Too much health

A joke about general practitioners goes something like this. A little old lady who visited her GP every week stopped coming. The GP became worried, fearing he may have caused offence or that she had found someone else. When she returned a week later, the GP asked her where she had been.

“Oh, doctor. I was sick,” the little old lady replied.

While this is a joke, it probably represents the reality for a good portion of the day for the average family doctor.

The Royal Australian College of General Practioners estimates that around a third of patient presentations to a family doctor are what’s known as “psychosomatic ailments”.

This is technical speak for the worried well.

While the Productivity Commission’s report into the medical workforce released in January 2006 suggested that we need more doctors, particularly to supply the rural shortage, it did not look into the kind of work modern doctors are required to do.

The fact is that a good portion of the modern doctor’s work is to appease those who are feeling anxious, lonely or disconnected. They are on the frontline of a community where a large part of the old functions of the family, namely child care, care of elderly people and just plain emotional support, are increasingly being turned over to the market and the state.

The problem here is that doctors, even when they don’t bulk bill, are actually the cheapest form of social worker.

Another medical joke is that a little old lady called her doctor one night for a house call. When he arrived, she said that she needed her light bulb changed. When the doctor asked why he was called, she said that he was cheaper than the electrician.

A large part of the problem is that it is just too cheap to see a doctor. Even for doctors who don’t bulk bill, patients are barely forking out $20 after they receive a rebate. It is no financial disincentive to avoid seeing them.

Of course, this was the reason behind Medicare in the first place. A person shouldn’t have to think twice before consulting advice for their health, or so the reasoning goes.

But the question then arises how much extra health expenditure are we willing to sacrifice as a community in order to make health immune to the forces that make people think about how they spend their money.

Health is increasingly becoming a politically unwinnable issue. People demand the best health services but refuse to pay extra for it. In surveys, they say they are willing to pay higher taxes for better health and education, but every politician knows that what people say in a casual survey is far different to how they actually behave.

Health is the most difficult non-security issue for modern governments, especially in the ageing West.

The largest-ever health financing survey by the American think tank, the RAND Corporation, put thousands of patients on different co-payment and compared their usage of health services with their health outcomes over a number of years. It showed that when patients have to pay a reasonable slice of the health care cost, they buy fewer services.

This is bad, isn’t it? People won’t show up even when they’re sick.

Wrong. They just think about it more carefully. Like other transactions, when a buyer thinks it’s important they will take the time to assess the information and make a more informed decision. The study found the actual effect on health outcomes was minimal.

Payment basically wiped out a large portion of the “worried well”.

A big reason for why there is a growing resentment in newly qualified doctors is that the nature of the job is so different to how they thought it would be. While no job is like its television representation, the biggest gap in expectation and reality is probably in the medical industry. Newcomers hoped for a prestigious, well-paid job where they happen to have a significant impact on human lives.

Instead they get a job where they are inundated with patients whose problems are often more related to sociology or economics than actual medicine. Furthermore, they are trapped in the public sector for years on end with relatively poor pay. They are the losers of global capital, trapped in an essential service caring complex.

While health should remain a social good and there should certainly be a safety net for poor and disabled people, it is important to question the modern role of a doctor. Do we really need to train people for a decade when so much of their daily experience is primarily that of a social worker.

It becomes less clear whether we need more doctors when their actual activities are put into question. Health is a classic case of an area where resources are allocated poorly because the market is not allowed to work effectively.

If doctors were more expensive we would go less and go when we needed to. The effect on health would be small. The savings in our national budget would be extraordinary.