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16 | Healthcare
They found that people in high-income aren’t always available. Poorer countries may withdrew throughout the 20th century, leaving
countries that spend more on healthcare live simply be unable to afford them. local factions to battle over resources and
longer. And it’s well known that life expectancy There’s a commonly held view that the power. War-torn landscapes do not serve the
in developing nations is frequently (but not pharmaceutical industry is a root cause of healthcare ideal well.
always) lower than that of richer nations. healthcare inequality. The real picture probably Political instability and poverty breed another
In short, you get what you pay for. When it isn’t so simple. It might make it easier to label enemy of health too: corruption. Politicians and
comes to buying a car, most of us are happy to ‘big pharma’ as evil, but these companies are a officials more concerned with lining their own
accept that cost equates to quality. When it by-product of global capitalism. For patients to pockets than establishing care for their citizens
comes to our health, the reality can be harder to have access to any drug, someone has to have held back the development of effective
swallow. This is especially true in richer nations, manufacture them. And that costs money. health care in many developing nations.
where people think that they’re entitled to good Pharmaceutical companies defend their
healthcare. prices by citing the huge sums spent on research Too much for too few?
But it seems that the equation is not that and development. This was estimated – by the As touched upon earlier, it has to be admitted
simple. In the case of the United States, where industry itself it’s worth noting – to be around that healthcare systems in richer countries have
there is the highest GDP expenditure on health, $58 billion a year in 2007. With new drugs plenty of problems too. As medical systems
the events of New Orleans a few years ago taking 10 to 15 years to bring to market, they become more defined they reach further and
unmasked a vast swathe of the population, argue that losses need to be recuperated. Yet further into society, and the risk of medical over
almost 50 million individuals, who were time and again the industry has faced intervention grows. A healthcare system may
uninsured and therefore effectively had no accusations of inflating the figures to justify assume intervention is necessary when it isn’t.
access to even basic care. high prices and increased profit margins. There is a large body of evidence, originated
So the conundrum is complex. But putting Wherever the truth lies, the pharmaceutical by the Foundation for Informed Medical
money aside, what other factors influence our industry has – at least recently – offered more Decision Making, that shows that when
healthcare lottery? flexible pricing schemes, which mean poorer incentivised in the wrong way, or in a system
countries can buy more of the medicines they where supply is more than demand (such as in
The Hygiene Factor need. But many say more needs to be done to the world of private healthcare), more is often
One of the keys to good medical treatment is make sure that life saving medicines are made done than is needed.
sanitisation. It was the industrial revolution of available to everyone who needs them. The Dartmouth Health Atlas of North
the 19th century and the introduction of sewers Given the recent and very real challenge of America showed unequivocally that certain
and basic hygiene, followed by the subsequent widespread counterfeit medicines being surgical interventions were performed not
discovery of antibiotics, that allowed people to produced and distributed widely in Asia, it is dependent on actual need, but more on surgeon
survive diseases and infections that would fair to predict that access to effective medicines preference. That means that patients were
otherwise have killed. will continue to flame the fires of our healthcare having procedures they didn’t need and didn’t
It sounds easy on paper, but following lottery. want.
general hygiene standards takes rigour and Sadly, this overprovision continues to grow
diligence. And the necessary ‘tools of the trade’ Infrastructure and the political and exist, although the healthcare industry is at
– sterilisation methods, disinfectants, scene last seeing the greenshoots of the movement to
antibiotics, even running water – aren’t always ‘Healthcare’ itself is a fluid concept. At its core, a combat this and ration healthcare more
available in poorer countries. Inevitably, nation’s healthcare system looks after the health appropriately.
standards of care suffer. needs of its residents. This can encompass many
Even for rich countries, however, hospital specialities. Interventions range from Are you winning the lottery?
hygiene is a central issue. It is well known that emergency care, to chronic disease Given the variations and differing drivers for
one of the most pertinent signs of a quality management, to cancer therapy treatment. the standards of care, the core message is in
institution is infection prevention and control. Dementia care, disability services and mental making sure you offer yourself the best chances
In the UK, the rise and rise of MRSA health strategies must all be accounted for too. of securing yourself an equitable and long-term
(Methicillin Resistant Staphylococcus) has The scope is huge to say the least. Different coverage in case of ill health.
exposed significant gaps in otherwise high countries have varying success in getting the Staying knowledgeable, seeking wide
standing centres. The prevention of surgical site necessary infrastructure in place to deal with information about your own condition, keeping
infection has been a key focus of the World the vast array of treatment modalities implicit healthy and ultimately knowing who to go to
Health Organisation, and prevention of spread with general healthcare. when you do need to access healthcare are the
in the wake of pandemics is more important Getting this infrastructure in place is far from keys to winning our healthcare lottery.
now than ever before. easy. It requires political stability, with the
necessary time and resources. Some poorer
Access to medicines countries have never had the chance. Former Dr Sneh Khemka, MBChB MRCOphth
Even when a country has the requisite hygiene colonial countries in Africa or Asia have been Medical Director
procedures, the drugs needed to treat patients left in turmoil as their former invaders suddenly Bupa International
July/August 2009 Investment International www.investmentinternational.com7
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