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Map of the International Healthcare Pages

There has been a global drive to commodify health care and trade the treatment of sick citizens on the worlds markets. Incredibly this has been seen as the way to bring health care to the worlds developing nations - even the poor. World Bank and other humanitarian groups have made funds for health care conditional on privatisation.

The International Section of the Web Site has been left hopelessly behind. I have written a small amount of material covering the WTO and brief comments on other countries. Some can still be accessed from this page. There has not been time to research or deal with Canada, New Zealand, the United Kingdom, Europe or South America in any detail. All of them have been subject to ideological conflict and pressures to corporatise health services using for profit groups.

The criticism of Graeme Samuel's speech links to other pages (mostly on the Corporate Practices Map) which address the issues he raises. While some of these pages could do with editing it provides another way of exploring the site. The views and ideas of the chairman of Australia's National Competition Council (NCC), a very senior market advocate, are set against the real world as some of us have experienced it - a very different point of view!

 

 

 

 

 

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INTERNATIONAL HEALTH CARE
The International pages have languished because of more pressing issues in the USA and Australia.

This page gives an overview of the material in the section.

 

 

 

 

 

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International Expansion of Corporate Medicine

Health care corporations have increasingly seen themselves as Global players. Starting in the USA but spreading globally the market focus in health has been on growth and globalisation. Companies from Generale de Sante Internationale in Europe and Mayne Health in Australia, from pharmacology to managed care have joined the rush. Fraud pressures and market saturation in the USA have driven companies to buy into other markets to insulate them against their local problems. I have not written at length about this but some pages address some of the issues.

  • The Dominance of the US market and US marketplace Ideas
    This page was written some time in early 2000 after the chairman of Australia's National Competition Council (NCC), Graeme Samuel's speech to the world bank calling for urgent global health care reform using economic levers. This page examines the pervasiveness of US corporate market thinking in health care and its globalisation.
  • A RASH OF NEWS ARTICLES ABOUT OPPORTUNITIES IN FOREIGN COUNTRIES
    This page started as the covering sheet for a collection of revealing articles extolling the opportunities in foreign countries published in the US magazine Modern Healthcare in November 1997. These were circulated to politicians and others. This was the era of managed care expansion. The clash of culture between the market and the ethic of the community and the professions is obvious as is the morality of the bevy of experts who marketed themselves as international consultants and advised corporations in the sort of behaviour most of us would be ashamed of.
  • Managed Care Part III : Globalisation of Managed Care
    This page written in late 2003 covers some of the same material and includes extracts from those above and many other press reports. The material gives a good insight into the wild enthusiasm of US businessmen and the strong reservation of informed professionals.
  • Is Market Medicine really Sweeping the World?
    The claim that market medicine is the way of the future and is sweeping the world is challenged. This page written in 2000 briefly examines the failure and abandonment of many market solutions in the United Kingdom, Australia, New Zealand and Canada.
 

HEALTH AND WORLD TRADE

HEALTH AND WORLD TRADE AGREEMENTS
In 2000 the powerful US Coalition of Service Industries (CSI), a body which represented service industries including large health care giants enlisted the support of the US government to press for a whole range of social services including health care to become part of the WTO international trade process by default. I wrote this page at this time. The WTO process ran into so much trouble that most of these proposals have not seen the light of day. Health and international trade agreements remain very much of a threat in Australia and in Canada and have excited opposition. The idea is far from dead and it is likely to come hidden in words. I have not had the time to follow this up.

 

THE WORLD BANK

The world bank is understandably heavily influenced by economists. In giving loans for health care it has exerted strong pressures and conditions which forced developing nations into market models of care. In February 2002 Graeme Samuel, chairman of Australia's National Competition Council gave a speech to the world bank urging all countries to rapidly adopt his proposed model of care, one which like managed care operated through a complex series of economic levers and regulatory processes. To anyone who had practiced medicine and who had worked in developing countries this was the height of folly and terribly dangerous. I was apoplectic!

My criticisms link to other pages of the web site including many in the corporate practices section which were written in response. Some could do with more editing. This provides another pathway into the site.

CRITICISM OF GRAEME SAMUEL'S SPEECH to the World Bank : INTRODUCTION

I wrote a long and detailed criticism and sent it to Samuel. He ignored it. Some of the web pages on this site were developed from this criticism - which was not one of my best. I shortened and narrowed down some of the material and it is still here. I tried to contrast the world of Samuel's cold mechanistic economic model with the world of real people subjected to a full blown health care marketplace in the USA. This is the introductory page to the criticism.


The Response of ordinary citizens

The following pages giving the raw responses of ordinary US citizens to corporate chains. The intense anger and disgust of ordinary people who encounter the corporate health system when they are vulnerable and in need is put here to contrast it with Samuel's mechanistic academic model.

  • ILA SWAN'S WARNING -- This is an unpublished letter to a Canadian newspaper written by a Californian citizen who has exposed extensive exploitation of the aged in nursing homes in her state. This is an appeal from the heart by someone who has experienced the US system and responded to her experience. She urges Canadians to protect their system and not allow a US style for profit system.
  • HOW THE COMMUNITY VIEWS CORPORATE NURSING HOMES -- when the Director of HCFA for California spoke to a collection of family members and their lawyers she showed herself so out of touch and so resistant to addressing the problems that there was intense anger. Hundreds wrote or sent emails calling for her resignation - these show the depth of feeling generated by the corporate chains and the politicians who support them. Read the emails.


Criticism of a speech by Graeme Samuel to the World Bank, on 29 February 2000

Introducing competition in the public delivery of health care services -- This is the text of Samuel's speech. Samual proposes a complex market model for the the delivery of public health care internationally. It is built around a series of independent roles each of which depends on contracts, market forces and increased competition. The system relies for its success on regulation and oversight.

  • Criticism Number 1 : INTRODUCTION
    This first page looks at Samuel's model from outside the marketplace paradigm. It points to fundamental errors in logic, and an ideological bias as exhibited by ignoring critical evidence and common sense. It looks at fundamental inaccuracies in Samuel's model. It looks at the development of market thinking within one social structure, the market, and its applicability to the rest of society. It points to the difficulties of arguing within marketplace thinking. The market has appropriated the discourse and the language we use, then modified meanings for its own public relations purposes. It uses these to claim success in meeting the community's values and objectives but this is often no more than an illusion.
  • Criticism Number 2 : THE RELEVANCE OF OTHER MARKETPLACE DOMAINS : THE PROCESS OF CRITICISM
    This page further explores the flawed argument that Australia is different and that because the market has worked in other industries it will work in health care.
  • Criticism Number 3 : Satisfaction and Affordability
    The page confronts the arguments that declining satisfaction, declining affordability, declining care, and a need for stability call for a market based system. It makes the point that each of these factors is greater in a corporate market context than in not for profit or public care. During 2003 and 2004, long after this criticism was written, a series of studies have indicated that for profit care not only results in a higher mortality and morbidity but is much more costly than not for profit care.
  • Criticism Number 4 : Spiraling Technology Costs - An aging population
    The page contests the extent of the problem and points out that the market is responsible for much of the problem. If funds are short ithe market would ration for profit. Alternatives would be much more appropriate. Since the criticisms were written in 2000 hard data and analyses have shown that the threat of prices spiraling out of control is unsupported.
  • Criticism Number 5 : Better Educated Consumers and Choice
    The argument that the market improves choice is countered by pointing out that managed care and corporations such as Columbia/HCA and Tenet/NME have in practice limited choice. Corporate marketing and education have clouded issues making choice more difficult. Samuel's view of the way medicine is currently organised is misleading.
  • Criticism Number 6 : A reform blueprint
    Samuel's claim to a system which displays "internal consistency" and is tightly "articulated" goes to the heart of the problem - the use of a single unconfronted market paradigm ignoring alternate understandings and interpretations is stupid and has been disastrous in the USA. A broadly based reflective system is never totally consistent. While one paradigm may dominate different paradigms give different understandings and challenge consistency. This allows balanced decsion making in areas where there are problems. Experience and available evidence both show that the market paradigm is innapropriate for health and aged care.
  • Criticism Number 7 : Performance dimensions for a reformed health care system
    Claims to better access to care, greater equity, more efficiency, better quality, and accountability are challenged by pointing out that the market elsewhere has performed poorly in each. This is what you would expect. It is clear that the meaning and use of words is different to that outside the marketplace. Interestingly in 2004 Professor Leeder makes the same observation in regard to the USA. (See New Doctor Autumn 2004
    http://www.drs.org.au/new_doctor)
  • Criticism Number 8 : The reform model : description and analysis
    The page responds to the model by showing its similarity to other market systems by linking to other pages on this web site.
  • Criticism Number 9 : Roles, Competition and Cooperation
    Samuel's model hinges around a series of defined and competing economic roles. In criticism the page points to the complexity and difficulties as well as the discordant ethos introduced. I contrast it with the benefits of a cooperative system. Samuel acknowledges his dependence on oversight and regulation. To underline the difficulties in this page looks at problems in data collection, failures in oversight and accreditation, and the reality of market and political power structures as these impact on health care in the marketplace. The structure, the logic and the profit ethos are criticised. A very similar system in the USA has failed.
  • Criticism Number 10 : Clarifying different roles in health care provision
    As Samuel acknowledges most funding comes from government or insurers (read HMO). It is capped. Samuel's roles relate to spending this money using funders, purchasers, providers and regulators who are all competing for their share of the cake. This is exactly what they have in the USA and it is called managed care. Samuel's purchasers, called "Health Improvement Agencies or HIAs", is where he sees the maximum benefit. They are for all practical purposes the hated and dysfunctional Health Maintenance Organisations (HMOs). The page looks at how these have operated in the US marketplace.
  • Criticism Number 11 : The role of competition in health care : Health Care as a Market Based Industry
    Samuel's reemphasis on market principles is met by looking at trust in health care. His claims to efficiency, empowerment and addressing conflict of interest are addressed by examining these in the real world. His criticism of professionalism is met by examining the adverse impact of the market on professional value systems and trust. Samuel's claim that other countries are embracing market reform is disputed and his advocacy of more private sector involvement is challenged. Market reform of health care has been imposed on the community and has been opposed by large sections of the community.
  • Criticism Number 12 : COMPETITION - Provider competition
    Samuel's claims about providers are disputed on the basis that this is simply managed care. The pressures towards competition for market share and profits both of which are best met by compromising care are described, as is the disempowerment of consumers and the community.
  • Criticism Number 13 : PURCHASER COMPETITION
    Samuel's purchaser is a thinly disguised HMO in a managed care system. From Samuel's speech it is difficult to understand just how this would relate to the patient and citizen for whom the service is purchased. The page examines corporate integration, market control, enforcement of contracts and the difficulties for not for profit providers.
  • Criticism Number 14 : Key benefits of a competitive model
    The page examines the claims that competition will reduce costs, improve quality and ensure equity by showing that it has done the exact opposite. In fact these are the criticisms of marketplace medicine. Studies since this criticism was written show that the market model increases costs, increases mortality and morbidity, and has a very different understanding of equity. A Royal Commission in Canada has rejected all of these claims. Samuel seems to live in a looking glass world.
  • Criticism Number 15 : Getting from here to there - Staged Implementation
    It is suggested that Samuel is telling us how to get from where we are to somewhere we don't want to be and most certainly should not be. Criticisms are made.
  • Criticism Number 16 : Answering some common criticisms -- Introduction
    Samuel side steps the major criticisms which are of his starting points, the market, profit motives and competition. He seems to consider them unchallengeable self evident "goods". The page looks at government, community, contracts and common sense in order to meet Samuel's defense of other criticisms.
  • Criticism Number 17 : Answering some common criticisms - Accountability related concerns - multinationals
    Governments faith in the free market's ability to self correct impacts on their willingness to hold corporations accountable. The track record in the USA and Australia shows that they don't. The willingness to embrace multinationals is addressed by examining their disturbing conduct.
  • Criticism Number 18 : Answering some common criticisms - Efficiency related concerns
    Samuel doesn't actually claim that his model will reduce costs and his claims to quality are already disproved. Samuel's response to many of the criticisms is simply to ignore evidence and claim the opposite. The page deals with cost, efficiency, integration, quality, the flow of information, assertions about the USA, control of decisions, choice, information sharing, breech of contracts and private provider failure.
  • Criticism Number 19 : Answering some common criticisms - Equity and access related concerns
    The page looks at the diversion of funds from care to profit and market activities. It comments on universal access, altruism, as well as commitment to research and training.
  • Criticism Number 20 : Conclusion
    Samuel's conclusion is addressed by summarising the criticisms of the points he reiterates.

 

HEALTH CARE IN CANADA
There has not been time to write at length about Canada. The page gives an outline and some links but much has happened since it was written in 2000. This includes the Romanow Royal Commission.

 

CANADA PAGES

 

NEW Zealand empty page
This is a page which has not been written. New Zealand was one of the countries which enthusiastically adopted health care reform. There was a backlash against this which brought the labour party to power in 2000

 

EUROPE

Generale de Sante Internationale (GSI)
The French company GSI was the largest hospital corporation in Europe. It bid to buy Tenet/NME's Australian holdings in 1995. It was involved in insavoury practices and was accused of providing "factory" care in the UK. Australians unearthed all this and publicised it. GSI backed away. This page was put on the www in 1998. In 1997 Mayne Nickless and Columbia/HCA bid for GSI but French Authorities were kept informed of both company's conduct. It was bought by European groups and I think broken up.

 

Health Services in Singapore
Singapore was where I first learned about Tenet/NME and heard of its business practices - but I was unable to get evidence to confirm this.  When I voiced my concerns a defamation action was taken against me - an action that was never prosecuted. A Singapore doctor later described some of these matters in court. Tenet/NME no longer operates in Singapore.

This is a short account of the health system in Singapore.

 

National Medical Enterprises (NME but renamed Tenet Healthcare) in Singapore.

This company operated in Singapore from 1985 to 1996 when it departed under a cloud. It was here that I first set out to challenge NME and force its conduct into the open. In 1993 a Singapore doctor described some of the company's conduct in court.

  • Singapore - allegations of trading in patients
    This is part of my submission to Tenet's ethics committee in 1996 - a submission challenging the probity of those who worked in Singapore and their suitability to hold high office in health care. It describes and quotes the allegations made by the doctor.
  • The Singapore Court Transcripts
    These court documents finally put an end to Tenet's ambitions in Australia. This link is to a published paper I wrote in 1996 and describes how they were used to accomplish this.
  • Vista Healthcare and its National Medical Enterprises Heritage
    Tenet/NME vacated Singapore in 1996 but by 1997 a new company had been formed in Singapore and it was headed by Michael Ford who had been president of NME's International Division and had been based in Singapore. The directors were largely past US and Singapore Tenet/NME staff. It was an "international health care adviser" to other companies. It was very experienced in the way Australia's regulations worked and how to get around them.
  • TAKING ON NATIONAL MEDICAL ENTERPRISES (NME)
    This page tells the story of my involvement in confronting and blowing the whistle on Tenet/NME in Singapore and Australia.


LINKS TO MAPS
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This page created June 2004 by Michael Wynne