Privatisation creep: are corporations stealthily taking over our health care?

This article was originally published in Croakey . Read the original article

But health workers and activists in Europe are using the occasion to mark another area of global public health concern, with a day of action against the commercialisation of health, with the slogan: Our Health is not for sale!

In our second post today examining the role of private health insurance in health care and equity, Paul Laris, Fran Baum and Toby Freeman from the Southgate Institute for Health Society and Equity at Flinders University say Australians should be just as concerned and should take action tomorrow and in the coming federal election campaign.

See also our earlier post from GP Tim Senior asking important questions about the role of private health insurance in the Federal Government’s new Health Care Homes model for chronic care.

Paul Laris, Fran Baum and Toby Freeman write:

Health workers and activists in Europe are holding a day of action against the commercialisation of health on Thursday 7 April because they are deeply concerned about the extent to which the for-profit motive is coming to dominate the provision of care. They are also arguing for the value of publicly funded and provided services. These arguments are equally true in Australia.

From the 1940s a social democratic consensus meant health care came to be seen as a universal right to be publicly provided on the basis of need. The United Kingdom National Health Service was established and Medibank and then Medicare in Australia. More recently, neo-liberalism proposes the state as inherently inefficient and the market as the solution. Rising costs have helped make health care a recent target for privatisation. Like the infamous boiled frog, our sensitivity to this process has been dulled by the trickle of apparently minor changes, which when assessed together amount to an alarming trend which suggests we have as much to be concerned about in Australia as our colleagues in Europe.

The spread of private health insurance (PHI) is part of this trend. PHI increases costs and reduces equity. The public funds supporting the PHI industry through the rebate to those who take out cover continue rise in lockstep with premium increases. International comparisons demonstrate that the higher the proportion of health costs from private insurance the higher the per capita cost of health care – for no better outcomes.  Four of the 31 Primary Health Networks have a private health insurer as a partner in their management and this suggests they are positioning themselves to enter the primary health care market as the next place to turn a profit.

PHI companies’ primary commitment will be to their members and the AMA has expressed concern that uninsured members of the public may miss out. Increased co-payments for GP consultations, pathology and diagnostic services open up new market opportunities for private health insurance while restricting access for the less wealthy.

The PHI companies are also increasing their visibility in Australia through aggressive marketing and sponsoring or affiliating themselves with key organisations like the Public Health Association of Australia, the Grattan Institute and co-sponsoring a program of research with NHMRC.  The evident conflicts of interest are seemingly ignored. The real risks of so many primary health care stakeholders accepting PHI money are more constricted public and academic conversations about the role of PHI in our health system, and potentially less advocacy against the negative consequences evidence indicates PHI has.

Private hospitals in Australia provide accommodation and nursing support for private medical specialists to treat privately insured patients. These hospitals are profitable because they ‘cream skim’, providing lucrative elective surgery and avoiding the chronic and longer term care that is left to the public sector.

In their 2012 report, Private health insurance: high in cost and low in equity, John Menadue and Ian McAuley  have referred to an:

implicit message of social division: PHI and therefore private hospitals are for those who have the means; public hospitals are for the poor. This is a reversion to the ‘charity ward’ system, which, in time, will morph into something akin to the US Medicaid program for the indigent.

The most recent proposal outsourcing administration of Medicare rebate payments seems innocuous but introduces a conflict of interest between patients and profit-driven administrators. The complexity of Medicare benefit scales is far beyond the experience or competence of the largely US corporations poised to take this on, as Margaret Faux has demonstrated in this article at Croakey.

Free market economic approaches to health care provision have been shown to widen socio-economic and health inequities. There is evidence that health inequities may be increasing in Australia and that PHI may have some role in this (see Socioeconomic status and accessibility to health care services in Australia and, from the World Health Organisation, The Concepts and Principles of Equity and Health). The rationale for free-market models makes basic economic assumptions that simply do not apply to health care. The terms patient and consumer are not synonymous. Life and death decisions requiring specialised knowledge mean ‘providers’ have vastly more knowledge and power than ‘consumers’ debilitated by illness or injury.

Australians should consider supporting the day of action against the commercialisation of health on World Health Day on April 7. The coming federal election provides another opportunity for Australians to send out a clear message about the dangers of commercialisation in health care.