness.
It is my belief that the next election will be the last at which any
substantial impact can be made and that we should mobilise now, with other
concerned groups such as the RCN, and have pro-NHS candidates in every
constituency.
We have the example of Dr. Richard Taylor MP who has been elected
twice on a health ticket.
A colleague recently supplied an apt phrase - 'the world is run by
those who turn up.' We are all concerned, we command the confidence of a
far larger section of the electorate than many, we can be articulate, we
could be a very effective parliamentary influence - who knows - we might
even win.
Why does the profession not mobilise politically? I'm game - anyone
else?
Yours sincerely
Steven Ford
Competing interests:
None beyond the obvious - a devoted NHS wage slave.
Competing interests: No competing interests
From the lead story in this morning's Guardian (1), headline: £64bn
NHS privatisation plan revealed.
A secret plan to privatise an entire tier of the NHS in England was
revealed... when the Department of Health asked multinational firms to
manage services worth up to £64bn.
The department's commercial directorate placed an advertisement in
the EU official journal inviting companies to begin "a competitive
dialogue" about [taking over] purchasing of healthcare...
...Under the new system, the PCTs would contract out the
commissioning to big healthcare management consortiums with greater
purchasing muscle.
Contenders for the contracts are likely to include... United Health
and Kaiser Permanente [and maybe] BUPA and PPP...
...Lord Warner said: "The government has no plans to privatise the
NHS." ...
1. (Byline) John Carvel, Guardian 30 June 2006, p1, col 1; and at
guardian.co.uk
Competing interests:
None declared
Competing interests: No competing interests
Lets apply these priciples to the BMJ!
The Editor of the BMJ apparently beilieves that the BMA members "want
a vision for health care that does not involve the market, uses ethical
rationing based on clinical need, has commissioning driven by quality not
profit, is patient not shareholder centred, and is clinician led.”
Would we, the members of the BMA, be happy if our Editor was
demanding this as a model for our journal (of which she is the temporary
paid custodian)? If it is not to involve the market, the BMJ should stop
taking payment for advertisements, rather assessing each on its potential
to satisfy the needs of BMA members. It should “ration” its publications
to those subjects and questions for which there is an evidence based need
from the membership (perhaps based on focus groups – LMCs would do!),
commissioning should be based on quality as defined by members not the
editorial cabal currently in control of policy, should not be influenced
by providers (the implied interpretation of “shareholders” in this
statement) meaning that the Editor should never attend academic meetings
at our expense.
By “clinician led” she presumably means that the NHS should do what
its workers say rather than what its customers say. Is the Editor (and the
membership) too young to remember the pre-Thatcher, Union controlled,
Britain in hock to the IMF? She made a fuss when the Canadian Medical
Association took issue with its Editors undermining its political work on
behalf of its members – do we really believe she should be unaccountable?
An alternative explanation is that the Editor might be prepared to
eschew the Market and work simply on the basis of the membership meeting
her basic needs in the Soviet system she and the section of the BMA
membership she reports on appear to crave!
The ARM should be careful that its left wing, "holier than thou"
assumptions will simply be used to reduce the remuneration of the vast
majority of us who see the BMA's principal function as negoting pay and
conditions on our behalf!
Competing interests:
I am not prepared to do the job I love for nothing!
Competing interests: No competing interests