Vulnerability of Health to Market Forces
Vulnerability of Health to Market Forces
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DOI：
10.1097/mlr.0b013e31820ab638
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发表时间：
2011-03-01
期刊：
影响因子：
3
通讯作者：
Wiist, William H.
中科院分区：
文献类型：
--
作者：
Brezis, Mayer;Wiist, William H.
研究设计：叙述性综述。结果：营利性医疗行业可能会增加成本，降低质量，导致市场失灵，并导致美国在医疗效率国际比较中的不利地位。药品和器械公司使用的策略包括做出有偏见的推断，影响科学家和医生，营销而不是告知公众，以及游说控制自己的行业法规以创造市场优势。成功的营销导致更多人使用昂贵的盈利药物和程序，而不是更便宜的非专利疗法。由于资源有限，过度使用昂贵的医疗方式助长了昂贵的医疗保健，这对全民覆盖构成了挑战。自由市场还助长了烟草、食品和化学品等行业的扩散，这些行业将成本外部化以实现利润最大化，试图通过向专家和大学支付报酬来不适当地影响研究，并试图控制媒体和监管机构。最容易受到这些策略累积伤害的是儿童、穷人、病人和受教育程度最低的人。结论：自由市场会损害健康和医疗保健。公司增加利润并确保向股东回报的义务影响公众健康。资本主义的这种过度行为对社会正义和公共健康构成了可怕的挑战。认识到公司控制的市场带来的健康风险对公共政策具有重要影响。需要进行改革来限制企业的权力。
Objectives: This article reviews adverse influences of for-profit enterprises on health care and public health, and examines significance for public policy.Research Design: Narrative review.Results: For-profit health-care industries may increase costs and reduce quality, leading to market failure and contributing to the USA's unflattering position in international comparisons of healthcare efficiency. Drug and device corporations use strategies such as making biased inferences, influencing scientists and physicians, marketing rather than informing the public, and lobbying to control their own industry regulations to create market advantage. Successful marketing leads to the increased use of costly profit-making drugs and procedures over cheaper, nonpatented therapies. Because resources are limited, the overuse of costly modalities contributes to expensive health care, which presents a challenge to universal coverage. The free market also fosters the proliferation of industries, such as tobacco, food, and chemicals, which externalize costs to maximize profits, seek to unduly influence research by paying experts and universities, and attempt to control the media and regulatory agencies. Most vulnerable to the cumulative harm of these tactics are children, the poor, the sick, and the least educated.Conclusions: The free market can harm health and health care. The corporate obligation to increase profits and ensure a return to shareholders affects public health. Such excesses of capitalism pose formidable challenges to social justice and public health. The recognition of the health risks entailed by corporation-controlled markets has important implications for public policy. Reforms are required to limit the power of corporations.