The ethics of profit in the healthcare sector

The debate about the presence of profit in healthcare systems often reduces to a political argument of the relative merits of publicly funded national health services and healthcare systems that rely on patients paying for the service, usually through insurance policies. This is far too simplistic and actually has very little to do with profit.

Profit is everywhere in the healthcare sector, all of the time, in private and public models. The doctors and nurses and medical device companies and pharmaceutical corporations and the sterile glove manufacturers do not provide their goods and services on a subsidized basis. No system as complex as a national healthcare system would be viable if its constituent parts were not financially sustainable. That means having healthy competition among commercially motivated and viable suppliers.

Competition between suppliers and service providers increases the quality of goods and services provided. The most technologically advanced, best staffed, cleanest, best value for money diagnostic facilities will gain market share at the expense of weaker competitors. The patient receives a significant benefit from such commercially motivated competition.

Many medicines and treatments simply would not have been discovered or developed if there was no commercial driver behind the process. The best scientific minds tend not to work for free. Clinical trials cost tens of millions to complete. Innovation requires investment and investment requires a financial return.

So, should we conclude that there is no need to restrict the profit motive within the healthcare sector? Is it really the same as every other part of the economy?

One commonly cited objection to the presence of profit is that in countries where healthcare is not “free at the point of service” and a private payer model dominates, some individuals get left behind. Whatever your political persuasion, statistics in the United States show a significant gap between people that can afford health insurance premiums and those that qualify for Medicaid or Medicare support.

One part of the equation here is not about profit but about having an adequate safety net that doesn’t leave anyone behind. But the other part is that healthcare costs are so high that the associated insurance premia are unaffordable, even for a group of individuals in employment and with disposable income. Perhaps profit has been allowed too free a reign in such systems? In the absence of a solution to bring down healthcare costs to a more affordable level, an adequate safety net that leaves no one behind is essential.

Another area of concern is where the profit motive creates conflicts of interest between patient and clinician. Treatment volume targets for private hospitals are unlikely to be consistent with the highest quality of those treatments. Or put another way, the most profitable treatment – whether for a mundane medical matter or for a truly serious one – may not be the best one for the patient. Can we be confident that the Hippocratic Oath always trumps the profit motive in such circumstances?

This concern is valid. As is the need for a safety net to ensure that all citizens have access to adequate healthcare. But both issues can be dealt with by legislators and regulators and there is no ethical reason to exclude profit from the healthcare industry. To do so would run counter to the best interests of citizens and patients.

Tom Speechley