Saturday 19 November 2022

Medical cartels

The Medical Board of Australia has proposed new guidelines under which anyone going for cosmetic surgery, including face lifts, nose jobs, liposuction and breast augmentation, would need a GP's referral. 

Australian Doctor expects (HT Dylan Mordaunt) this could involve up to 100,000 GP consultations per year. 

All patients going for cosmetic surgery would require a GP referral under proposed new guidelines from the Medical Board of Australia, which aim to protect patients from aggressive marketing tactics.

The board has gone a step further than its independent cosmetic surgery review — which merely noted that GPs were often out of the loop — by suggesting patients “must have” a GP referral before undergoing major cosmetic procedures.

These included procedures that “involve cutting beneath the skin”, such as rhinoplasty, surgical face lifts, liposuction and breast augmentation, its consultation paper published on Monday states.

“The referring GP must work independently of the medical practitioner who will perform the procedure and must not perform cosmetic procedures themselves,” it adds.

And at least two consultations would be required before surgery. 

They claim it's to protect patients from aggressive marketing - like pictures of people with perfect bodies or unrealistic before/after shots. 

I expect that Australian consumer law has the same kinds of restrictions against false advertising that are prevalent elsewhere and that cosmetic surgery would be under the same restrictions as other services. 

The simplest explanation is the standard bootleggers-and-Baptists drill that operates in medicine. The public interest rationale is just veneer over top of measures that restrain competition. 

Mandatory superfluous consultations pre-surgery prevents anyone from chiselling on cartel arrangements by offering speedy services. 

GP referrals can block new entrants or force new entrants to go and work for an established practice, if the GP's recommending where to go for the surgery. 

And the GPs, and everyone associated with them, will convince themselves that it's all part of protecting patients.

I really hope that NZ's Commerce Commission will run a market study on medical services, focusing in on whether Medical Council rules unduly restrict entry. It's a tough problem. Government hasn't the knowledge to set the rules in a complex, changing, high-stakes area. It has to rely on experts to tell it what the standards have to be. But delegating standard-setting to a body whose members have a financial interest in restricting entry and restraining competition is also risky.

Cartel-stuff isn't everything going on in this. But it's certainly consistent with some of it. 

If the doctor's cartel were solely acting to maintain standards, rather than to maintain standards and restrict competition, wouldn't doctors from Canada or the US in good standing with their own professional bodies, and not under investigation for malpractice or misconduct, be able to just set up shop here after some short course outlining how systems here work and to reminding them that some parts of NZ are more developing-country than developed?

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