Australia has a unique mix of private, public, for profit and NFP stakeholders in its health system. This structure derives significantly from Constitutional issues. Corporate medicine now occupies a significant part of the health landscape. Is this a cause for concern?
During three decades since the introduction of Medicare, increasing the complexity of medical treatments and diagnostic modalities, and rise of accreditation standards, profit-driven corporations delivering medical services have been born and flourished.
Perhaps the most notorious example (in the medical profession) is Primary Health Care Ltd. Established in the 1980s by the late Dr Edmund Bateman, it now boasts revenues in excess of $1.6B (majority MBS service fees) and is ranked 264 out of the top 2000 companies in Australia. Critics of Primary point to poor clinical governance, disgruntled doctors, unhappy patients and “6-minute medicine.” However, its spectacular growth would only be possible if at least some stakeholders were happy. After hours services and bulk billing go a long way to explaining this.
There are many other examples. But there are also examples of non-corporate medical structures delivering suboptimal care. In my experience in 4 states working in private, not for profit (government and NGO), in primary secondary and tertiary centres: no ownership structure monopolises either poor care or good care, nor efficiency or inefficiency.
What is corporate medicine? My preferred definition would be a structure that separates ownership and management from lead clinicians. This would include many non-listed medical centres owned by investors, pharmacists etc, but would be more difficult to quantify than simply public listing.
There is an upside for all stakeholders from ethical business efficiency but a downside to allowing non-clinicians to drive them. Ideally, a positive engagement between clinicians and non-clinicians leads to efficiencies within an optimal clinical framework. In my experience engaged clinicians lead to both better clinical outcomes and efficiencies.
The AMA provides limited business training for its members. Some specialist accounting firms go further. But how does public policy encourage this?
Pharmacies must include a pharmacist in their ownership/ governance structure. However, there is no requirement that a medical centre, radiology or pathology practice have a relevant doctor in its structure. Public policy is inconsistent here. Yes, there is a conflict of interest if a doctor owns a pharmacy, but there is also a conflict if the pharmacy owns the doctor’s surgery. Currently the former is prohibited but the latter is not. Perhaps including relevant doctors in the ownership/governance structure would link clinicians to management more efficiently?
Another example of inconsistent public policy is found in aspects of regulations around the prohibited practice amendments (2007) to the Health Insurance and Medicare Acts. Many of these regulations effectively apply only to independent general practices and GPs, not to GPs contracted to large companies that own the pathology or radiology services. A “corporate” like Primary will be able to retain the considerable commercial benefits of colocation of services simply because they also own the collocated service and therefore they are not subject to a commercial lease. This is not a level playing field, and current attempts to define the term “market” will make it considerably worse.
Some commentators suggest that commercial benefits of colocation should be banned altogether. But they are only commercially valuable because patients and other stakeholders find them convenient and efficient. If this wealth generation is used to make services viable, in an ethical way, by allowing lower fees (eg bulk billing) is this a bad thing? Doesn’t this help reduce cost barriers for patients to healthcare?
Public policy around medicine is a minefield. There are numerous powerful interest groups which often advocate a confusion of good public policy and naked self-interest. The debate around the issue of corporate medicine is scant outside medical circles and contested within medical circles.
Personally I don’t believe Corporate medicine itself is the problem. It is more a natural response to the current policy settings. But I say that with the comfort of never being in any danger of working for one, and acknowledging that debate must be had about the regulatory framework around corporate medicine.
Dr Warwick Yonge is a GP in Port Macquarie. He is a GP supervisor and examiner for the RACGP, a fellow of the RACGP and ACRRM, GAICD, Director of 2 GP Superclinics and a Director of GPSynergy. His views are personal and do not represent that of any organisation he is associated with.
Comments
One response to “DR WARWICK YONGE. Corporate medicine: Illness or cure?”
I adopt a somewhat different position and have done ever since politicians replaced evidence-based community need with market-driven regulation and ethics.
Under this new regime, I consider that businesses that sell remedies and procedures for sick people, will be in perennial opposition to preventative medicine, and absolutely hostile to information that promotes good health.
All around me, I see people ill and dying because corporations sell them food bereft of nutrition; food that is rendered toxic by virtue of preservatives, food colourings, and flavour enhancers, hormones (ie rBST & rBGH), antibiotics that will soon bypass immune systems (ie 70% of antibiotics go into food-animal feed); wheat products; herbicides and pesticides; GM; BPA plastics; and tonnes of sugar. No doctor gallops the streets calling out warnings.
I listen to ignorant AMA doctors informing ABC TV viewers that Aboriginal ill-health can be fixed by setting up more clinics and modern medical treatment; entirely ignoring that in the north of Australia almost no Aborigines have been made aware that their lifestyle and foods are killing them, because such information must be in their own languages. Yet in Nhulunbuy and feeder region, $27 million is spent keeping doctors and nurses employed to close the gate when the horse has long ago bolted. Funerals are the most popular social activity in these parts.
I see people dying of skin cancers that could have been cured with ancient remedies, now enhanced with modern chemicals; whilst radiologists, chemotherapy exponents, and surgeons inflict their futile albeit ultra-lucrative frauds on the dying.
I hear pious media medicos denying the right of cancer and epilepsy patients to be treated with cannabis oil because these self-appointed experts “don’t know enough about such treatments to regard these as safe”; the implication being that yobbos like me are too stupid to make such judgments.
I read the words of medical and pharmaceutical lobbies who work diligently to prevent studies that might compare the health of vaccinated children with those who are not.
And I observe general practitioners who have abandoned old-fashioned evidence-based diagnosis in favour of a computer that prescribes the appropriate pharmaceutical, even if the problem is clearly malnutrition. The occasional exception is the doctor who actually refers to a dietitian or nutritionist; all of whom are just as appallingly ignorant.
So, Dear Doctor Yonge, I already see a sickness industry that is dominated by all-powerful corporations, with a single goal in its sights… profits. I cannot understand your preoccupation with corporate inconsistencies. Sure, a doctor cannot own a pharmacy yet a pharmacist can own a clinic, but big pharma owns you all, so what, at the end of the day, is the difference?