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Markets and Medicine


March 19, 1997

A recent article in the New England Journal of Medicine has challenged the argument -- currently in vogue -- that relying on market forces is the most effective way of guaranteeing a prosperous and therefore accessible and effective health-care system. The article presented results from a study that showed that for-profit hospitals were no more efficient -- and in some cases less efficient -- than nonprofit hospitals.

A former editor-in-chief of the New England Journal of Medicine, Arnold S. Relman, spoke out in the March 13 Boston Globe in support of the study, saying "those facts in the study... once and for all set aside claims of for-profit hospitals that they run a more efficient ship. They don't. They are more efficient at taking money out of the system for their profits."

In the March, 1992, Atlantic, in "What Market Values are Doing to Medicine," Relman discussed at greater length his belief in the importance of maintaining medical care as "a social good, not a commodity," and expressed his concern that "In the past two decades or so health care has become commercialized as never before, and professionalism seems to be giving way to entrepreneurialism."

By contrast, in the March, 1970, Atlantic, in "The High Cost of Cure," Michael Crichton (author of such books as The Andromeda Strain and Jurassic Park, and creator of the television series E.R.) argued that the complex technology and refined expertise available in modern hospitals justify the expense of modern American health care. "You get what you pay for," he wrote. In order to ensure that high-quality equipment and personnel are always available he argued, hospitals need to learn to cut unnessary costs and to become more efficent. "Doctors tend to operate on a 'spare-no-expense' philosophy, which will, eventually, need to be tempered." One cost-cutting measure he recommended was that "No one should be admitted unless his care absolutely depends upon being inside the hospital... unless he requires the hour-to-hour facilities of the house staff, the nursing staff, and the laboratories."


  • See Cutting Down on Care, Suzanne Gordon's first-hand account from the front-lines of nursing

  • See the Flashbacks archive
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