Corporatization of Medicine:

Human Health as a Business Transaction

An increasing number of patients over recent years have noted appointments at a doctor’s office feel rushed or have been in an emergency department or clinic feeling as though they were just another number on the list to be crossed off. Many other patients additionally noted feeling as though they had to re-introduce themselves to their physicians whom they have seen multiple times—occasionally even their long-term providers.

On the other hand, many physicians have recalled having similar experiences regarding patients. Physicians have indicated feelings of being just another cog in the wheel, cranking through one patient after another with very few moments to spare in between—let alone enough time to truly connect with their patients. Who or what is to blame for this progressively worsening phenomenon? Is this a result of bad doctors or unachievable patient expectations? Surely, some contribution lies within both of those explanations, but it is almost with certainty that another factor reigns a heavy influence in this complex question.

These impending concerns are symptomatic of the consequences that exist in the corporatization of medicine. In other words, there has been a transfer of principles which are utilized, and deemed effective, in large business models into medicine. The problem in applying these principles to healthcare systems is a mass effect of depersonalizing medicine as a whole and dampening the sanctity of the patient-physician relationship. What is happening in the implementation of these systems is the transformation of the aforementioned relationship into one of producer and consumer with the commodity of trade being the consumer’s health. A person’s well-being and health status should not be perceived as a commodity, but maybe that is not so obvious to some people [1, 2, 6].

So, what is the cause of this shift in medicine? In 2019, the top publicly traded health insurers’ revenue nearly reached a cumulative $1 trillion. Within these big insurance players, the top-seven companies raked in $913 billion in revenue last year, which follows their trends of increasing financial performance over the last few years [3]. Patients are seeing increases in their premiums for less coverage, all while these insurance executives are seeing significant increases in the depth of their pockets. Keep this in mind next time you get surprised by a large bill for your treatments.

Another unrelenting consequence is the effect on medical practices. With an expanding number of corporate moguls buying out physician groups and private practices, there is an increased difficulty in maintaining the standard quality of care. Large buyers implement higher standards while cutting compensation across the board. An argument at this time may probably be something along the lines of, “physicians and the majority of other healthcare workers earn a good living, what’s the big deal?”

The problem is asking for more work hours for less income, so in an act to maintain income employees are forced to up their rate of efficiency. An increase in efficiency is typically indicative of improvement in most sectors, but in this setting, the unintended consequences lie in the reality of providers being forced to see more patients in a smaller window of time while assisting staff are asked to do more and more tasks in a shorter time. This leads to the problems I introduced in discussion at the beginning of this piece – mediocre patient care with the missing backbone of human connection. To top it off, many of these companies implement performance metrics to withhold these efficiency standards only further incentivizing this model of care. Medical providers’ focus is then shifted away from the patient and towards being able to meet corporate standards in an act of self-defense [2, 6].

Additionally, for those smaller private practices still out there, physician owners are finding it harder to keep up with taking care of their own employees. With private practice reimbursements trending downward, maintaining employee benefits such as insurance, salary adjustments (accounting for increases in the cost of living, inflation, etc.), and time-off is a struggle. Many practices eventually end up losing quality employees to larger corporate companies with these incentives as a result and consequently take a hit in the quality of the practice. These physicians also then are pressured into seeing more patients more quickly as a financial decision to keep their practices afloat while still taking care of their staff.

In addition to patients sustaining a diminished quality of care, physicians are also eating burden with work satisfaction. Burnout is at an all-time high and does not show any signs of slowing down. Various studies and surveys show over half of all physicians feeling burnt out and ready to leave the field [4, 5]. Physicians additionally wield the heavy statistic of the highest suicide rate of any profession in the United States. We consistently hear the need for more healthcare providers in the coming years, but with these conditions perpetuating onwards how can we expect to draw more into the field?  

As evidenced, there are a multitude of trickled down effects of corporatizing medical practice. It should be evident at this point that the problem at hand is multifactorial, and as such, should be met with a multidimensional solution.

On a large-scale basis, various economic analyses have broken down the components of healthcare costs and made it clear the primary contribution of expenditures is towards the profits of insurance companies – not on healthcare worker salaries. In fact, it is shown that these salaries do very little in driving up health care costs. Adjustments need to be made to the insurance system to provide coverage for everyone and premiums should be modified to no longer deter access to care—health is a human right regardless of what conditions a person has.

Furthermore, I have personally witnessed working with so many providers who have been pushed into altering their medical decisions to adhere to the red-tape boundaries of insurance, “I can’t order this test because insurance won’t cover it,” or “this patient needs this procedure, but it won’t be covered so we have to try a different method.” I have even seen physicians be forced into ordering more tests that drive up costs for the patient because it is the only way insurance will cover treatment plans for the patient. This only creates a time and energy suck in fighting insurance for providers trying to practice clinically-sound, personalized, and intelligent medical care. Providers are also being asked to increase their documentation to provide more justification and data for their decision making, and this just adds to the time burden and diminished job satisfaction. It is disturbing when a healthcare system relies on insurance workers and administrators who have no medical experience to decide which treatments and tests are deemed acceptable.

On a more personal scale, there needs to be a culture shift. Healthcare workers should be reminded of their motivations for choosing this line of work and truly find gratitude in the profession. It is not every day that you can wake up and say you have an equal opportunity each day to profoundly impact someone’s life. As for patients, a little bit of sympathy for those who are coming in to care for you and putting their personal needs behind yours can go a very long way. The relationship between the physician and patient is sacred and should be maintained in that light. 

There is no easy solution and even less likely that there is one solution that addresses every problem here, and for that reason it is imperative we do not rule out any suggestions moving forward. This only scratches the surface of problems with the current system, but together we can all work towards and advocate for a reformed healthcare infrastructure that allows for us to return to caring for one another as human beings – not as a series of business transactions. 

Aaron Tran

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Aaron Tran is a member of The University of Arizona College of Medicine – Phoenix Class of 2023. He graduated from Arizona State University in 2018 with a degree in Kinesiology. In his spare time, he enjoys training Brazilian Jiu-jitsu, bodybuilding, playing guitar and piano, and hanging out with his labrador retriever, Rex, outdoors.

For questions, concerns, or discussion: atran13@email.arizona.edu

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