The Sick System: From A Disease-Oriented Economy to Caring For People . A plea for a new access to health care

By Bernhard Stein

The health system is sick, but still has chances to heal. Its economic alignment has not only led the doctor's profession into a 'business model' on a 'medical market', but it risks leading to an illogical, inhumane and unfair care system - without reaching the initial economic goals.

Dr. Bernhard Stein, MD, anesthesiologist and health economics expert, shows the weaknesses of our current health care system and pleads for understanding the crisis as an opportunity for a fundamental reorientation: the transformation of the old-school hospital into a lean, modular and regionally networked unit. With the maxim - a maximum of outpatient care in this network, and synergy instead of competition. This bottom-up approach, changing the philosophy of care and made possible by new technologies, gives a new chance to disfavored and regionally isolated populations. They are the first victims of the current industrial model of "healthcare".

• Language: English
• Publisher: tredition
• Release date: Mar 8, 2017
• ISBN: 9783732390564

Book preview

Prologue: Crash or New Start

Discussing the health system is delicate. It is a killer topic for political careers. Due to its complexity and political explosive force, it probably is too big to be optimized instead of too big to fail.¹

This book is meant as a manifest, born from the critical reflection and the feeling that we are going in a wrong direction.

The initial point is a critical, provable analysis of the current state, questioning our well-shaped image and our make-believe truths in order to show alternatives for a different way in health care.

The subjectivity consists of interpreting the facts and the verbalized theses, definitely provocative but provable and percebtible. The consequences we draw from this depend on the level of maturity of our society and the wish for changes.

This is a complex system that is threatened to become a victim of its own success. Its economic and political penetration influences its protagonists as well as a lot of normal people. When we subsequently deal with three key terms that have been unknown in health care, mainly been connected with other areas up to now or have been lost during the last trente glorieuses ² critical questions arise:

•Sustainability , meaning the three pillars ecological, economical and social sustainability , supplemented by inter-/and intragenerational justice. Our current approach of the diseaseoriented economy is not sustainable .

•Subsidiarity as a principle striving for the development of individual abilities, self-determination and personal responsibility. Jobs, actions and problems should be handled by each individual, the smallest group and the lowermost level of an organization. Only when the obstacles are irresolvable, higher instances should support or take on the jobs. For health politics, this means a bottom-up approach, from simplicity to complexity or from the inside to the outside. Personal responsibility is shriveling under the pledge of expertise and quality and cost management (ILLICH, 1995).

•Sufficiency , meaning the careful handling of resources – financial resources, people, energy, work time, routes of transport etc. The current waste of resources promotes unregulated and unjust growth (SACHS, 1993).

Every crisis provides the chance of making a virtue of necessity and creating new ways of health care that serve as model examples and are focused on caring for people. The top priority should be social, ecological and economical subsidiarity and inter-generational fairness, re-directing personal sovereignity on health, disease and death and health care focused on the people – and last but not least rethinking in favor of self-restraint on what people consider sensible and desired.

This would lay the foundation for a new start.

1.Thesis: Within a few generations only, the attitude of people toward ailments and disease and their treatments has created a condition that is neither economically bearable nor strongly satisfactory for the people in the long run. A holistic approach and helping the people to help themselves have been replaced by a disease-oriented economy driven by economics and technology, which is now threatening to make itself independent. Their superficial success in life extension, economic performance and progress orientation are throwing a smokescreen over the other side of the coin: the incapacitation of people and the development of a health care system serving its protagonists more than the people.

2.Thesis: If we seriously apply the terms sustainability, subsidiarity and sufficiency on the health care system and if we give the authority for health, disease and death back to ourselves, we can create a new start for another type of health care system.

There is a time for everything and a season for every activity under the heavens:

A time to be born and a time to die, a time to plant and a time to uproot, a time to kill and a time to heal, a time to tear down and a time to build.

Old Testament, Solomon, chapter 3, verses 1-3

Analysis of The Current State – Spirals into the Abyssa

a. What Happened?

Under the impulse of a strong economization and adjustment to industrial management, today's health care focuses on the acute disease and its speedy, technically and economically demanding treatment. All the more, a person's entire life and medical history is considered a sequence of acute diseases in which the social, psychological and individual dimension is put in the background.

The professions of doctor and nurse, based on human attention toward the patient and requiring trust and concern, become business models of the market-oriented barter trade of services (MAIO). They get devaluated and ripped by pseudo-evident instructions turning their work into cost efficient and success-oriented consumer goods with the help of an industry-adapted arsenal of processes and therapy modules (MAIO).

For 100 years, medicine has always claimed to be non-judgmental and academic but eventually, it has played the card of unconditional technical and pharmacological progress rather than social or societal, or even global development.

The sheer quantitative problems caused by medical progress and demographic development, such as more old and chronically ill people, lead into a spiral of triply pressing problems:

•The increasing gap between the claim of an equal and affordable health care system despite social and regional discrepancy and reality. If we have believed up to now that this only applies to South and Eastern Europe and the Third World, that are so far away, we will soon come to realize that the gap is right within our countries, France and Germany – regionally as well as socially.

•This development is on the account of chronic and age-related diseases. In the logic of acute diseases, they are medicinally and economically wrongly or excessively treated and neither benefit from consequent prevention nor alternative or less invasive concepts of treatment.

•This is accompanied and enforced by a development in science and medicine influencing large parts of the medical mainstream in terms of an ever-expanding health care market with expensive pseudo-innovations and new mental disorders implying pathological significance.

The consequences are:

•Wrong incentives , most of all, wrong investments in a still oversized, expensive acute care range unable to adjust adequately to the changed frame conditions,

•the development of a lifestyle health care , mainly privately funded yet lucrative,

•the negligence and insufficient development of care and treatment of chronic and age-related diseases as well as the outpatient sector ,

•the monopolization of health care by presumed experts, for 20 years complemented and increasingly dominated by squadrons of specialized managers, economists and quality managers, resulting in a definitely efficient high-end health care but creating a multi-tier health care and the increasing incapacitation of non-experts and patients.

While politics, public but also professional associations often concentrate on high-end health care and the medical progress, it is forgotten that approx. 90 per cent of public medical care takes place in their region, right outside their door and off the the university centers.

The region in particular is the first to suffer from deficits in the supply chain but at the same time,