The Sociological Character of Health Care Markets
by Donald W. Light
From "Handbook of Social Studies in Health and Medicine" Gary L. Albrecht, Ray Fitzpatrick, Susan C. Scrimshaw, eds.
Donald W. Light, Ph.D., Professor of Comparative Health Systems, University of Medicine and Dentistry of New Jersey:
"Economic competition and markets in health care, as observed in a review ten years ago (Light 1989), embody a paradigm shift from the professional dominance which prevailed in most systems, even public ones like Britain's National Health Service (NHS), to buyer dominance; from a doctor-led pressure for more services to a buyer or payer-led pressure for better outcomes; from an emphasis on hospital-based specialized treatments to prevention and primary care. This paradigm shift to buyer dominance promises better care at a lower cost. Yet one can separate, as Prime Minister Tony Blair has done, the results-oriented focus of a purchaser-led paradigm from a competitive strategy. For price competition in health care is so fraught with dangers of selective marketing, inequalities, worsening care, and ironically higher costs that it is unclear how many countries will employ it for how long. Already, one of the most sweeping adaptations, the transition of the NHS from the world's largest administered managed care system, to the world's largest competitive internal market contracts between purchasers and providers, has been replaced by reforms that emphasize cooperation and partnership, because competition was found to be too disruptive, demoralizing and costly. Competitive markets in health care, then, may be a phase in the historical process of rebalancing relations between the countervailing powers of professions, patients, payers and states."
Also, Dr. Light will be a featured speaker at the meeting of Physicians for a National Health Program on October 20, 2001 in Atlanta, Georgia.
The response of Donald W. Light, Ph.D., to ethicist David Fleming's comments on commodities and health care (in Dr. Fleming's response on the ethical implications of a physician's collection letter):
"Dr. Fleming's scenario is precisely the reason why many countries hold to the principle that medical care should be free at the point of delivery. Other reasons support this conclusion. Billing patients, co-payments, and other front-end deterrants decrease, about equally, initial office visits that were not necessary and that were necessary, resulting in the problem getting worse and more costly to treat. Moreover, the savings are tiny -- patient-initiated visits for elective problems. Managing costs can be done much more justly and effectively at the system level, not by making health care into a commodity. Doing so distorts clinical work for physicians and nurses, raises administrative costs considerably, and keeps patients away when they need to come in."