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All of above, and probably more. In all of these areas, the danger of conflict of interest would arise, but somehow it has always been managed. In fact, medical ownership or control of ancillary services has probably declined, although it is likely the medical owners have usually been happy to be rid of the distraction. Medical malpractice insurance is probably an example of medical owners filling an unfilled need. When competition returned to the field, the owners have generally preferred being rid of the unpleasantness, rather than enjoying distasteful profits.
If to all these associated for-profit corporations, is added the educational loan system for healthcare providers, plus the myriad institutions to house the patients, it starts to become clear the danger of monopoly control is a small one. While there is no doubt local monopolies would arise, and some instances would occur of provider control of them, the industries now making up 18% of a gross national product would greatly dwarf the number of providers. Physicians were paid 20% of the healthcare dollar in 1980, but only 8% today, as an example of how great the field has become dominated by non-professionals. The scientific field has become so huge and so attractive in itself, that comparatively few medical professionals of eminence are interested in business careers. It is true professionals lacking eminence are more attracted to such activities, but the resulting peer pressures strongly favor the few eminent professionals who allow themselves to be involved.
Originally published: Wednesday, June 29, 2016; most-recently modified: Wednesday, May 22, 2019