SANE Views Vol.6, No.42, 6 December 2006

Why healthcare is dysfunctional

Solly Benatar, Cape Times, December 04, 2006 Edition 1

Philip Stevens correctly says it is dysfunctional healthcare systems that should be the focus of attention instead of the cost of drugs ("Real issue not the price of medicines", November 22).

However, why are these systems dysfunctional? There are many reasons, most of which are seldom discussed by those who think solutions to healthcare lie in free market policies.

It is notable that many healthcare systems, even in wealthy countries, are dysfunctional. For example, in the US (where 50% of all money spent on healthcare in the world each year is spent on 5% of the world's population) and where annual per capita health care expenditure is more than $5,000 (15% of GDP), 45 million Americans lack access to healthcare and health outcomes are not as good as in Canada or Western Europe.

This is dysfunctional in the extreme.

In the UK, where there is universal access to healthcare, a potentially superb National Health Service has been rendered dysfunctional by a bloated bureaucracy and by holding expenditure to about 7% of GDP - much less than in any other industrialised country.

In South Africa, healthcare services are even more dysfunctional as we have neither the wealth nor the universal access of other countries.

There are two major reasons why health services are dysfunctional globally despite massive expansion of the world economy and spectacular medical advances. First, medicine is increasingly driven by the "imperative" to use expensive technology excessively and often wastefully. Second, current economic trends (led by blind faith in free market policies) are widening the gap between rich and poor, and shifting medicine away from a caring social service towards an increasingly commercialised activity benefiting mainly those who can pay.

Witness the trends here. In 1980, 30% of doctors worked in the private sector and many also did part-time work in the public sector. Today, almost 70% work in the private sector caring for the 18% of the population who have medical insurance. Discovery Health made a gross profit of R1 billion in 2005. Few private practitioners do any work in our inadequately funded and understaffed public services that languish under the escalating disease burden of an increasingly impoverished and ailing majority - and particularly so in the HIV/Aids era.

Globally, almost 90% of global annual healthcare resources is spent on 16% of the world's population who bear 7% of the burden of disease, and 90% of medical research expenditure on diseases responsible for 10% of the global burden of disease.

Healthcare is driven by market forces and the unrealistic expectations of doctors and patients that, even when there is very little hope of success, everything possible must be done regardless of cost. As a result, aggressive and expensive investigations and treatments often merely prolong suffering.

Without any sense of shame or considerations of recompense, wealthy countries, which have not trained enough professionals for their own needs, recruit health professionals trained in developing countries. This is just one of the many sad manifestations of a world in which the quest for continuous economic growth by the wealthy thrives on depriving others.

In the early 2000s, international medical graduates accounted for between 23-28% of physicians in the US, UK, Canada and Australia. Low-income countries supplied 40-75% of these international graduates. The World Health Organisation reports that, of 82,417 doctors trained in 11 sub-Saharan Africa countries, 18,566 (23%) work in eight recipient, wealthy countries.

South African New Economics Foundation (SANE)

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