Introduction
The tragedy of the commons describes a situation where individuals, acting in their own self-interest, overexploit a shared resource, leading to its degradation or extinction. This principle, originating from economic sciences and resource management, applies to many aspects of our daily lives, including the private healthcare system.
The Role of Intermediaries in Private Medicine
Intermediaries, such as doctors, brokers, agents, or health managers, have become increasingly common in private medicine. They present themselves as advisors with an understanding of the system, guiding patients based on their supposed expertise. However, their decisions often prioritize short-term agendas, compromising the sustainability of high-quality medical care.
Short-term Agendas and Their Impact
Under the guise of “efficiency” or “cost-saving,” these intermediaries redirect patients to lower-quality hospitals, disregarding essential criteria such as medical staff experience, patient safety, and clinical resolution capacity. The common argument is the lowest cost for patients or insurers, although the reality often involves hidden economic benefits for the intermediaries themselves. Patient well-being rarely takes center stage in their recommendations.
The Paradox of Intermediary Recommendations
The paradox is evident when these “know-it-alls” seek medical attention themselves. They unhesitatingly choose hospitals that invest in technology, innovation, human talent, and strict safety protocols. This inconsistency between their recommendations and actions is not only hypocritical but also deeply damaging.
Impact on Hospitals Offering High-Quality Care
Hospitals striving to provide top-tier medical care need a minimum volume of patients to sustain their model, which includes well-prepared doctors, cutting-edge equipment, strict adherence to safety standards, and patient-centered processes. When these centers are economically penalized by patient diversion, their financial margin and long-term viability are compromised.
The Complexity of Running a Hospital
Running a hospital optimally is an intricate task requiring constant financial and time investments, along with continuous quality monitoring. A hospital is a complex system that not only delivers specialized medical care but also functions as a hotel with accommodation and food services. Ensuring 24/7 availability of qualified personnel, maintaining sophisticated medical equipment and technologies, and coordinating robust logistics for over 3,000 distinct medications and around 10,000 non-pharmaceutical materials are significant operational challenges.
A Personal Perspective
As the director of a non-profit hospital in Veracruz, I have dedicated years to building and strengthening a medical facility that offers high-quality care to patients in Veracruz and surrounding areas without requiring them to travel to Mexico City or abroad. Alongside over 500 collaborators and a Board of Directors, we have worked for nearly 15 years to demonstrate that a dignified, efficient, modern, and responsive private medical system is possible. However, when short-sighted decisions with significant biases erode these efforts, we face a modern version of the tragedy of the commons: if everyone prioritizes immediate self-interest without considering the entire system, it does not improve, and we all lose in the end.
Consequences of Poor Quality Medical Care
Weakening the provision of high-quality medical care in provinces can lead to at least two possible scenarios. Lower-income patients will have to settle for substandard medical services, while those with greater economic resources or more expensive medical insurance will once again be forced to travel to other cities for adequate care.
The Importance of Ethical Practices and Transparency
Most doctors, brokers, and managers act professionally, ethically, and genuinely prioritize patient well-being. Many adhere to strong ethical principles, avoid conflicts of interest, and work transparently to offer the best possible alternatives. Although private healthcare costs have risen significantly in recent years, with medical inflation estimated to exceed 14% this year alone, we must become more efficient to serve our patients without proportionally increasing costs. Private insurance is an effective way to expand access to high-quality medical services.
Fostering Competition and Collaboration
There is an opportunity to increase coverage nationwide while promoting competition in a market where four insurers control 75%. Alliances between hospitals and insurers are crucial for developing centers of excellence that offer efficient, affordable, and high-quality care, benefiting both patients and the system as a whole.
Key Questions and Answers
- What is the tragedy of the commons? It describes a situation where individuals, acting in their self-interest, overexploit shared resources, leading to degradation or extinction.
- How do intermediaries impact private medicine? Intermediaries often prioritize short-term agendas, redirecting patients to lower-quality hospitals and compromising high-quality medical care sustainability.
- What are the consequences of poor quality medical care? Lower-income patients may settle for substandard services, while those with more resources might need to travel to other cities for adequate care.
- What role do ethical practices and transparency play in private medicine? Most medical professionals act ethically and prioritize patient well-being. However, increasing efficiency is crucial to serve patients without proportionally raising costs.
- How can alliances between hospitals and insurers improve the system? These partnerships can foster competition, develop centers of excellence, and offer efficient, affordable, high-quality care, benefiting both patients and the system.
