Nowadays, public health appears to have become no more than a business problem.
While patients are increasingly seen as customers than as service users, respect for fellow human beings seems to be slipping into the background. Health care is a driving force moving huge business interests, so if health is a right, illness has become a duty.
There are less rights and goods and there are more products and services. Whereas the 1970s’ ideology pushed for health care for everyone everywhere to be provided by an all-encompassing public service, the current trend is for widespread privatization seen as, or rather represented as, a liberalization of options and a thoroughfare towards increased efficiency. But many doubts still remain about the real effectiveness of a system protecting everyone from everything and based on a private service that turns patients into clients, where the product on sale is health, and that tends to seek out the more profitable market sectors, leaving the costlier ones to the public administration.
Discriminating between diseases and patients means that high-cost treatments are diverted to the public service while the private sector tries in every way to attract customers that are profit-yielding, either directly (by paying their own bills, in part or in full) or indirectly (having more influence thanks to their DRG). In fact, the result is not so much a reduction of costs but their redistribution, with resources being levied from public institutions and transferred to private organizations. Consumer analyses shows that the commodity “health” is among the most appreciated and sought after by an ever-increasing and diversified demand: public health is a business.
Paradoxically, a sick society would prove more convenient than having all citizens in full health – the latter posing a concrete threat to a consumer society. More people live off cancer than those who die from it, HIV-AIDS has given rise to a thriving industry, there are a multitude of treatment centres and communities devoted to rehabilitation from drug-abuse, obesity and other pathologies are at the centre of vast business interests: health food producers, gyms, slimming clinics and health clinics, psychologists and dieticians. The effects of illnesses is heightened in order to stimulate the sale of medicines.
From a macroeconomic viewpoint, if the public health system is to be prevented from being blown away by the private sector, it will have to be given adequate capacity to meet growing demands without increasing taxation or requiring consumers to pay more than they do already, either directly or indirectly, but above all it is essential to avoid distortions that result in channelling earnings into the private sector and expenses into the public sector.
Health is priceless, but the cost that we pay for it should not become the price of uselessness. In the health system as it is, far too many resources are currently absorbed by non-fundamental activities. Spending must be rationalized and wasting reduced: are we sure that all we spend in health is properly used? How much is wasted? What expenses might be avoided? We often have to report health service malfunctions - perhaps we should weed out health service mismanagement.
Nobody wants to discard the public health system..., public health care gets plenty of lip service but not all the attention it needs..., even though the health system is in the red it still moves around large sums..., there’s a good deal of money to be made..., corrective measures are being studied to increase efficiency and productiveness and also to stimulate the industry, but frequently the bare necessities are lacking: we can make projects to go on the moon but first we need a decent stairway or a reliable lift to get to the next floor.
(Translated by interpres sas)