The business of medicine

It was never meant to become a commercial enterprise but one look at the global healthcare sector leaves no doubt that medicine is one of the largest and most profitable industries. The arguments on either side of the fence regarding the ethical and moral issues of medicine and money have been extensively documented but what neither side can deny is that for modern medicine to exist a lot of money is required. This situation has both advantages and disadvantages which will be discussed.

Research and the clinical application of solutions is an expensive proposition particularly in western countries where the populations now demand faultless medical care. The funding of these endeavours comes from the major financial institutions and governments. Both privately and publicly held corporations invest purely for financial profit and have little regard for the human aspect unless poor outcomes negatively affect the balance sheet. The relationships between the pharmaceutical and medical device manufacturing industries and the medical profession is complex and some would say fraught with ethical dilemmas. One cannot escape the fact that significant progress has been made as a consequence of these interactions which has undoubtably benefitted patients. However the relationships also create conflicts of interest that some outside observers describe as potentially harming patients from receiving the most appropriate care as the claim staes the physician is incentivized to use a drug or product which benefits him financially. Various laws have been passed in an attempt to curtail the more abusive end of this spectrum but one of the main concerns today is that it will stymie innovation as physicians fear the consequences of violating any of these laws.

There is marked global disparity in the provision of modern healthcare which admittedly has been decreasing over the last decade but which still presents a major public healthcare challenge. It is no coincidence that the correlation between the economic standing of a country and its healthcare system is a direct one in which clearly the wealthier countries can afford to provide better services. An interesting anomaly however has been the variability of healthcare services in the US which happens to be the wealthiest country in the world and yet has some of the most unhealthy people on the planet. Part of this is explained by the epidemic of obesity and the excessive consumption of processed foods. Ironically these troubling trends end up feeding the healthcare system with sick patients to treat and from who it profits. A vicious cycle within the US has been established that generates vast profits for large healthcare and food companies.

The relationship between the doctor and the patient was interrupted in the 1960s as the insurance companies inserted themselves into the equation. Using their financial and political muscle they have progressively subjugated this relationship and are now some of the largest beneficiaries of the healthcare system. This is ultimately not good for patients or physicians as the tendency for these insurance carriers has been to dictate how clinical care is delivered. A potential solution to this expensive and inefficient configuration is the refusal of physicians to accept any insurance and ask the patient for immediate payment with instructions that they should seek reimbursement from the insurance carrier. This solution would however require physicians to lower their prices, particularly in the US, to allow the average citizen access to the majority of care.

The Affordable Health Care Act enacted in 2010 aims to address some the inequities that had developed in the US healthcare system and it remains to be seen whether the legislation will achieve its goals. One of the more positive aspects of the law has been the mandate that insurance carriers cannot deny insurance coverage to patients with pre-existing conditions which was a particularly cruel part of the previous healthcare system. One of the other main aims of the act was to reduce the overall cost of the healthcare system from 18%GDP to in the first 5 years 14%.This will still continue to make the healthcare sector an extremely attractive sector for international investors who especially see the growth in spinecare services.

The philosophy of free healthcare is unicorn that was unfortunately sold to the British public after WW 2 but there is no escaping the fact that inordinate amounts of money are required to administer a modern healthcare system. Education is one of the most critical and costly components of any healthcare system and is free in some countries while being extremely expensive in others. Medical School curriculums should include educational courses in business management so that graduating students are equipped with the most basic rudimentary skills to establish and administer a medical business. Without these skills they put themselves at the mercy of the large healthcare corporations.

Ultimately the goal of modern medicine is to bring it to as many global citizens as possible which will require the development of techniques and medical management tools that can be delivered cheaply while maintaining quality.Well ket clinical data collection has a large amount of inherent value to pharmaceutical and device companies as it enables them to get some idea of the success of their product. This area of medical business is in it’s nascent stages as more organization is being applied to a very fragmented healthcare sector. However as this process evolves it will become a very powerful tool in both the analysis of past failures and any amendments required for improvement. This data mining and selling provides a great commercial opportunity to well organized providers and healthcare systems.

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