Medicine and the Market: A research Agenda

One of the most important developments in international medicine over the past two decades has been a turn to the market as a way of coping with rising costs and responding to calls for more freedom from government control. A full moral evaluation of the rela-tionship of medicine and the market requires asking a wide range of questions bearing on the meaning and impact of market strategies on the economics of health care and on the clinical and public health outcomes of those strategies. A number of the leading questions are presented and some provisional answers offered. Key words: commodification, international, market, outcomes, regulation. Some months ago I undertook the organization of an international project with the broad title of “medicine and the market. ” It is meant to be an ambitious venture, aiming to put together a coherent global picture of the meaning and impact of market ideology, thinking, and practice on medi-cine and health care. I was warned that it might be wiser to tackle only a part of the full problem, and that was probably good counsel. But my early explorations of the topic revealed any number of piecemeal studies, im-portant and interesting enough in their own right but unclear in their over-all meaning and implications. To pass some sensible judgment on the value of the market for medicine and the delivery of health care in general now requires a more synthetic effort. As with all health policy matters, context, culture, and politics are crucial, and hence the value of specifici-ty. Yet the moment appears ripe to stand back a few steps to see if some broadly valid international conclusions can be reached. The contested na-ture of the topic, the ideological passions coursing through the assorted debates on the subject, and the mixed, often ambiguous results of market thinking and experience, would seem to make such an effort all the more useful