More and more while practicing DPC firsthand, I keep asking myself with so many obstructions and high costs of care our patients experience outside of DPC, what the hell happened?
The transformations of Medicine into a corporate-dominated field in the United States can be attributed to a variety of critical elements and progressions over the last few decades:
Medicare and Medicaid in 1965 significantly boosted the demand for medical services. This surge in demand paved the way for corporate participation. Unfortunately, so many steps along the way were unchecked by the involvement of private physicians.
Advancements in medical technology and treatments demanded considerable financial investment and infrastructure. Corporations, with their capacity to secure funding and invest in new technologies, emerged as key figures in the healthcare sector.
The expansion of the insurance industry, both with and without government oversight particularly in the realm of employer-sponsored health insurance, altered the landscape of healthcare financing and provision.
Insurance companies became influential middlemen, setting prices and shaping medical practices. Corporations, with their perceived management skills and economies of scale, were viewed as a solution to cost control. And we all know what happened from here.
This is where it really started to get ugly. Legislations and regulations, like the enactment of the Health Maintenance Organization (HMO) Act of 1973, supported the establishment of managed care organizations and the involvement of corporations in healthcare. Is this something else we should thank California for?
The emergence of investor-owned hospital chains in the 1970s and 1980s represented a significant move towards a corporate-led healthcare system. Physicians were seen by businesses as just another cog in the wheel. Sadly, physician organizations we thought were rooting for us, clearly could have cared less.
The trend toward corporate privatization and deregulation in the latter part of the 20th century influenced the healthcare sector, leading to further corporate engagement. But wait, there’s more!
The growth of pharmaceutical and medical device companies, fueled by substantial investments in research and development, further integrated the healthcare industry into a corporate framework.
The adoption of information technology in healthcare, including electronic health records (EHRs) and telemedicine, required huge financial investments and technical changes without participation from physicians.
The saddest part is most of this happened without the input, direction, or awareness of the once-private practice of medicine, and its impact on physicians, and especially the physician-patient relationship.
We've got some work to do.
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