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December 23, 2007
In his recent Political Economy of Health Care: A Clinical Perspective Julian Tudor Hart warns of the creeping commercialization of the health service - the privatization of a growing number of spheres and the application of market economics to procurement, delivery and management. Hart, now a retired family doctor working occasionally as a research Fellow at the new Medical School in Swansea, Wales, has spent a life applying Marxist philosophy to primary health care.
In the forementioned text Hart explores how health care in the UK might be reconstituted as a humane service for all, rather than a profitable one for the few, and a civilizing influence on society as a whole. Hart is referring to the NHS in the UK. and he tells a story with a past, present and a future—where the NHS has come from, what ithas achieved, the threats to its future, and what that future might be.
In Australia we have both a health market medical and non-medical health professions, public health care (hospitals) and the application of market economics to procurement, delivery and management of public health care. Tudor Hart's central thesis is that rational and effective health care cannot follow a pattern of market competition.He is best known for his formulation
of the “inverse care law” in 1971, in which he showed how patients with the greatest need tend to receive the poorest healthcare, particularly in areas where market forces operate. He makers a good point when he says:
I don’t think primary care is yet taken really seriously by government. They think primary care is cheaper than secondary care so they want to expand it and shift work from secondary to primary care. It’s
better, but not cheaper
Hart argues that at its heart, the NHS produces social value, as a result of encounters between patients and professionals, to which both make an essential contribution. The market can hive off the profitable parts of care, based on a cruder business model of consumers and providers, but in doing so, threatens the service at its philosophical and practical core. Hart understands NHS as a gift economy and argues that while this is at odds with prevailing political views about the NHS, it is part of most people’s experience, allows expression for their core values.
The public health care system is under attack, and, by all accounts, it will not be saved by simple sentimentalism or superficial ideas about inequality.
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