Symptoms of a sick society

By Jacob Arfwedson

France has been the paragon among EU health systems. But the situation is changing, in France as elsewhere, as the medical profession comes under ever-greater pressure to ration services and to prescribe the cheapest drugs.

Corralling doctors has been an objective of French health policy for more than 20 years, with restricted entry to medical schools and financial incentives for early retirement.

The justification for such coercive guidelines around Europe is that unrestricted scientific progress and increasing demand for new treatments will make government healthcare unsustainable.

Restricting access to doctors or treatments frequently results in costly invasive surgery, and/or longer hospital stays. Good healthcare inevitably means people live longer, which inevitably increases costs. But is the unspoken position of finance ministries that they would prefer citizens not to live so long?

Doctors and patients are increasingly weary of government-imposed healthcare management systems that lead to waiting lists and one-size-fits-all treatments. Many seek care abroad: India and Thailand provide first-world care at third-world prices.

People value time and attention from doctors. In Belgium, most doctors spend at least 15 minutes with each patient and more than half spend more than 20 minutes. Belgians believe government has no place in regulating a doctor’s daily activity. Most French people feel the same.

Wrong-headed government attacks on standards are provoking protest among a profession with little natural inclination for going onto the streets. In Spain, physicians went on strike in 2007 to demand an increase of average consultation time from eight to ten minutes. Czech physicians went on strike in September 2007. In Italy, 5 million appointments and 45,000 surgical procedures were postponed in October 2007 when a 24-hour strike rallied 135,000 medical and non-medical staff.

Two-thirds of German doctors resent the interference that limits them to a maximum of ten minutes for most patients and that penalises them for prescribing expensive drugs. More than half the German public reckon they are no longer getting the optimum treatment from their doctors.

Doctors’ protests are symptoms of a sick system. Healthcare should be viewed not as a burden but as an investment. Market-based provision and financing is the only way to turn healthcare into the growth industry it should be.

Doctors have yet to make their voices heard in the battle of ideas between the guardians of socialised medicine and proponents of a free healthcare market. The outcome will shape the fate of their patients and their own profession. They can ill afford to ignore the debate.

Jacob Arfwedson is director of the Centre for Medicine in the Public Interest in Paris. Figures quoted are drawn from the recent 'The Hazards of Harassing Doctor', by Alphonse Crespo.