Who does your doctor really work for? (Corporate Healthcare)

You may have experienced this at times. You wait weeks to see a doctor, and when you finally do, you don't even get a chance to talk about all your health problems. The doctor seems like a nice guy, but he's very nervous. It's not like before, and you may have felt like doctors are like machines, checking off things on a list. Why did everything change like this?

Simply put, the answer is: Doctors these days often don't work for you. They work for big corporations.

Why is this happening? What has happened to the health service?

Over the past few decades, healthcare has undergone a major transformation around the world. According to Dr. Jane Zhu, a researcher on the subject, the main thing you see when you look at the healthcare system is that everything is rapidly becoming more interconnected. That is, large corporations have started buying up hospitals, nursing homes, medical centers, and even pharmacies in large numbers.

In countries like the United States, three-quarters of doctors now work for hospitals or other corporate entities. These institutions are not controlled by doctors, but by people in business and finance. Even so-called nonprofits are now run like big business.

Another reason for this is what is called 'private equity'. Simply put, this involves buying a large company with money, an existing hospital or clinic, making a profit as quickly as possible, and selling it for a higher price in a short period of time, like 5 years.

Why are the results so poor despite spending a lot of money?

At first glance, there might not seem to be much wrong with running healthcare as a business. One might think that when people with business knowledge manage these things, the entire system would be more efficient. That is, one could argue that if medical services were managed like other businesses, perhaps healthcare would be even better.

But it was actually the other way around.

Over the years, as healthcare became a business, we saw rising costs, medical bills that drove people into even more debt, and ultimately poorer healthcare than expected.

For example, the United States spends the most on health care among the world's high-income countries. But people in that country have shorter life expectancies than other countries. They die from preventable diseases more often. They also have high maternal and infant mortality rates. So why are the results so bad despite spending so much money?

Two contradictory goals

Herein lies the heart of the problem. The purpose of medicine and the purpose of a business are two completely different things. When these two collide, the patient's side should always come first, but is that really what happens?

As Dr. Shue says, "The fundamental risk of corporate involvement in healthcare is the risk of putting profit above everything else." In fact, in this business model, there's no way that it wouldn't be.

These dangerous consequences can be seen throughout the health system.

• Staff reduction: To increase profits, the number of doctors in emergency treatment units (ETUs) is being reduced. The result? Patients have to wait longer in line and have less time to talk to a doctor.
• More patients, less time: Doctors are under pressure to see more patients per day, which reduces the amount of time and attention they can give to each patient. Sometimes, the doctor may feel overwhelmed by the amount of time they have to answer every question you have.
• Avoiding diseases that are easily treatable if caught early: A disease like diabetes may not be recognized until a leg has to be amputated, because there is no time to properly talk and listen to the details.
• Unnecessary tests: Sometimes, to increase the bill, lab tests that are not clinically necessary andDoctors may be pressured to perform scans (imaging tests).

This pressure has caused severe mental stress and burnout even among doctors.

Are doctors speaking out against this?

Even though we as patients are starting to understand these things now, doctors face this every day. But talking about this is very dangerous. Because, many doctors work on a contract basis. Therefore, if they criticize the company's methods, they can be fired without any reason.

For example, in 2017, American doctor Dr. Raymond Brovont was fired after he said that the Pediatric ETU where he worked was understaffed and that it posed a threat to the safety of children.

This is a big problem for doctors, because their professional oath is to "do no harm, and put the best interests of the patient first."

However, doctors are now standing up against this.

• Legal action: In some countries, there are laws prohibiting non-physicians from providing medical services. Using these laws, some medical associations are filing lawsuits against these large companies.
• Trade Unions: Doctors are increasingly joining trade unions, realizing that collective bargaining is the best way to protect their rights and those of their patients.

What can we, as patients, do?

The final solution lies in the hands of the public. We need to be aware of this. We need to ask questions.

The ``No Surprises Act'' in America, a law that protects patients from unexpected large bills, was passed because ordinary people came together and raised their voices for it. Even though big companies lobbied against it, the government listened to the people.

We all need to ask ourselves this question:

"Do you want a profit-driven, commercial healthcare system whose sole purpose is to make money off you? Or do you want a socially responsible healthcare system whose sole purpose is to help you?"

Thinking about this, talking about it, and being aware is the beginning of change. The next time you see a doctor, remember these things. Ask your questions clearly, understand the treatment, and take responsibility for your health.