One of the keys to reversing the health disorder and getting out of the chaotic labyrinth that hides the network of corporate interests and businesses would be to change the focus.
Instead of limiting ourselves to outlining the obstacles, we should go on to notice the powers that reside even in the problematic aspects.
Because it will not be by avoiding the conflict that we will be able to overcome the crisis, but by going through it with the tools we have available, although sometimes a little rusty, or we have to readjust them.
What do we have?
With a digital revolution and data science that take a leap forward compared to computing twenty years ago, with permanent advances in science and technology, which must, for this reason, be monitored;
with new forms of economic functioning, called “platformization” or platform economy.
The term refers to a new network association of companies and clients where they go from being simple consumers to being part of the production process.
Translated to the health area, it would be, for example, giving the place it deserves to patients' medical records.
That is, a possibility of transformation that seeks to harmonize and associate parts in a collaborative manner to obtain a product that provides a plus instead of a suboptimal one.
Let's look at an example.
A new drug for advanced cases of a type of lung cancer arrived in the country:
amivantamab
, a monoclonal antibody, which prolongs the life of patients in an advanced stage of the disease.
But the specificity of each patient must be found to evaluate their suitability, and to do so we need a detailed survey that we do not have: genetic testing, which requires a DNA sequencing study.
There is a proposal for the same laboratories that produce these drugs to finance the molecular studies that would show which patients this drug would provide up to five years of survival.
That is, a platform economy at the service of a public health policy concerned with inequities in transversal and intersectoral access to therapeutic advances, where private parties can also do legitimate business.
The opposite of abandoning each sector on its own, in an illusory and misunderstood liberalism that assumes that the social optimum is based on the convergence of selfish agents.
The national government decreed that the Superintendency of Health Services (SSS) withdraw from its role as intermediary between public hospitals and social works regarding the collection of benefits.
Let each effector earn as much as they can.
Any inefficiencies that exist should be corrected, but in no way obliterate the role of monitor and guarantor of intersectoral collection that, in addition to the purely monetary, functions as a way of making the medical services provided transparent.
What is sometimes called “shadow invoice”: billing the details of what was done (and providing it to the patient even if he or she does not pay), thus leaving a record so that what was actually done is charged, no more and no less;
and at the same time it serves as the first step of the medical audit.
In short, the essential health reorganization must integrate (but not merge) its parts, seeking operational mechanisms that adapt to the challenge of directing an operation that enhances not their immediate interests, but the final objective: health.
In other words, move from the vicious circle to a virtuous spiral that lifts us above the labyrinth.
Ignacio Katz is a Doctor of Medicine (UBA)