Another short post
Was reading through some of the articles I've written. By far I feel that this piece is the most impressive by my standards. Entered it for a competition, didn't win anything though.
Is Medicine a Profession or a Business?
Medical ethics has long been associated with the investigation of moral questions and challenged by social, economy and political realities. Is medical care a consumer good like any others, a commercial service provided by skilled vendors for consumers willing to pay a market price, or is there something fundamentally different about the relationship between a doctor and a patient? Will the society be served best by treating medical care like commerce, or should we regard medical care as a form of social service?
Profession is a job or career which requires specialised knowledge and often long and intensive academic preparations. The word "profession" comes from the Latin word "professio", which means a public declaration with a force of promise. The profession presents itself to the society as a social benefit and society accepts the profession, expecting it to serve some important social goals. The marks of a profession are, competency in a specialised knowledge or skill, being responsible and dutiful towards the society it serves. Some of the traditional professions are medicine, law and education. Definition for business is more straightforward. It is an occupation, work or trade in which a person is engaged. It also consists of commercial, industrial or professional dealings. In short, business is about making profits.
It takes an enduring and intensively long period of time to become a doctor or physician. In America, a person will need to complete four years of college, followed by another four years in a medical school. Then he has to go through three or four years of residency followed by a two to three year fellowship before he begins to practice medicine. That is a total of twelve to fifteen years of training after high school, a magnitude longer than any other professions. In National University of Singapore (NUS), the undergraduate medical programme is a 5-year course leading to the degree of Bachelor of Medicine and Bachelor of Surgery (M.B.,B.S.).
The truth is that, business permeates medicine. Business is as important to medicine as new pharmaceuticals are to an effective physician. You just cannot have one without the other. Doctors’ practices are businesses. They pay rent and buy equipment. Health insurance and managed care companies, the pharmaceutical and medical device industries need money for marketing, advertising, investments, research and developments for new drugs. By following the business model, the funding required will then be available to enhance medical technology. Earlier this year, April 7, the Yong Loo Lin Trust has donated $100 million to the NUS Faculty of Medicine. The gift will accelerate the development of eight areas in the Faculty which are important to Singapore’s health needs: Ageing/Neurosciences, Cancer, Cardiovascular Diseases, Gastrointestinal and Liver Diseases, Immunology, Infectious Diseases, Metabolic Medicine and Regenerative Medicine. With money, we can certainly improve health-care, and we must understand the fact that business does bring in the money. We cannot be expecting other health-care organisation to be depending on generous donations as such kind acts do not come by often.
It is actually hard to separate profession and business. Professionals usually engage in business. Even organisations that fall under the categories of "non-profit" and "public-sector" are now run like a profit-making business. Today, National Kidney Foundation (NKF) is the largest not-for-profit dialysis provider in the world. NKF is recognised as a world-reputed healthcare institute, benefiting over 260,000 Singaporeans every year through various life-saving programmes. Their achievements have been great since their establishment in 1969. In 1987 they established the world’s first public-funded subsidised dialysis programme. In 1992, the 1st International Congress on Organ Transplantation in Developing Countries was formed. NKF's Institute of Nursing Education and Research (INER) initiated the formation of the Association of Renal Professionals of Asia Pacific (ARPAP) in 2001, the first in the region, and in the same year, Children's Medical Fund to help chronically ill children and young adults was established. For the past 36 years, NKF has been transformed dramatically with drastic improvements, with over SG$200 million in the reserves, and the ability to support their patients for the next 3 decades. If not for the business and marketing plans by the experts, the achievements, in terms of contributing to the society in the area of medical care, would not have been so great. We have seen NKF doing huge amount of advertisings, and hiring popular celebrities in charity shows to raise funds from the public. In a system where health care budgets are tight, bureaucrats and politicians tend to see new technology as too costly to justify the benefit they would provide. As a result, funds, if any, are provided only for the purchase of a limited amount of the newest technology. The decisions on what to buy and when to buy it are often guided more by good politics than good medicine.
Canada has been very explicit about its attempt to avoid using the business model in health care. However, has the country achieve that goal? The New York Times has revealed numerous problems all across Canada. In Winnipeg, ‘hallway medicine’ has become so routine that hallway stretcher locations have permanent numbers. No doubt, patients recuperate more slowly in the drafty, noisy hallways. At Vancouver General Hospital on the West Coast, Maureen Whyte, the hospital vice president, estimates that 20 percent of heart attack patients who should receive treatment within 15 minutes now wait for an hour or more. In 1999, as waiting lists for chemotherapy treatments for breast and prostate cancer stretched to four months, Montreal doctors started to send patients 45 minutes down the highway to Champlain Valley Physicians’ Hospital in Plattsburgh, New York. As the New York Times points out, “Canada has moved informally to a two-tier, public-private system. Although private practice is limited to dentists and veterinarians, 90 percent of Canadians live within 100 miles of the United States, and many people are crossing the border for private care".
While Canada ranks fifth in terms of total health care spending (as a percent of GDP), a recent study by the Fraser Institute, comparing OECD data, found that the country ranks 21st out of 28 in CT scanner availability; 19th out of 22 in lithotripter availability; and 19th out of 27 for the availability or MRIs. Canadians often wait for weeks and even months to see a specialist. According to The Vancouver, British Columbia-based Fraser Institute’s annual survey of waiting times in Canada, the average total waiting time between a referral from a general practitioner and treatment by a specialist rose from 13.3 weeks in 1998 to 14 weeks in 1999. The waiting time between specialist consultation and treatment increased from 7.3 weeks in 1998 to 8.4 weeks in 1999.
Several years ago, an enterprising hospital in Guelph, Ontario, decided to allow animals needing Computed Tomography (CT) scans to enter the hospital in the middle of the night, charging pet owners $300 apiece. There is nothing necessarily wrong with that action, except that thousands of people in Ontario were waiting up to three months for an appointment on the same machine. As people are not allowed to pay out of pocket for medical procedures covered under the government-run plan, they have to wait. However, if you are a dog, you can get medical technology immediately. When dogs get better treatment than people, then people will “become dogs.” In December 1999, the Washington Post reported that waiting lines for Magnetic Resonance Imaging (MRIs) in Ontario has grown so long that one Ontario resident booked himself into a private veterinary clinic that happened to have one of the machines, listing himself as ‘Fido’. While we may have a good laugh at this report, we must question ourselves that, is this the model (Canada's attempt to avoid using business model) we want to follow for providing quality health care?
In Australia, virtually every shopping centre incorporating a Woolworths store already has a pharmacy, as do most smaller centres and towns with more than a few hundred people. Pharmaceutical Society of Australia (PSA) Vice-President Frank Payne said, protecting public health is more important than Woolworths’ profits and should be the primary consideration in any government decision over whether to allow pharmacies in supermarkets. PSA is concerned that allowing pharmacies in supermarkets would undermine the progress that has been made in ensuring the safer use of medicines within the community. Moreover, they believe that a pharmacist exercising professional responsibilities should not be influenced by commercial considerations, but the health of the community is paramount. Woolworths’ sole argument for entering the pharmacy industry has been based on financial considerations, with managing director Roger Corbett claiming that Australians are paying too much for medicines. Mr. Corbett also argued that by allowing pharmacies in supermarkets, it would increase consumers’ access to prescription medicines, saying the move would significantly broaden the community’s access to expert, professional pharmacist advice.
Incorporating a business model into a medical-related organisation, can allow the firm to be more dynamic, flexible and more importantly, customer-oriented as well. The reason businesses seek to offer a quality product at an affordable price is that customers want value for their money. That is, they weigh cost, quality, service, convenience and other factors before making a decision on what to purchase.
Some physicians think medicine already looks too much like self-serving capitalism. Business is about the proprietor taking care of himself while medicine is about taking care of others. Business is guided by pragmatic decisions, medicine by ideals, and some physicians seek to take the business out of medicine so that the ideals can prevail. The idealists hope to do good without regard to doing well but the businesses in medicine strive to do well in order to continue doing good.
I will argue that, in contrast to such idealistic views, the problems facing the health care system result not from being too business-like, but because the practice of medicine does not act enough like a business. Business is guided by the very pragmatic goal of providing high quality goods and services to consumers, at affordable prices. Is not that also the goal of medicine? The medical profession will probably never operate completely like a business. However medicine can learn from business, and even become more like it. That means adjusting the incentives so that they create a positive, rather than a negative, impact. For years many people both inside and out- side the medical community have argued that “medicine is unique.” In becoming more business-oriented, medicine doesn’t have to give up its own unique values. Indeed, it is only by adopting the business model that medicine can embrace its values in providing a high level of quality for an affordable price.
Is Medicine a Profession or a Business?
Medical ethics has long been associated with the investigation of moral questions and challenged by social, economy and political realities. Is medical care a consumer good like any others, a commercial service provided by skilled vendors for consumers willing to pay a market price, or is there something fundamentally different about the relationship between a doctor and a patient? Will the society be served best by treating medical care like commerce, or should we regard medical care as a form of social service?
Profession is a job or career which requires specialised knowledge and often long and intensive academic preparations. The word "profession" comes from the Latin word "professio", which means a public declaration with a force of promise. The profession presents itself to the society as a social benefit and society accepts the profession, expecting it to serve some important social goals. The marks of a profession are, competency in a specialised knowledge or skill, being responsible and dutiful towards the society it serves. Some of the traditional professions are medicine, law and education. Definition for business is more straightforward. It is an occupation, work or trade in which a person is engaged. It also consists of commercial, industrial or professional dealings. In short, business is about making profits.
It takes an enduring and intensively long period of time to become a doctor or physician. In America, a person will need to complete four years of college, followed by another four years in a medical school. Then he has to go through three or four years of residency followed by a two to three year fellowship before he begins to practice medicine. That is a total of twelve to fifteen years of training after high school, a magnitude longer than any other professions. In National University of Singapore (NUS), the undergraduate medical programme is a 5-year course leading to the degree of Bachelor of Medicine and Bachelor of Surgery (M.B.,B.S.).
The truth is that, business permeates medicine. Business is as important to medicine as new pharmaceuticals are to an effective physician. You just cannot have one without the other. Doctors’ practices are businesses. They pay rent and buy equipment. Health insurance and managed care companies, the pharmaceutical and medical device industries need money for marketing, advertising, investments, research and developments for new drugs. By following the business model, the funding required will then be available to enhance medical technology. Earlier this year, April 7, the Yong Loo Lin Trust has donated $100 million to the NUS Faculty of Medicine. The gift will accelerate the development of eight areas in the Faculty which are important to Singapore’s health needs: Ageing/Neurosciences, Cancer, Cardiovascular Diseases, Gastrointestinal and Liver Diseases, Immunology, Infectious Diseases, Metabolic Medicine and Regenerative Medicine. With money, we can certainly improve health-care, and we must understand the fact that business does bring in the money. We cannot be expecting other health-care organisation to be depending on generous donations as such kind acts do not come by often.
It is actually hard to separate profession and business. Professionals usually engage in business. Even organisations that fall under the categories of "non-profit" and "public-sector" are now run like a profit-making business. Today, National Kidney Foundation (NKF) is the largest not-for-profit dialysis provider in the world. NKF is recognised as a world-reputed healthcare institute, benefiting over 260,000 Singaporeans every year through various life-saving programmes. Their achievements have been great since their establishment in 1969. In 1987 they established the world’s first public-funded subsidised dialysis programme. In 1992, the 1st International Congress on Organ Transplantation in Developing Countries was formed. NKF's Institute of Nursing Education and Research (INER) initiated the formation of the Association of Renal Professionals of Asia Pacific (ARPAP) in 2001, the first in the region, and in the same year, Children's Medical Fund to help chronically ill children and young adults was established. For the past 36 years, NKF has been transformed dramatically with drastic improvements, with over SG$200 million in the reserves, and the ability to support their patients for the next 3 decades. If not for the business and marketing plans by the experts, the achievements, in terms of contributing to the society in the area of medical care, would not have been so great. We have seen NKF doing huge amount of advertisings, and hiring popular celebrities in charity shows to raise funds from the public. In a system where health care budgets are tight, bureaucrats and politicians tend to see new technology as too costly to justify the benefit they would provide. As a result, funds, if any, are provided only for the purchase of a limited amount of the newest technology. The decisions on what to buy and when to buy it are often guided more by good politics than good medicine.
Canada has been very explicit about its attempt to avoid using the business model in health care. However, has the country achieve that goal? The New York Times has revealed numerous problems all across Canada. In Winnipeg, ‘hallway medicine’ has become so routine that hallway stretcher locations have permanent numbers. No doubt, patients recuperate more slowly in the drafty, noisy hallways. At Vancouver General Hospital on the West Coast, Maureen Whyte, the hospital vice president, estimates that 20 percent of heart attack patients who should receive treatment within 15 minutes now wait for an hour or more. In 1999, as waiting lists for chemotherapy treatments for breast and prostate cancer stretched to four months, Montreal doctors started to send patients 45 minutes down the highway to Champlain Valley Physicians’ Hospital in Plattsburgh, New York. As the New York Times points out, “Canada has moved informally to a two-tier, public-private system. Although private practice is limited to dentists and veterinarians, 90 percent of Canadians live within 100 miles of the United States, and many people are crossing the border for private care".
While Canada ranks fifth in terms of total health care spending (as a percent of GDP), a recent study by the Fraser Institute, comparing OECD data, found that the country ranks 21st out of 28 in CT scanner availability; 19th out of 22 in lithotripter availability; and 19th out of 27 for the availability or MRIs. Canadians often wait for weeks and even months to see a specialist. According to The Vancouver, British Columbia-based Fraser Institute’s annual survey of waiting times in Canada, the average total waiting time between a referral from a general practitioner and treatment by a specialist rose from 13.3 weeks in 1998 to 14 weeks in 1999. The waiting time between specialist consultation and treatment increased from 7.3 weeks in 1998 to 8.4 weeks in 1999.
Several years ago, an enterprising hospital in Guelph, Ontario, decided to allow animals needing Computed Tomography (CT) scans to enter the hospital in the middle of the night, charging pet owners $300 apiece. There is nothing necessarily wrong with that action, except that thousands of people in Ontario were waiting up to three months for an appointment on the same machine. As people are not allowed to pay out of pocket for medical procedures covered under the government-run plan, they have to wait. However, if you are a dog, you can get medical technology immediately. When dogs get better treatment than people, then people will “become dogs.” In December 1999, the Washington Post reported that waiting lines for Magnetic Resonance Imaging (MRIs) in Ontario has grown so long that one Ontario resident booked himself into a private veterinary clinic that happened to have one of the machines, listing himself as ‘Fido’. While we may have a good laugh at this report, we must question ourselves that, is this the model (Canada's attempt to avoid using business model) we want to follow for providing quality health care?
In Australia, virtually every shopping centre incorporating a Woolworths store already has a pharmacy, as do most smaller centres and towns with more than a few hundred people. Pharmaceutical Society of Australia (PSA) Vice-President Frank Payne said, protecting public health is more important than Woolworths’ profits and should be the primary consideration in any government decision over whether to allow pharmacies in supermarkets. PSA is concerned that allowing pharmacies in supermarkets would undermine the progress that has been made in ensuring the safer use of medicines within the community. Moreover, they believe that a pharmacist exercising professional responsibilities should not be influenced by commercial considerations, but the health of the community is paramount. Woolworths’ sole argument for entering the pharmacy industry has been based on financial considerations, with managing director Roger Corbett claiming that Australians are paying too much for medicines. Mr. Corbett also argued that by allowing pharmacies in supermarkets, it would increase consumers’ access to prescription medicines, saying the move would significantly broaden the community’s access to expert, professional pharmacist advice.
Incorporating a business model into a medical-related organisation, can allow the firm to be more dynamic, flexible and more importantly, customer-oriented as well. The reason businesses seek to offer a quality product at an affordable price is that customers want value for their money. That is, they weigh cost, quality, service, convenience and other factors before making a decision on what to purchase.
Some physicians think medicine already looks too much like self-serving capitalism. Business is about the proprietor taking care of himself while medicine is about taking care of others. Business is guided by pragmatic decisions, medicine by ideals, and some physicians seek to take the business out of medicine so that the ideals can prevail. The idealists hope to do good without regard to doing well but the businesses in medicine strive to do well in order to continue doing good.
I will argue that, in contrast to such idealistic views, the problems facing the health care system result not from being too business-like, but because the practice of medicine does not act enough like a business. Business is guided by the very pragmatic goal of providing high quality goods and services to consumers, at affordable prices. Is not that also the goal of medicine? The medical profession will probably never operate completely like a business. However medicine can learn from business, and even become more like it. That means adjusting the incentives so that they create a positive, rather than a negative, impact. For years many people both inside and out- side the medical community have argued that “medicine is unique.” In becoming more business-oriented, medicine doesn’t have to give up its own unique values. Indeed, it is only by adopting the business model that medicine can embrace its values in providing a high level of quality for an affordable price.
posted by Valiant | 9:06 PM
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