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Commercialisation is bad for public health

BMJ 2012; 344 doi: (Published 11 January 2012) Cite this as: BMJ 2012;344:e149
  1. David McCoy, consultant in public health medicine, Centre for International Health and Development, University College London, London WC1N 1EH
  1. d.mccoy{at}

The Health and Social Care Bill 2011 is yet to be passed into legislation, but the NHS is already going through a process of considerable transformation. Such is the scale of change that I’m reminded of the time I spent working in the new, democratic South Africa.

The health system of the apartheid regime was abominable. Structurally, the public sector was a fractured mess, divided into multiple departments according to three races and 10 so called tribal homelands. A vast and unregulated network of private providers and insurance schemes added a further layer of fragmentation.

The South African health system was also deeply iniquitous, with world class medical care for an elite minority and a rudimentary service for the majority poor black population. Less well recognised was its inefficiency: a huge oversupply of medical care, overpriced medicines, and more money spent on the healthy than on the sick.

The drivers for this inequity and inefficiency were not just racism and organisational chaos, but also commercialisation and the profiteering and erosion of professional ethics that it spawns. Many within the health system were virtually printing money; shamelessly exploiting both patients and the public purse.

When offered a job that would …

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