Wednesday, August 28, 2013

Pain OK for those who can't pay for health care

Vanguard September 2013 p. 9
Louisa L.

I've just had an operation, and it's blown me away how little pain I've felt.

Years ago I remember my parents' distress as they headed to a funeral leaving me uncharacteristically sobbing after an operation. Fifteen minutes later the painkillers arrived and I settled, but Mum and Dad worried all day. Pain medication was given four hourly, and patients suffered till it arrived.

Scientific research has now uncovered the far better recovery rates, and reduced use of painkillers, if pain remains under control.

That's science in service to the people, but scientific analysis too often serves big business.

“They don't want sick people”

British multinational BUPA and Ramsey Health Care are two of the biggest private hospital owners in Australia. Ramsey is more open than BUPA about how research and analysis increases profit.           

According to Ramsey's managing director Christopher Rex, private hospitals treat 43% of all hospital patients in Australia, provide 33% of hospital beds and perform 66% of all elective surgery.

By 2021 private providers expect to treat 50% of all hospital patients.

In labelling public hospitals 'public acute hospitals', Rex makes clear Ramsey's plan, that the private hospitals will get the easy operations and public hospitals will get the really sick.

A friend who had complications after an operation in a for-profit hospital described it like this, “They don't want really sick people. They don't have enough staff.”

She said staff were overworked and not always able to attend to basics. If you went home within a set period, you got nursing help at home, but you didn't get home help if you were sicker and had to stay longer.

This fits the government's 'case mix' funding, where each procedure is funded to a certain amount, and funding doesn't cover complications. Given that public patients have to wait much longer for 'elective surgery' (seemingly everything that isn't life threatening) there's greater likelihood of such complications. Anything difficult and expensive gets dumped on the public system.

Privates have a planned system for churning through routine procedures because few have emergency departments. And if you get sick after discharge, you may, like my friend, have to go to another hospital.
Targeting those with money      

Ramsey, which began with one hospital in Australia, now runs 120 hospitals and owns regional broadcaster Prime. It's expanded into Asia, particularly through a joint venture with Sime Darby signed in July. (The latter is a multinational involved in six core sectors across Asia and Africa: plantations, property, industrial, motors, energy and utilities and healthcare. Accusations of deliberate lighting of forest fires in Indonesia and a land grab in Liberia have plagued its palm oil operations.

Christopher Rex states Ramsey's aim is “build a quality portfolio of hospitals in Asia” targeting “600 million people in ASEAN with (a) rising middle class demanding quality health care”. He writes of “opportunities for value creation via key synergies such as procurement, medical tourism and productivity benchmarking”.

So it's all about wringing the greatest profits from their workers (“productivity benchmarking”), using Sime Darby's Asian networks plus publicity to rope in the Asian middle classes (“procurement”) and cutting costs through the use of cheaper labour in Asia (“medical tourism”).

It's obnoxious, but it's capitalism. The middle class can afford “quality healthcare”. The rest can suffer in underfunded public hospital systems, both here and in Asia.

Scientific analysis has been used by medical multinationals to boost capitalist profits. How long will people put up with it?

(For Christopher Rex's full statement, see his Presentation to USB Australian Healthcare Conference 2013)

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