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Medical Students’ Opinions About the Commercialization of Healthcare: A Cross-Sectional Survey

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Abstract

There are serious concerns about the commercialization of healthcare and adoption of the business approach in medicine. As market dynamics endanger established professional values, healthcare workers face more complicated ethical dilemmas in their daily practice. The aim of this study was to investigate the willingness of medical students to accept the assertions of commercialized healthcare and the factors affecting their level of agreement, factors which could influence their moral stance when market demands conflict with professional values. A cross-sectional study was conducted in three medical schools in Turkey. The study population consisted of first-, third-, and sixth-year students, and 1,781 students participated in total. Students were asked to state if they agreed with the assertions of commercialized healthcare. Of all students, 87.2 per cent agreed with at least one of the assertions, and one-fifth (20.8 per cent) of them agreed with more than half of the assertions. First-year students significantly agreed more with some assertions than third- and sixth-year students. Being female, having mid-level family income, choosing medicine due to idealistic reasons, and being in the third or sixth years of medical study increased the probability of disagreement. Also, studying in a medical school that included integrated lectures on health policies, rights related to health, and health inequities, along with early field visits, increased the probability of disagreement. This study suggests that agreement with the assertions of commercialized healthcare might be prevalent among students at a considerable level. We argue that this level of agreement is not compatible with best practice in professional ethics and indicates the need for an educational intervention in order to have physicians who give priority to patients’ best interests in the face of market demands.

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References

  • ABIM Foundation, ACP-ASIM Foundation, and European Federation of Internal Medicine. 2002. Medical professionalism in the new millennium: A physician charter. Annals of Internal Medicine 136(3): 243–246.

    Article  Google Scholar 

  • Aksan, H.A., I. Ergin, and Z. Ocek. 2010. The change in capacity and service delivery at public and private hospitals in Turkey: a closer look at regional differences. BMC Health Services Research 10: 300. doi:10.1186/1472-6963-10-300.

    Article  PubMed  PubMed Central  Google Scholar 

  • Alvarez, L.S., J.W. Salmon, and D. Swartzman. 2011. The Colombian health insurance system and its effect on access to health care. International Journal of Health Services 41(2): 355–370.

    Article  PubMed  Google Scholar 

  • Andereck, W.S. 2007. Commodified care. Cambridge Quarterly of Healthcare Ethics 16(4): 398–406.

    Article  PubMed  Google Scholar 

  • Angell, M. 2005. The Truth about the drug companies: How they deceive us and what to do about it. New York: Random House Inc.

    Google Scholar 

  • Baldwin, D., and D. Self. 2006. The assessment of moral reasoning and professionalism in medical education and practice. In Measuring medical professionalism, edited by D.T. Stern, 78. London: Oxford University Press.

  • Breen, K.J. 2001. The patient-doctor relationship in the new millennium: Adjusting positively to commercialism and consumerism. Clinics in Dermatology 19(1): 19–22.

    Article  CAS  PubMed  Google Scholar 

  • Churchill, L.R. 2007. The hegemony of money: Commercialism and professionalism in American medicine. Cambridge Quarterly of Healthcare Ethics 16(4): 407–414.

    Article  PubMed  Google Scholar 

  • Day, L. 2008. Commercialism and the professional practice of healthcare providers. American Journal of Critical Care 17(2): 164–167.

    PubMed  Google Scholar 

  • Dixon, A., R. Robertson, J. Appleby, P. Burge, N. Devlin, and H. Magee. 2010. Patient choice. London: The King’s Fund.

    Google Scholar 

  • Dougherty, C.J. 1990. The costs of commercial medicine. Theoretical Medicine and Bioethics 11(4): 275–286.

    Article  CAS  Google Scholar 

  • Field, A. 2009. Discovering statistics using SPSS. Los Angeles: Sage publications.

    Google Scholar 

  • Fins, J.J. 2007. Commercialism in the clinic: Finding balance in medical professionalism. Cambridge Quarterly of Healthcare Ethics 16(4): 425–432.

    Article  PubMed  Google Scholar 

  • General Medical Council, U.K. 2013. Good medical practice. Manchester: General Medical Council.

    Google Scholar 

  • Griffin, P. 2007. Neoliberalism and the World Bank: Economic discourse and the (re)production of gendered identity(ies). Policy Futures in Education 5(2): 226–237.

    Article  Google Scholar 

  • Hafferty, F.W. 2003. Finding soul in a “medical profession of one.” Journal of Health Politics, Policy, and Law 28(1): 133–158.

    Article  Google Scholar 

  • Hanson, W.E., J.W. Creswell, V.L.P. Clark, K.S. Petska, and J.D. Creswell. 2005. Mixed methods research designs in counseling psychology. Journal of Counseling Psychology 52(2): 224–235. doi:10.1037/0022-0167.52.2.224.

    Article  Google Scholar 

  • Homedes, N., and A. Ugalde. 2005. Why neoliberal health reforms have failed in Latin America. Health Policy 71(1): 83–96. doi:10.1016/j.healthpol.2004.01.011.

    Article  PubMed  Google Scholar 

  • Homedes, N., and A. Ugalde. 2009. Twenty-five years of convoluted health reforms in Mexico. PLoS Medicine 6(8): e1000124. doi:10.1371/journal.pmed.1000124.

    Article  PubMed  PubMed Central  Google Scholar 

  • Keane, C., J. Marx, and E. Ricci. 2002. The privatization of environmental health services: A national survey of practices and perspectives in local health departments. Public Health Reports 117(1): 62–68.

    Article  PubMed  PubMed Central  Google Scholar 

  • Keshavjee, S. 2004. Medicine and money: The ethical transformation of medical practice. Medical Education 38(3): 271–275.

    Article  PubMed  Google Scholar 

  • Mackintosh, M. 2003. Health care commercialisation and the embedding inequality. Geneva: United Nations Research Institute for Social Development. http://www.unrisd.org/80256B3C005BCCF9/(httpAuxPages)/4023556AA730F778C1256DE500649E48/$file/mackinto.pdf. Accessed August 31, 2015.

    Google Scholar 

  • Maynard, A. 2012. Privatisation: An exercise in ambiguity and ideology. The British Journal of General Practice 62(597): 174–175. doi:10.3399/bjgp12X635967.

    Article  PubMed  PubMed Central  Google Scholar 

  • McCoy, D. 2012. Commercialisation is bad for public health. British Medical Journal 344: e149. doi:10.1136/bmj.e149.

    Article  PubMed  Google Scholar 

  • Navarro, V. 2008. Neoliberalism and its consequences: The world health situation since Alma Ata. Global Social Policy 8(2): 152–155.

    Article  Google Scholar 

  • Naylor, C.D. 1988. Private medicine and the privatisation of health care in South Africa. Social Science and Medicine 27(11): 1153–1170.

    Article  CAS  PubMed  Google Scholar 

  • Ocek, Z.A., M. Ciceklioglu, S.T. Gursoy, et al. 2008. Public health education in Ege University Medical Faculty: Developing a community-oriented model. Medical Teacher 30(9–10): e180–8. doi:10.1080/01421590802337146.

    Article  PubMed  Google Scholar 

  • Oh, J., J.S. Lee, Y.J. Choi, H.K. Park, Y.K. Do, and S.J. Eun. 2011. Struggle against privatization: A case history in the use of comparative performance evaluation of public hospitals. International Journal of Health Services 41(2): 371–388.

    Article  PubMed  Google Scholar 

  • Price, D., A.M. Pollock, and J. Shaoul. 1999. How the World Trade Organisation is shaping domestic policies in health care. The Lancet 354(9193): 1889–1892. doi:10.1016/S0140-6736(99)11060-2.

    Article  CAS  Google Scholar 

  • Price, M. 1988. The consequences of health service privatisation for equality and equity in health care in South Africa. Social Science and Medicine 27(7): 703–716.

    Article  CAS  PubMed  Google Scholar 

  • Ravindran, T.K. 2010. Privatisation in reproductive health services in Pakistan: Three case studies. Reproductive Health Matters 18(36): 13–24. doi:10.1016/S0968-8080(10)36536-0.

    Article  PubMed  Google Scholar 

  • Relman, A.S. 2005. The health of nations. The New Republic, March 7. http://www.newrepublic.com/article/the-health-nations. Accessed August 31, 2015.

  • Relman, A.S. 2007a. Medical professionalism in a commercialized health care market. The Journal of American Medical Association 298(22): 2668–2670. doi:10.1001/jama.298.22.2668.

    Article  CAS  Google Scholar 

  • Relman, A.S. 2007b. The problem of commercialism in medicine. Cambridge Quarterly of Healthcare Ethics 16(4): 375–376.

    Article  PubMed  Google Scholar 

  • Republic of Turkey Ministry of Health. 2001. Health transformation programme. Ankara: Republic of Turkey Ministry of Health.

    Google Scholar 

  • Republic of Turkey Ministry of Health. 2007. Turkey health transformation program—the progress so far. Ankara: Republic of Turkey Ministry of Health.

    Google Scholar 

  • Republic of Turkey Ministry of Health. 2009. Health transformation program in Turkey—progress report. Ankara: Republic of Turkey Ministry of Health.

    Google Scholar 

  • Ruthjersen, A.L. 2007. Neo-liberalism and health care. PhD dissertation, School of Humanities and Human Services, Queensland University of Technology, Brisbane, Australia.

    Google Scholar 

  • Schoen, C., K. Davis, C. DesRoches, K. Donelan, and R. Blendon. 2000. Health insurance markets and income inequality: Findings from an international health policy survey. Health Policy 51(2): 67–85.

    Article  CAS  PubMed  Google Scholar 

  • Schoen, C., and M.M. Doty. 2004. Inequities in access to medical care in five countries: Findings from the 2001 Commonwealth Fund International Health Policy Survey. Health Policy 67(3): 309–322. doi:10.1016/j.healthpol.2003.09.006.

    Article  PubMed  Google Scholar 

  • Tuan, T., V.T. Dung, I. Neu, and M.J. Dibley. 2005. Comparative quality of private and public health services in rural Vietnam. Health Policy Plan 20(5): 319–327. doi:10.1093/heapol/czi037.

    Article  PubMed  Google Scholar 

  • Ugalde, A., and N. Homedes. 2005. Neoliberal health sector reforms in Latin America: Unprepared managers and unhappy workers. Revista Panamericana de Salud Pública 17(3): 202–209.

    Article  PubMed  Google Scholar 

  • Unger, J.P., P. De Paepe, G.S. Cantuarias, and O.A. Herrera. 2008. Chile’s neoliberal health reform: An assessment and a critique. PLoS Medicine 5(4): e79. doi:10.1371/journal.pmed.0050079.

    Article  PubMed  PubMed Central  Google Scholar 

  • Villa, S., and N. Kane. 2013. Assessing the impact of privatizing public hospitals in three American states: Implications for universal health coverage. Value Health 16(Suppl 1): S24–S33. doi:10.1016/j.jval.2012.10.003.

    Article  PubMed  Google Scholar 

  • Waitzkin, H., R. Jasso-Aguilar, and C. Iriart. 2007. Privatization of health services in less developed countries: An empirical response to the proposals of the World Bank and Wharton School. International Journal of Health Services 37(2): 205–227.

    Article  PubMed  Google Scholar 

  • Wilkes, M., I. Coulter, and E. Hurwitz. 1998. Medical, law, and business students’ perceptions of the changing health care system. Social Sciences and Medicine 47(8): 1043–1049.

    Article  CAS  Google Scholar 

  • Woolhandler, S., and D.U. Himmelstein. 1997. Costs of care and administration at for-profit and other hospitals in the United States. The New England Journal of Medicine 336(11): 769–774. doi:10.1056/NEJM199703133361106.

    Article  CAS  PubMed  Google Scholar 

  • World Bank. 1993. World development report 1993: Investing in health. New York: Oxford University Press.

  • World Bank. 2002. Turkey: Reforming the health sector for improved access and efficiency, report no. 24358-TU. https://openknowledge.worldbank.org/bitstream/handle/10986/14824/multi0page.pdf?sequence=1. Accessed August 31, 2015.

  • World Bank. 2003. In Innovations in health service delivery the corporatization of public hospitals, edited by A.S. Preker and A. Harding. Washington, DC: World Bank.

    Google Scholar 

  • World Bank. 2014. Project in support of restructuring of health sector. http://www.worldbank.org/projects/P102172/health-transformation-social-security-reform-project?lang=en. Accessed August 31, 2015.

  • World Medical Association. 2006. International code of medical ethics. http://www.wma.net/en/30publications/10policies/c8/. Accessed August 31, 2015.

  • Zuberi, D.M., and M.B. Ptashnick. 2011. The deleterious consequences of privatization and outsourcing for hospital support work: The experiences of contracted-out hospital cleaners and dietary aids in Vancouver, Canada. Social Science and Medicine 72(6): 907–911. doi:10.1016/j.socscimed.2010.12.024.

    Article  PubMed  Google Scholar 

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Acknowledgements

Authors do not have competing interest to declare. An earlier version of this paper was orally presented at an international conference and a national symposium:

•M. Civaner, Y.I. Ulman, H. Balcıoglu, and K. Vatansever. 2009. Medical students’ opinions about commodification of healthcare services and the alteration during medical education. EACME Conference, September 10–11, Venice, Italy.

•M. Civaner, Y.I. Ulman, H. Balcıoglu, and K. Vatansever. 2011. Tip ogrencilerinin saglik hizmetlerinin metalastirilmasi hakkindaki dusunceleri: Tip egitimi boyunca degisim [in Turkish].Topluma Dayalı Tıp Eğitimi—Eğitim Araştırmaları Sempozyumu, Tıp Eğitimini Geliştirme Derneği, May 5–7, Antalya, Turkey.

Yesim Isil Ulman, the second author of the presentation, has withdrawn from the study of her own will and has documented her decision (the signed document is available at request). The authors are grateful to Yesim Isil Ulman for her contributions and also to Raymond De Vries, Marcello Ienca, and Ademola Kazeem Fayemi for their critical review.

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Civaner, M.M., Balcioglu, H. & Vatansever, K. Medical Students’ Opinions About the Commercialization of Healthcare: A Cross-Sectional Survey. Bioethical Inquiry 13, 261–270 (2016). https://doi.org/10.1007/s11673-016-9704-6

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