Dear colleagues: I am looking forward for your valued contributions on this topic

Putting health care on the market as you would any other good, say a laptop, I doubt is going to lead to an effective health care system. Firstly, and I'm sure there will be disagreements to this, is that health care is not the same as laptop. The differences vary and one of the most important differences is uncertainty, we don't know when we're going to need it, you can plan for a laptop but in most cases you cannot plan for health, but then there's insurance, so in a way you can.

leaving health care to determine its own market prices will lead to out of pockets costs (for those without insurance) being too high and it will be only based on those willing and able to purchase it. What that will lead to is inequity. Health would not become accessible to those who might be in most need of it. and isn't the promise of every health care system to be equitable?

Hope this makes some kind of sense :)

In short - NO. The fundamental question to contemplate is: Is health a public good or a commodity? For me the answer is unequivocally clear - health and healthcare is a public good. Commercialization of healthcare results in huge inequalities, exploitation and ultimately poor outcomes.

In developing countries private healthcare is an essential part of the health system as the public healthcare system is inadequate to supply services to all the people.

So private healthcare system fills the demand gap.

there are multiple problems with the private health system , as mostly it is unregulated and left solely in the private hands and price is set by the market system.

Private health system charges different prices at different levels and standards. Private hospitals charge according to their standards and according to the customers income group they cater.

Efficiency and patients trust can only attract patients to a public hospital. In developing countries Private Healthcare means a perception of quality care along with satisfaction.

and also when we look in the developed world private healthcare is leading the way in many countries, attracting patients allover the world for their latest technology and ultra high care and professionalism. The charges are high but the demand is always on the rise further pushing the prices up.

The debate can never end until one is totally abolished in a country for example in Cuba or Iran where only public healthcare is available.

Comprehensive public healthcare is the hallmark of a civilised society - the mutual recognition that risk sharing to help those currently less fortunate may well be of benefit to you in the future if or when you become the less fortunate. Comparing health care insurance in the US and individual National Insurance payments in the UK, it is clear to me that over our lives we spend far less on our individual health costs - we only pay whilst we are working adults.

We pay nothing towards our health care costs until we reach a minimum income level of £7700 (around US$10,000) then we pay at a rate of 12% of gross salary, with the employer paying a further 13.8% on top of gross salary. Once earning £41,500/annum gross, (around US$60,000) we pay at a rate of only 2% of gross for anything over that figure, with the employer continuing to pay a further 13.8% on top of gross salary on anything above £41,500. The first £10,000 of salary is free of tax and national insurance costs, and Personal pension payments are exempted of these costs, so the cost is worked out on gross salary over £10k, minus personal pension payments.

When considering this, yes, it is on top of general taxation - however as well as free at point of service health care including

- free dental care for children, those on benefits and all pensioners and low cost dental care for everyone else, also

- free eye tests and spectacles for children & those on benefits, and

it also meets the cost of:

- unemployment benefits,

- disability benefits,including workplace support for those working,

- working tax credits for low paid workers,

- housing benefits to meet housing costs of the unemployed, low paid workers and low income pensioners, and the following

- Sick pay,

- industrial injury pay,

- maternity pay, and maternity benefits,

- paternity pay,

- adoption pay,

- widow/er/s pension,

- state pension,

- and pension credits to ensure every pensioner reaches an income of £5720 plus housing benefits if needed

- and probably a few other things I cannot think of.

All in all, the UK system gives us a hell of a lot, but as I say this , the current government is doing its utmost to ensure as many people as possible do not qualify for the benefits paid for.

That however is an ideological issue, and should not be used to condemn the system which is fundamentally wonderful.

I personally do not think that this "presumed" superiority of market over public provision is always true and especially not so much in the case of health care. I think the provision of basic services to a wide range of people is simply a sign of civilization even if defining a line between what is essential and what is superfluous is always difficult. in other words cancer or heart surgery is essential in my view and aesthetic surgery is definitely not essential but the problem might arise with respect to what is in the middle and that is a lot. However we should not be scared to get our hands dirty and thus prefer to find a one-size-fits-all solution that goes under the name of market competition. At the same time we should also not be willing to accept high inefficiency to justify public provision.

edoardo

I believe that basic health services are those of first instance, to be understood as those that are able to revive the person. Unlike the case of chronic illness or treatment of transplant patients, where the public purse is essential.

Everything else must be borne by the party concerned, who must be induced to take out health insurance portable.

Do you favor the trend toward health care for profit?

You have two driving factors that effect clinical outcome.

1. The strength of Charter of the physician to provide the best care possible while not being influenced by monetary reward. This is placing a heavy burden on the charter of the treating physician.

2. Is fair market payment for his services (fee for service model) Doctors tend to respond rather quickly in private hospitals.

My observation in reviewing surgeons behavior with in these two separate payment plans. First the United States has a social medical program for their military personal with active duty health team members. The get paid the same amount regardless of how many patients they see or what the clinical outcome is. This is also true in our Veteran Hospitals. Doctors see very little finical reward for how many patients they treat as compared to private medicine that get paid on a fee for service.

I have seen military men in state side hospitals let open fracture tibias set for hours why surgeons argue who is on call. This does not happen in a for profit hospital.

The hospitals that pay their health care team the highest salaries have happy workers who enjoy taking care of patients.

Tim

Your observation certain holds true in the Australian context, too. But at the same time it really tells a sad story about the attitudes of many health professionals towards their chosen vocation. It begs the question whether or not it still is a vocation, or just a job?

In my view we have reached the point where we need to have a worldwide discourse about health system reform, rather than reform/tinkering of service and remuneration models.

As an aside: Why do we pay CEOs a salary rather than a fee for every decision?

The issue raised is interesting and controversial as long as we immagine that the market for this specific service is not completely competitive due to the asymmetry in information between buyer and seller. The public sector at large should, in any case, be involved at least with a certification of proven quality role.

Furthermore, I see also another functional issue linked to the provision of (a limited) number of services at a subsidized price due to redistribution issues and with social cohesion purposes. In this case one has to effectively balance the private and public service provision with respect to a set of different indicators linked also to the type of service provided.

May be one should look for a well balanced solution progressively searching by trial and error and, more importantly, without having any strong prejudice with respect to any solution tested.

edoardo

Still, in every country whether a public-, private, or a combination of systems is applied, health care technologies afford us a healthy population though against increasing costs. Public healthcare always has the dilemma of efficiency. Private healthcare is much more focused on profit and therefor on efficient delivery. The core business of healthcare professionals is care and cure, and working effectively. Since 2006 in the Netherlands health care institutions and insurers are allowed – by law – to trade prices on most common interventions. And, yes, healthcare professional do work more efficiently. But, profit made by insurers is not directly invested in health care technologies. So, again healthcare is vulnerable whatever system is applied.

I will provide an example where both the public and private pay models do not work at the current time. One of my dear friends and a Board Member of my Non Profit Foundation is a total joint surgeon that specializes in the care and treatment of infected total joint surgery. He is in private practice works six days a week on average 12-14 hours per day. His revision surgeries can run anywhere from two to six hours per case.

He is a dedicated surgeon that teaches and publishes his work so his overhead is high. Everyone knows that Medicare reimbursements have been significantly reduced over the years and since he never turns away an infected joint it is difficult for him to build his primary hip and knee side of the business.

His average annual net pay for all the hours he puts in on some of the most difficult surgery anyone will ever see is well under $200,000. He is based in the L. A. area where competition is strong but no ones whats to do these difficult cases so he receives many of these referrals. He could turn them away but his dedication to the care of patients does not allow him to act that way.

Hospitals do not want his business because his surgeries cost too much. Partnership does not want him because he does not generate enough in fee for service. There is no adequate public sector money to compensate him for the work he does in both saving lives and restoring their function.

As most are aware many patients that use Medicare have significant personal wealth but under todays laws it is not possible for doctors to negotiate additional pay for services for a Medicare patient. I have even see patients that fly into a city in their private jet to be treated but again the surgeon cannot charge them a penny more for his services. This makes no sense. With the increase demand for total joint surgeries there is no health care system that can provide equal access and treatment at the moment. We need to allow highly trained surgeons the opportunity to negotiate higher fees to the patient population that can offered to pay leaving the public money to those that do not have the resources, otherwise we will lose doctors to withdrawing from treating public patients. This is happening now. We need to maintain the high standards that comes with training and experience. All physicians and surgeons are not equal in their ability to treat and cure disease . Monetary compensation is an important part of the equation otherwise alternative activities will be sought out. We want the best and brightest in our health care system and compensation has to meet fair market competitiveness.

Our system is broken and I am afraid the current model does little to address this.