Doctors' concern over health insurance companies influence on medicine

Seven out of 10 doctors believe private health insurance companies are increasingly dictating the delivery of medical care while not always promoting evidence-based care.

Doctors’ views on the creeping commercialisation of the health service are captured in a survey by the Irish Medical Organisation (IMO) which also found that four in five medics agree that “private care can lead to over-investigation”.

One doctor said: “The advertisement of independent sectors for non-evidence-based activity (health checks) exposes persons to excessive medical care, including over-diagnosis and over-treatment. I think of cases of healthy people receiving ionising radiation.”

The survey results, published by the IMO as part of a broader policy paper on commercialism in medicine — Preserving Medical Professionalism in an Increasingly Commercial Healthcare Environment — also found half of doctors agree there are “few independent sources of information with regard to new drug therapies” and that pharmaceutical sales representatives, promotional material and even magazines, journals, and news reports could be biased.

Of particular concern to doctors is the role of pharmaceutical companies in the sponsorship of educational events.

The IMO said many doctors believe the pharmaceutical industry has too much influence on Irish medicine and that pharmaceutical therapies are promoted above non-pharmaceutical treatment.

One doctor said: “Pharma companies are too involved in medicine. From research to hospitals they are silent decision makers.”

Another said: “Pharmaceutical company influence means promotional materials are everywhere and management don’t support non drug approaches… knock-on is under-development of non-drug treatment facilities and staff... Huge factor in mental health.” The survey also looked at the affordability of pharmaceutical care. Those without a full medical card face charges of up to €144 per month for prescription drugs under the Drugs Payment Scheme. The IMO said doctors are concerned that due to the high level of out-of-pocket payments for medicines many patients are not adhering to treatment.

More than three quarters (76%) of doctors who responded to the survey agreed with the statement “I am obliged to consider my patients’ financial circumstances when discussing options for care”.

The paper said IMO doctors found private health insurance reimbursement favours admission to hospital above day treatment, outpatient care or care in the community. The paper also said many doctors are critical of the willingness of private health insurance companies to reimburse more expensive MRIs over less expensive diagnostic procedures whether the tests are clinically indicated or not.

Dr John Duddy, IMO president, said there was a need for vigilance to prevent the over commercialisation of medicine.

The paper makes a number of recommendations including resourcing of the public sector to reduce reliance on the private sector; provision of non-directional educational material on new pharmaceutical therapies; encouraging appropriate care in the appropriate setting and routine registration of conflicts of interest in advocacy, education, and academia.


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