On the contrary, to the extent that market-based incentives tend to operate against the most needy and vulnerable members of the community, the indigent and socially disadvantaged populations are likely to be worse off under a more competitive system. In the US, where it is commonplace for healthcare organisations to seek openly to maximise their profits by restricting medical care in individual cases, this appears commonly to be the case. 3,14 In Australia, the introduction of casemix funding has openly discouraged admissions for social or compassionate reasons by attributing low weights in these categories, and there is evidence that specific social groups may be particularly disadvantaged. Indeed, competition policies explicitly seek to challenge many of the traditional norms underlying medical practice, on the assumption that these are simply devices for protecting the financial interests and power of physicians. As both doctors and patients have always recognised, however, the medical relationship cannot be understood purely as a commercial relationship.
Patients come to doctors because they are experiencing pain, illness or fear.
They offer access to their bodies and to the intimate recesses of their personal lives. They grant wide discretion and decision-making power to doctors, on the understanding that doctors will exercise their judgement in a disinterested and compassionate manner. It is mutually agreed that the power of doctors is subject to rigorous ethical constraints arising from the long tradition of medicine, which have been upheld by the professional organisations for hundreds of years. They primarily reflect altruistic concerns of doctors to separate personal and financial considerations from the paramount professional goal of doing what is best for their patients, even if, undeniably, they also have the effect of protecting doctors' financial interests. They do not prohibit competition, but rather channel it into non-economic forms, such as competition for reputation, recognition and status, and social influence.