SEARCH

SEARCH BY CITATION

By Mary J. McDonough . Published by Georgetown University Press , Washington DC . Paperback, 272 pages with index. RRP $49.95. ISBN 9781589011571 .

Reviewed by Francis Sullivan

Catholic Health Australia

Since at least the late 1980s Australian health policy makers have toyed with the usefulness of market forces in the containment and distribution of scare resources. Over the same time, there have been strong opponents who ‘demonise’ the market for its misfit in health policy. This polemic has characterised the politics of health as well. The Left has been wary of market forces while the Right has embraced their utility. Only in recent years has there been a discernible convergence on the role of the market in health care. With rising costs and growing demand, public authorities have turned to market solutions to appease the political pressures of the health system.

This long gestation for legitimising market forces in health care has come like most other things – through a moderation of ideological stances. Markets can work and also do fail. Government has a role to ameliorate the failures while encouraging the success. Whether the overall results appease social concerns is another matter altogether.

It is this issue of what best promotes the common good that lies at the heart of Mary McDonough's book, Can A Health Care Market Be Moral? A Catholic Vision. She more than adequately traces the development of Catholic social thought in regard to the place of capitalism in society as well as the critiques offered by the Catholic Church to the role of socialism. She likewise offers a succinct summary of the fundamentals of market economics. Fortunately, she has remained relatively balanced in her own critiques and provides the astute reader with a reasonable roadmap through the otherwise dense debate surrounding the efficacy of market forces in health care.

McDonough's contribution is timely for Australian policy makers. Although her experience is grounded in the United States health system, where markets are far from demonised, she has a healthy scepticism that affords her a curious but open disposition to the usefulness of markets. She has developed an interesting template to assess the worthiness of markets – in the end, they need to promote the common good, respect human dignity and deliver social equity.

For McDonough, this template is the most significant contribution the Catholic Church makes to issues of social policy. In this she is on solid ground. This is especially the case for health systems that prize universal public insurance schemes for both their cost effectiveness and social outcomes. She has presented plausible arguments whereby market forces can be integrated into health systems to a degree that they assist with the sustainability of universal coverage while enabling a shift of the cost burdens to those better off.

In many ways this is the formula being adopted by Australian governments – a mixed system of regulated health funding programs along with price-competitive markets. The balance appears to be working satisfactorily. However, with the ever-present inflationary pressures and the seemingly insatiable demand from a prosperous community, this balance may skew towards greater market involvement. McDonough's work cautions such an approach. Maybe her US experience overly flavours her view. In fairness, this is more than tempered by her rigorous analysis of Catholic social teaching as applied to health care services.

The Catholic Church considers access to essential health care as being a right. Since ill-health and chronic illness do not respect differentiations in wealth, access to assistance must be based on need, not merely on an individual's capacity to pay. However, the Church also recognises that because resources are scarce those with more need to contribute more.

It is the excesses of the market that need attention. In the real world, a fee-for-service system is acceptable. The issue is one of intention. Charging a fee for a professional service is one thing, but it is quite another to profiteer for the sake of it. The nature of markets leaves open the prospect of self-interested profit making without recourse to the wider ramifications. These days there exists corporate investor strategies designed to maximise return on capital regardless of their impact on other essential services and community need. These are the questionable aspects of market approaches to health care. They rightly should be the preoccupation of public policy makers.

What is pleasing about McDonough's work is the fact that she has resisted the temptation to dismiss the market's contribution to health care. This could have been an easy, but one would suggest intellectually lazy option. She has provided a thought-provoking and contemporary contribution to what is an evolving debate. Her analysis bears serious consideration. Given the mounting pressures on Western democratic health systems, her work will have a long shelf life.