Healthcare is a network of individuals and organisations.
Each has its own portfolio of objectives.
In these the improved care of patients today or tomorrow may not be uppermost.
Return on effort/investment might be a high priority and that in the shortest possible time.
Commercial companies must satisfy their shareholders first and foremost and while classical economics might suppose that they would best achieve this by satisfying their customers - in this case patients, healthcare professionals, or organisations, the reality is more complex.
Goldacre takes big pharma to task for its manifest failure to hold the welfare of patients as its highest good and attending instead to its perceived best, its duty to its shareholders. In the end by whatever route a commercial company must attend to the needs of the shareholders who are the best organised of the three contributors (shareholders, staff and customers) to the company and can most readily affect performance and effect change.
This is uncomfortable reading for those of us who would wish to see patient welfare as the highest good and accordingly must encourage us to reflect on current models of provision. The private sector may not be the best model
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