When I embarked on my career in healthcare over a decade ago, I naively expected the industry to be a natural force for good—a siloed aspect of humanity that is uniform and genuine. After all, what place does "business" have in living a healthy and fruitful life?
However, experience has a way of changing perspectives. Today, seeing daily LinkedIn posts about profit and loss statements or equity funding in healthcare brought me to a place of ...hesitancy. Taking passion for reading and research has allowed me to delve deeper into this topic. While I don't have all the answers or the authority to declare what is right or wrong, I write this as a way to process my thoughts and share some interesting studies I have found on this topic.
The commercialization of healthcare in the United States has sparked intense debate for decades among political parties, policy writers, public health professionals, and clinicians of all kinds. As our healthcare system evolves with more mergers and investments, concerns about the implications keep growing. Sure, these changes undoubtedly bring increased efficiency and some truly pivotal innovations. But at the same time, they pose risks to equity, accessibility, and the quality of care.
1. Ethical Concerns
The Hippocratic Oath emphasizes that healthcare providers should always put patient welfare first, but this can clash with the profit motives in a commercial system. There’s real evidence, including findings from the Office of Inspector General (OIG), showing that financial incentives can lead to over-treatment, under-treatment, or unnecessary medical procedures. Plus, conflicts of interest can crop up when healthcare providers have financial stakes in the treatments or services they recommend.
2. Rising Healthcare Costs
We all know the story: the U.S. spends more on healthcare per person than any other country, but we don’t see better health outcomes compared to other developed nations. These high costs come from administrative expenses, high prices for medical services, and the profit motives of private insurers and healthcare providers. In perspective, administrative costs made up about 8% of total healthcare spending in the U.S. in 2017, while in countries with single-payer systems, it’s only about 1-3%.
3. Compromised Quality of Care
When profit becomes the main goal, there's a real risk that patient care takes a backseat to making money. A study in the Journal of General Internal Medicine found that for-profit hospitals had higher rates of bad outcomes and patient deaths compared to non-profit hospitals. This suggests that focusing on making money can distract from focusing on patient care and safety.
4. Inequitable Access to Care
Commercialization often creates a system where your ability to pay decides the quality and speed of the medical care you get. According to a report by the Kaiser Family Foundation, in 2020, nearly 28 million non-elderly Americans were uninsured, mainly because of high costs. This lack of insurance hits low-income individuals and minority groups the hardest, making existing health disparities even worse.
5. Fragmentation of Services
It's common to see different parts of healthcare being handled by various entities, each driven by their financial interests. This fragmentation has lead to a lack of coordination among healthcare providers, causing inefficiencies and potentially harmful medical errors. The Institute of Medicine (now the National Academy of Medicine) has pointed out that this kind of fragmentation is a big reason for the high cost and inconsistent quality of healthcare.
6. Reduced Focus on Public Health
In a commercialized healthcare system, there's a tendency to focus on acute and profitable medical treatments over preventive care and public health initiatives. This shift undermines efforts to tackle broader health issues like chronic diseases and social determinants of health. The COVID-19 pandemic as an example really exposed the weaknesses in our public health infrastructure, showing just how devastating underinvestment in public health can be.
7. Impact on Medical Research and Innovation
Commercialization can often push research priorities towards more profitable areas rather than what’s most needed for public health. For example, pharmaceutical companies might focus on developing medications for chronic conditions common in wealthier populations instead of diseases that affect low-income or developing regions.
So where do we go from here? The issues at hand involve generational and multi-disciplinary elements of economic and policy forces. While concerns about prioritizing profit over patient welfare listed above are valid, it's also true that we have made exponential progress in tackling disease burdens and improving access to care in unprecedented ways. Addressing these challenges requires a careful balance between leveraging the benefits of commercial approaches and ensuring that the primary focus remains on improving health outcomes for all individuals.
My dream is to see more public collaborations between policymakers, healthcare providers, and stakeholders, where innovation is actively pursued and implemented.
References:
Kaiser Family Foundation. (2020). Health Insurance Coverage of the Total Population. Retrieved from KFF.
Papanicolas, I., Woskie, L. R., & Jha, A. K. (2018). Health Care Spending in the United States and Other High-Income Countries. JAMA, 319(10).
Himmelstein, D. U., Campbell, T., Woolhandler, S. (2018). Health Care Administrative Costs in the United States and Canada, 2017. Annals of Internal Medicine, 169(1), 45-47.
Devereaux, P. J., Choi, P. T., Lacchetti, C., Weaver, B., Schünemann, H. J., Haines, T., ... & Guyatt, G. H. (2002). A systematic review and meta-analysis of studies comparing mortality rates of private for-profit and private not-for-profit hospitals. CMAJ, 166(11).
Institute of Medicine. (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: The National Academies Press.
National Academy of Medicine. (2020). Public Health COVID-19 Impact Assessment: Lessons Learned and Compelling Needs. Washington, DC: The National Academies Press.
Brody, H. (2010). Medicine's Ethical Responsibility for Health Care Reform — The Top Five List. New England Journal of Medicine.
Light, D. W., Lexchin, J. R. (2012). Pharmaceutical research and development: what do we get for all that money? BMJ, 345.
Sinsky, C., Colligan, L., Li, L., Prgomet, M., Reynolds, S., Goeders, L., ... & Blike, G. (2016). Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties. Annals of Internal Medicine, 165(11).
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