The Business of Health -- Can we afford to ignore reality?

Rita Luthra, MD,
Director, Women's Health & Education Center

Naturally, provider payment mechanisms are something about which providers have strong feelings. Part of the pressure in many countries for the establishment of health insurance schemes comes from physicians, who see these as a way to raise their income above the level of a poorly paid public employee. (1)

In the USA, this simple dream is a shattered reality. Health care is both a necessity and luxury. Medical insurance is not insurance - one might give it the name assurance. All this insurance medicine may seem tolerable since it appears free - until you or your loved ones become desperately ill. The point is, that, at present most medical care is being paid by creative billing and creative paying. There is little relation to anything else. Even the most strong proponents of the third - party payment and involvement must realize, not only that third-parties seek gain and perhaps control for themselves; but that this gain must come from physicians and/or patients and both will be impacted. It is difficult to convey to patients some of the stresses, these very human people, called physicians undergo. The average physician works harder, under more stress, for longer and more irregular hours than most people would tolerate.

Much is said about the problem of uninsured or underinsured. It would indicate that having insurance is important, in the solution. This is simply incorrect, given the present meaning of medical (health) insurance. Not only do we have assurance instead of insurance in most cases, we have perversion of accountability. Medical insurance as it is used today is far from being the solution for health-for-all, but is a part of the problem.

Realize that the best medical care delivery system has yet to be found. For what it is worth, today the physician's morale is the lowest as compared to anytime in my 20 years in practice. Furthermore, the rift between patients and physicians has never been wider in my experience. Sometimes in an effort to solve problems we create more problems. Too many specialists or too few primary care physicians may not be a problem at all. The term primary care is as fashionable as health care reform, these days.

In this connection it is desirable to examine the role of the general practitioner whom, working as a member of a team, occupies a central position in the primary care system. (2) It sometimes limits women's access to gynecologists, who can provide more comprehensive care, during her routine annual physical examination.

Constant media pressure and demands by the patients to see a specialist often makes general practitioners or family physicians the "referral agents" or "gatekeeper." Primary care physicians are likely to over-utilize expensive technologies just like any specialist. Medicine is becoming increasingly more technical. We need specialists who are like primary care physicians in their area, well trained, so that unnecessary and expensive procedures are not done. The humanness has been squeezed out of the system. We have lost touch.

What will be accomplished by economically enslaving most of us to insurance companies? Socialism does not produce a classless society. It produces a controlling class and controlled class. We are seeing this in USA, and it is developing now. Physicians and the staff are busy handling bureaucratically inspired procedures and paperwork. Whoever had set out to help poor, it seemed did not understand the poor.

The Traditional Concept of medical care, wherein the patient and physician are directly accountable to each other, is the only concept that is workable in the long run. National Health Care System in USA might work, if there are three, essential elements present:

  1. Patient freedom of choice
  2. Practitioner freedom of choice
  3. A healthy enthusiasm for competitive alternatives.

Understand that there will never be financial equality. Another guiding principle is excellent scientific medical care, available to all, regardless of the ability to pay.


  1. Creese A.: Global Trends in Health Care Reform. World Health Forum, 1994, 15: 317-322
  2. Fisher J.: What Kind of General Practitioner for the Twenty -First Centaury? World Health Forum, 1996, 17: 178-180.

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