Defend Private Healthcare

Jaggy Bunnet said:
Given that we currently have pretty much all GP services provided in the "for-profit" sector, do you consider that this has already happened?
Click to expand...
Not yet in my view, but movement in that direction has occurred. As I understand things, the government (via the NHS) negotiates what it pays to GP businesses, and apparently gave providers a pretty generous deal when the GP contract was set up in 2004, so there has been room for GPs themselves to significantly increase their income under those terms, which I believe they have. Politically the message has been that doctor's pay was "too low" before so there is nothing wrong with this. Recall this was accompanied by a large increase in the Department of Health's budget. But it is not clear what happens when GP pay is no longer "too low" and what forces stop it rising "too high".

If not, what has prevented it and why would that not apply to other areas of healthcare?
Click to expand...
What has prevented it so far is the short history. What can prevent it in the future is government spending caps and government bargaining power.
 
Ivor the Engineer said:
Because private physicians can rely on someone else to help a person in need of medical care who cannot pay their fee?
Click to expand...
Partly, yes. Food is a necessity, and most modern countries recognize that people who can not afford it should receive sufficient assitance from the state not to go hungry. Nobody thinks that state assistance should pay for caviar, and very few think that caviar should be banned because some people can not afford it.

I think you and I (or you and Francesca) have a very basic disagreement. You think it is unethical for some people to have access to medical care which some others have no access to. I disagree. As I said, I do not begrudge Hugh Hefner and Bill Clinton top-flight experimental care I can not afford. First it means Hugh and Bill are paying for the significant chunk of medical research -- as opposed to it being entirely funded with my taxes. Second, it creates motivation for medical researchers which do not exist otherwise. Again, basic disagreement -- you think profit motive has no place in medical care. I say profit motive is essential in ALL innovation, whether medical, or space, or food production. Almost all major technological breakthroughs in history were done by people who wanted to get rich.

And there is one more, highly ironic benefit. Buying latest experimental treatments, rich people serve as additional (and often ONLY) human trials for these said treatments. I am all for guinea pigs paying for the lab!
 
D'rok said:
Don't be too jealous. Our constitutional order (federalism, with health care under provincial jurisdiction) means that we can never have a truly nationalized system. We're stuck with a patchwork system run by the provinces and (under)funded by the feds and plagued by power struggles between the two levels of government.
Click to expand...

Lets see, patchwork system that is not truly nationalized: Check - we have primary care trusts (303 in England alone) that set their own priorities and decide whether or not to fund certain treatments.

Underfunded - some would say it is, some would say it isn't. I think few would argue that the huge additional resources committed in recent years have been matched by a corresponding increase in results.

Power struggles: Check - do a google on postcode lottery NHS. An almost inevitable outcome of the existing structure.
 
Francesca R said:
Not yet in my view, but movement in that direction has occurred. As I understand things, the government (via the NHS) negotiates what it pays to GP businesses, and apparently gave providers a pretty generous deal when the GP contract was set up in 2004, so there has been room for GPs themselves to significantly increase their income under those terms, which I believe they have. Politically the message has been that doctor's pay was "too low" before so there is nothing wrong with this. Recall this was accompanied by a large increase in the Department of Health's budget. But it is not clear what happens when GP pay is no longer "too low" and what forces stop it rising "too high".
Click to expand...

The GP contract was not set up in 2004, it was renegotiated. I absolutely agree that the deal the GP's got was very generous. However I don't see what that has to do with the fact they have a profit motive - had they been employed they would simply have negotiated a large pay rise, instead of a large increase in charges.

What has prevented it so far is the short history. What can prevent it in the future is government spending caps and government bargaining power.
Click to expand...

Short history? GP's have always been private businesses operating within the NHS. Is 60 years really too short a period to judge it?

The controls seem to be exactly the same things that would apply whether the government was negotiating with the BMA about new contract terms for provision of services by GP businesses or if the government was negotiating with a hypothetical NHS doctors union over a new pay deal. I don't see why the latter (a state supply model) is necessarily any more efficient/cheaper than the former - if the people negotiating on behalf of the government are poor at their job (as they appear to have been) then the public finances suffer either way.
 
Ivor the Engineer said:
Where they are paid extra for providing medical treatment, yes.

Medical treatment is either required or not required.
Click to expand...

So you think that paying a bonus to a GP practice that has achieved a target rate of flu vaccination coverage among vulnerable sections of the population is unethical?
 
Jaggy Bunnet said:
How about those who choose to train as engineers rather than as doctors? Are they not equally guilty of relying on someone else to help a person in need of medical care?
Click to expand...

No. The OP was with respect to medical ethics. I.e. How people who have been trained and agreed to help people with their medical problems should behave.

Do private physicians take a different ethics course at medical school to those physicians who don't discriminate based on potential patients' ability to pay?
 
Jaggy Bunnet said:
Short history? GP's have always been private businesses operating within the NHS. Is 60 years really too short a period to judge it?
Click to expand...
Have private firms been able to completely buy out GP businesses (so that they no longer provide any services under the NHS) before very recently?
 
Jaggy Bunnet said:
So you think that paying a bonus to a GP practice that has achieved a target rate of flu vaccination coverage among vulnerable sections of the population is unethical?
Click to expand...

No. Payment for achieving prescribed extra output is not unethical.

I do think it is potentially counter-productive from a PR point of view.
 
Francesca R said:
Have private firms been able to completely buy out GP businesses (so that they no longer provide any services under the NHS) before very recently?
Click to expand...

I'm not sure what you mean. Can you clarify?

GP businesses ARE private firms. They are typically run as partnerships where the doctors are the partners and entitled to the profits the business makes.

GP businesses have always had the choice of providing NHS services or not.
 
Francesca R said:
Well I agree with that, but it's completely different from not allowing them to make a profit. So you've climbed down from that? (Or did you never say it?)
Click to expand...

I think I said the profit motive has no place in the provision of health care. I.e. the decision of how much medical treatment to provide (including no treatment at all) to a person in need should not be based on that person's ability to pay.
 
Ivor the Engineer said:
No. Payment for achieving prescribed extra output is not unethical.
Click to expand...

Strange, it was you who said you opposed the GP model "Where they are paid extra for providing medical treatment, yes." was it not?

Now you are saying that when they are both paid for doing it (per vaccination) and paid a BONUS if they achieve a target level, this is OK?

Which is it? Either it is unethical to pay them to provide medical treatment or it is not - you can't have it both ways.
 
Ivor the Engineer said:
I think I said the profit motive has no place in the provision of health care. I.e. the decision of how much medical treatment to provide (including no treatment at all) to a person in need should not be based on that person's ability to pay.
Click to expand...

But it can be based on the state's willingness to pay, as in the vaccination example?

So it is unethical for a doctor to charge me to administer a vaccination to go on holiday, but ethical for him to charge the state and earn a bonus to vaccinate me against flu?

Lets say I was one day too young to qualify for a free flu jab under the incentivised NHS scheme but I offered to pay him as a private patient at exactly the same rate as he would have earned from the NHS had I been a day older. Is it unethical of him to agree to provide the vaccination?
 
Jaggy Bunnet said:
Strange, it was you who said you opposed the GP model "Where they are paid extra for providing medical treatment, yes." was it not?

Now you are saying that when they are both paid for doing it (per vaccination) and paid a BONUS if they achieve a target level, this is OK?

Which is it? Either it is unethical to pay them to provide medical treatment or it is not - you can't have it both ways.
Click to expand...

Flu vaccination is not a good example because it is possible to argue it is not a medical need.

A better example would be a reduction in the average number of days patients spend waiting for surgery. In this case the need for treatment is not open to subjective interpretation and extra payment for increased output is not unethical.

In general the promise of reward for a particular course of treatment should not be in physicians' minds when they are deciding on treatment because it will distort their judgement to some extent.
 
Jaggy Bunnet said:
But it can be based on the state's willingness to pay, as in the vaccination example?

So it is unethical for a doctor to charge me to administer a vaccination to go on holiday, but ethical for him to charge the state and earn a bonus to vaccinate me against flu?

Lets say I was one day too young to qualify for a free flu jab under the incentivised NHS scheme but I offered to pay him as a private patient at exactly the same rate as he would have earned from the NHS had I been a day older. Is it unethical of him to agree to provide the vaccination?
Click to expand...

As I said before, flu vaccination is a poor example because it can be argued it is not a medical need, rather a wanted risk reduction.
 
Ivor the Engineer said:
As I said before, flu vaccination is a poor example because it can be argued it is not a medical need, rather a wanted risk reduction.
Click to expand...

No flu vaccination is a great example, because it shows that you can deliver healthcare benefits by giving doctors financial incentives.

I can understand why you want to try and ignore that, but that does not make it a bad example.
 
Ivor the Engineer said:
In this case the need for treatment is not open to subjective interpretation and extra payment for increased output is not unethical.
Click to expand...

This is simply not true. There are a number of conditions where surgery is an option as a treatment, but not the only option.

One simple example:

http://orthoinfo.aaos.org/topic.cfm?topic=A00349

"Treatment
A partial tear of the ACL may or may not require surgical treatment. A complete tear is a more serious injury. Complete tears, especially in younger athletes, may require reconstruction. Both nonsurgical and surgical treatment options are available for ACL injury. "
 
You must log in or register to reply here.

Back
Top Bottom