Among doctors, the most important principle of care is that it may be better not to do something, or even to do nothing, than to risk causing more harm than good.
Whether the health minister, Astrid Krag (Socialistisk Folkeparti), was inspired by medical ethics or just watching out for her voter approval, she ought to be applauded for seeking to prevent yet another public sector labour dispute last week. Her move to keep both doctors and their employers – the five regional councils responsible for managing the health service – working under their current agreement, even though they can’t agree on a new one, prolongs an untenable situation, but not acting would have been harmful for patients.
What Krag knows – and may even be counting on – is that like the recently ended teacher lockout, the primary victim of the dispute between doctors and regional councils is the public. Stepping in prevents a situation that would result in both reduced levels of care and see patients paying money for the central pillar of the welfare state.
But while Krag deserves praise for stepping in, it is disappointing that doctors reacted by announcing that they will refuse to co-operate entirely with the health service come September. Such a move would make it all but impossible for patients to be reimbursed for fees charged by general practitioners.
We have previously argued for a moderate threshold fee for health services to prevent frivolous appointments or inconsiderate cancellations, but the prospect of being required to pay for a service already paid for by our taxes is both unfair and unsettling.
Essentially private business owners, doctors are well within their rights to check out of the health system, charge prices as they see fit and collect money directly from the patient. It’s also understandable that they would do so given the proposed changes to their contracts, which would give regional councils far greater say in how they operated their practices. Doctors argue that it is the healthcare providers themselves – not the bureaucrats – who know the patients’ needs bests.
Putting the bureaucrats in charge does raise the spectre of turning a universal healthcare system that guarantees coverage, but allows for some measure of free enterprise, into a socialised system commanded by central authorities. Such care could quickly turn into one-size-fits-all approaches based primarily on cost, not on what patients need most.
Doctors are right to have the long-term health of the system in mind (and there’s no faulting them for thinking about their own financial well-being), but they ought first to consider what the effects of their proposed shock therapy would be.
