Dear Colleagues! This is Asrar Qureshi’s Blog Post 1048 for Pharma Veterans. Pharma Veterans Blogs are published by Asrar Qureshi on its dedicated site https://pharmaveterans.com. Please email to pharmaveterans2017@gmail.com for publishing our contributions here.
This post is inspired by an article by Donald M. Berwick, published in JAMA – Journal of American Medical Association. Link at the end.
Preamble
The healthcare in most countries has become a huge profit-making industry. Hospitals, physicians, pharmacies, drug suppliers are all part of the profiteering. The healthcare institutions advertise that ‘they keep the patient in the center’; this appears true. They do keep the patients in the center to slaughter them financially, mercilessly.
I am borrowing from the JAMA® article mentioned above, which is titled ‘Salve Lucrum: The Existential Threat of Greed in US Health Care’. We know that Pakistan healthcare system suffers from the same greed; only the forms vary.
Greed in Healthcare in the USA
[Quote] The grip of financial self-interest in US health care is becoming a stranglehold, with dangerous and pervasive consequences. No sector of US health care is immune from the immoderate pursuit of profit, neither drug companies, nor insurers, nor hospitals, nor investors, nor physician practices.
Rapidly increasing pharmaceutical costs are now familiar to the public. Pharmaceutical companies have used monopoly ownership of medications to raise prices to stratospheric levels, and not just for new drugs. Flaws in US patent laws leave loopholes allowing profiteering drug companies to gain control of some simple and long-known medications and to raise prices without constraint. Eye-popping prices for new, essential biological and biosimilar drugs, enabled by the failure of any serious drug price regulation, have yielded enormous profits for drug companies even though much of the basic biological research funding has come from governmental sources.
Particularly costly has been profiteering among insurance companies participating in the Medicare Advantage (MA) program. Originally intended to give Medicare beneficiaries the choice of access to well-managed care at lower cost, MA has mushroomed into a massive program, now about to cover more than 50% of all Medicare beneficiaries and costing far more per beneficiary than traditional Medicare ever has. According to some health services research, MA will cost Medicare over $600 billion more in the next 8 years than would have been the case if the same enrollees had remained in traditional Medicare.
Hospital pricing games are also widespread. Hospitals claim large operating losses, especially in the COVID pandemic period, but large systems sit on balance sheets with tens of billions of dollars in the bank or invested. Hospital prices for the top 37 infused cancer drugs averaged 86.2% higher per unit than in physician offices. A patient was billed $73,800 at the University of Chicago for 2 injections of Lupron depot, a treatment for prostate cancer, a drug available in the UK for $260 a dose.
Recent New York Times investigations have reported on nonprofit hospitals’ reducing and closing services in poor areas while opening new ones in wealthy suburbs and on their use of collection agencies for pursuing payment from patients with low income. The Massachusetts Health Policy Commission reported in 2022 that hospital prices and revenues increased during a decade at almost 4 times the rate of inflation.
Greed harms the cultures of compassion and professionalism that are bedrock to healing care. Health care executives and board members who know better nonetheless feel compelled to play the games of pricing, acquisition, and revenue maximization that others do. Professionals find themselves trapped in record keeping, coding behaviors, and productivity imperatives that belie the reasons many went into health care in the first place. “Moral injury” is the harvest, with demoralization and disengagement to follow. [Unquote]
Forms of Greed in Healthcare
Greed, the insatiable desire for wealth and possessions, can manifest in various forms within the healthcare system, potentially compromising patient care and ethical standards. In Pakistan, we see all these manifestations.
Overcharging and Price Gouging
- Inflated Procedure Costs: Hospitals and clinics may charge exorbitant fees for procedures, far exceeding what is reasonable or justified by the cost of providing the service. This is especially prevalent in systems lacking price transparency or regulation.
- Unnecessary Treatments and Tests: Driven by profit motives, many providers recommend unnecessary treatments, tests, or medications, even when they offer little or no benefit to the patient. This leads to financial burden and potential harm.
- Exploiting Drug Prices: Pharmaceutical companies, especially those with monopolies on life-saving drugs, may engage in price gouging, making essential medications unaffordable for many patients.
Prioritizing Profits over Patients
- Denying Coverage: Insurance companies may deny coverage for necessary treatments or medications to maximize profits, leaving patients with limited options and significant financial strain.
- Limiting Care: Healthcare providers might prioritize patients with lucrative insurance plans over those with limited coverage, leading to disparities in access to care.
- Understaffing and Overworking: To cut costs, hospitals and clinics may understaff, leading to overworked healthcare professionals, compromised patient care, and increased risk of medical errors.
Corporate Influence and Lobbying
- Influencing Policy: Powerful healthcare corporations and lobbying groups may influence policy decisions to favor their financial interests, even if it undermines public health or patient well-being.
- Blocking Reforms: They may oppose reforms aimed at cost control or increased access to care, prioritizing their profits over the needs of the population.
Fraud and Abuse
- Billing Fraud: Submitting false or inflated claims to insurance companies for services not rendered or unnecessary procedures. The same is done with corporate panel patients where bogus bills are submitted in connivance with the corporate staff.
- Kickbacks: Receiving illegal payments or incentives for referrals or prescribing certain medications.
- Unnecessary Hospitalizations: Admitting patients to the hospital unnecessarily to generate revenue.
Research and Development
- Profit-Driven Research: Pharmaceutical companies may prioritize research on profitable drugs over those addressing neglected diseases or public health concerns.
- Skewing Clinical Trials: There’s potential for manipulating clinical trial data to favor a profitable outcome, even if it compromises scientific integrity.
Consequences of Greed in Healthcare
The consequences of greed in healthcare are far-reaching and detrimental.
- Limited Access to Care: High costs and insurance barriers prevent many individuals from accessing necessary medical care, leading to delayed or forgone treatment and poorer health outcomes.
- Financial Hardship: Medical debt is a leading cause of financial stress, with many families struggling to afford even basic healthcare.
- Erosion of Trust: Greed erodes trust in the healthcare system, as patients feel exploited and prioritized less than profits.
- Compromised Patient Safety: Understaffing, overwork, and profit-driven practices can compromise patient safety and increase the risk of medical errors.
Addressing Greed in Healthcare
Combating greed in healthcare requires a multi-pronged approach, because it has taken deep roots in the system.
- Stronger Regulations: Stricter regulations are needed to prevent price gouging, unnecessary treatments, and insurance abuses. Where regulations do not exist, new one should be promulgated. Implementation of regulations is mandatory.
- Increased Transparency: Greater transparency in pricing and billing practices can empower patients and reduce overcharging.
- Ethical Guidelines: Reinforcing ethical guidelines for healthcare professionals and institutions to prioritize patient well-being over profit motives.
- Empowering Consumers: Providing patients with more information and resources to make informed decisions about their care.17
- Reforming the System: Exploring alternative healthcare models that prioritize patient needs and equitable access to care.
By addressing these issues and building a culture of ethics and patient-centered care, we can mitigate the detrimental effects of greed in the healthcare system and ensure that everyone has access to quality, affordable healthcare.
Concluded.
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For most blogs, I research from several sources which are open to public. Their links are mentioned under references. There is no intent to infringe upon anyone’s copyrights. If, however, it happens unintentionally, I offer my sincere regrets.
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