Coronavirus Shows the Dangers of Letting Market Forces Govern Health and Social Care

An eight-month-old boy with pneumonia is examined by a doctor at Amana Hospital in Dar es Salaam, Tanzania. Credit: Kristin Palitza/IPS

Jul 15 2020 (IPS) – In March, 10,000 NHS staff to UK prime minister Boris Johnson demanding better protection against COVID-19. Nurses and doctors wanted to treat patients without fear of infecting them and to minimise their own risk of falling ill. But they lacked the proper protective equipment.

The problem they described was rooted in changes made long before the arrival of the coronavirus. The NHS’s reduced capacity for dealing with the pandemic – including a lack of PPE – has been the result of years of to dictate the quality of care. Back in 2017, the government rejected advice that the NHS should stockpile protective equipment in case of a potential influenza pandemic. The reason? An found it would be too expensive.

The US’s private healthcare system epitomises the failure of letting the market govern care services. The country spends 17% of its GDP – or US$3.6 trillion (£2.8 billion) – on health, more than any other nation. Despite this, almost 30 million Americans (9% of the entire US population) remain uninsured because their employer does not offer health benefits or they cannot afford their own insurance

Such failings are representative of the long-running trend, beginning in the 1980s, of letting the logic of the market dictate how health and social care systems are run, both in Britain and abroad. It has left many systems without the capacity to withstand a crisis of the scale we’re currently seeing.

In turn, the pandemic has seen whistleblowers in health and social care disclosing systemic failures to protect staff and patients. The marketisation of health and social care, we suggest, has – and we need to support them better.

 

The results of market logic

The US’s private healthcare system epitomises the failure of letting the market govern care services. The country spends 17% of its GDP – or US$3.6 trillion (£2.8 billion) – on health, more than any other nation. Despite this, almost 30 million Americans (9% of the entire US population) remain uninsured because their employer does not offer health benefits or they cannot afford their own insurance. These are mostly .

The inaccessibility of health services to those who need them has contributed to the US having the in the world (together with one of the highest death rates per 1 million population). Yet, even while the pandemic spreads, some of its poorest hospitals and other healthcare institutions have had to put much-needed staff on leave. Having to compete in a ruthless market environment, .

The pandemic has also exposed failings in care homes. Prompted by the rising costs of elderly care and users’ expectations for personalised services, both the UK and Sweden in the 1980s. The idea was that encouraging competition among multiple providers would deliver more cost-effective and responsive services and empower consumers by letting them choose among them.

Large for-profit businesses with no prior experience of delivering such services were . In the intervening years, research has clearly shown the deficiencies of these changes. Both and analyses debunk claims that the market delivers high-quality care services efficiently.

In order to reduce costs, both British and Swedish organisations have come to rely on short-term staff with rudimentary training. During Sweden’s COVID-19 outbreak, a lack of continuity and skills stemming from using short-term staff has to the high death toll in care homes, exacerbated by the relaxed approach to social restrictions that was adopted by the government.
Sweden’s care homes account for .

In the UK, care homes account for . Higher rates of infection among residents have been linked to these institutions (incentivising them to work even if ill).

 

The need for whistleblowers

Health professionals’ disclosures have become a societal safety valve. Over have called a whistleblowing helpline to report safety concerns during the pandemic.

Whistleblowers’ disclosures are invaluable for showing us the necessity of reform, and also the specifics of what must be done. The – which saw up to 1,200 patients die as a result of substandard care – was made known by a . So too the in paediatric heart surgery at Bristol Royal Infirmary in the 1990s.

However, whistleblowing is typically a last resort, requiring . The sector to doctors and nurses who disclose wrongdoing. Because of this, we need and effective protection for whistleblowers forced to go outside their organisation to speak up. that covers all employees at an organisation is also key.

But first and foremost, we should bring health and social institutions back to their rightful purpose. This work should start by putting to rest, once and for all, discredited market-driven ideologies and prioritising providing good quality care.The Conversation

, Network Fellow, Edmond J Safra Center for Ethics, Harvard University and Professor of Business Ethics, and , Professor in Business and Society,

This article is republished from under a Creative Commons license. Read the .

 

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