The New Health Care for Profit

Doctors and Hospitals in a Competitive Environment

Auteur: Gray, Bradford H.
Éditeur: National Academies Press
ISBN: 9780309078559
eISBN Pdf: 9780309533836
Lieu de publication: United States
Année de publication électronique: 1983
Mois : Janvier
Pages: 187
Langue: Anglais

The New Health Care for Profit
Copyright
Preface
Contents
An Introduction to the New Health Care for Profit
- THE CHANGING HEALTH CARE ENVIRONMENT
- PROFESSIONAL AUTONOMY, TRUST, AND HEALTH POLICY
- IMPLICATIONS OF THE CURRENT CHANGES IN FOR-PROFIT HEALTH CARE
- THE INSTITUTE OF MEDICINE PROJECT
- CONCLUSION
- REFERENCES AND NOTES
Legal Differences Between Investor-Owned and Nonprofit Health Care Institutions
- ORGANIZATIONAL DIFFERENCES
  - Investor-Owned Hospitals
  - Nonprofit Hospitals
- FINANCIAL DIFFERENCES
  - Tax Exemptions
  - Reimbursement Factors
  - Sources of Capital
  - Restrictions On Transfers of Property
- OTHER LEGAL DIFFERENCES
- CONCLUSION
- REFERENCES AND NOTES
Wall Street and the For-Profit Hospital Management Companies
- ANALYSTS' SOURCES OF INFORMATION
- FINANCIAL ANALYSES OF COMPANIES
- THE IMPORTANCE OF STOCK PRICES TO THE COMPANIES
- REASONS FOR SUCCESS OF THE HOSPITAL MANAGEMENT COMPANIES
- DIFFERENCES AMONG COMPANIES
- ACQUISITIONS
- MAKING HOSPITALS HEALTHIER
- OUTLOOK FOR THE FUTURE
- REFERENCES AND NOTES
When Investor-Owned Corporations Buy Hospitals: Some Issues and Concerns
- THE FIVE CASES
  - County Hospital A
  - County Hospital B
  - Doctors Hospital
  - Osteopathic Hospital
  - Suburban County Hospital
- MAJOR ISSUES
  - Control
  - Job Security and Benefits
  - Plant and Equipment
  - Charges for Care
  - Quality of Care
  - Admission Policies
  - Buy-Back Provision
- THE PROCESS
- CONCLUSIONS
- Appendix Principal Interviews Conducted for This Paper
Physician Involvement in Hospital Decision Making
- A TYPOLOGY OF HOSPITAL DECISION MAKING
- CONVERGENCE VERSUS DIVERGENCE OF INTERESTS
- THE DECISION MAKERS
  - The Dual Authority Model
  - The Shared Authority Model
- STRAIN AMONG DECISION MAKERS AND BETWEEN THE TWO MODELS
- TYPES OF PHYSICIAN DECISION-MAKING INVOLVEMENT
- HOSPITAL/PHYSICIAN DECISION MAKING AND THE COST AND QUALITY OF CARE
  - Evidence Regarding Costs
  - Evidence Regarding Quality
  - Evidence Regarding Possible Trade-Offs Between Cost and Quality
- FUTURE ISSUES
  - The Changing Context of Clinical Decision Making
  - The Changing Context of Institutional Decision Making
  - The Demise of the Voluntary Medical Staff
  - Factors Promoting or Impeding Shared Decision-Making Models
- SUMMARY
- REFERENCES AND NOTES
Economic Incentives and Clinical Decisions
- MODELS OF CLINICAL DECISION MAKING
- INCENTIVES FROM THE PERSPECTIVE OF THE PHYSICIAN AND THE ECONOMIST
  - Incentives and the Use of Technology
  - Payment and Practice Setting Incentives
  - Individual versus Collective Patterns of Practice
- SUMMARY AND CONCLUSIONS
- REFERENCES
Ethical Dilemmas of For-Profit Enterprise in Health Care
- HISTORY OF THE ETHICS CONTROVERSY
  - The International Context
  - The American Medical Association
    - Advertising
    - Patents
    - Dispensing Pharmaceuticals and Receiving Rebates
    - Fee Splitting
    - Ownership of Health Facilities and Corporate Relations
- A SUMMARY OF THE PROFESSIONAL PHYSICIAN STANCE
  - Basic Principles of the Professional Stance
    - Service to the Patient
    - Physician Control of Decision Making and Fees
    - Acceptance of Profit Motive
    - Suspicion of Commercialization
  - An Interpretation of the Professional Stance
- PHYSICIANS COMPARED WITH OTHER PROFESSIONALS
- A PHILOSOPHICAL EVALUATION OF THE PROBLEM
  - Problems with Evaluations Based on Professional Codes
  - Basic Philosophical Themes
    - Business Ethics and Physician Ethics: The Role of Altruism
    - Deontological versus Consequentialist Ethics
    - Health Care as a Commodity
    - The Double Agent Problem
  - Differences Between Business and Physician Ethics
    - Lying and Deception
    - Competitor's Use of Outdated Information
    - Enticement of Customers into Needless Consumption
    - Exclusion of Inefficient Customers
    - The Duty to the Indigent
    - Supplying Unprofitable Products and Services
    - Differing Concepts of Self-Regulation
- CONCLUSION
- REFERENCES AND NOTES
Secondary Income From Recommended Treatment: Should Fiduciary Principles Constrain Physician Behavior?
- THE PHYSICIAN-PATIENT CONFLICT OF INTEREST PROBLEM
- BACKGROUND OF FIDUCIARY LAW
- FIDUCIARY THEORY IN MEDICAL LITIGATION
  - Physician As Guardian of Patient Property
    - Kickback Cases
    - Reimbursement Cases
    - Girl and Contract Cases
  - Physician As Advisor
    - Confidentiality Cases
    - Statute of Limitations Cases
    - Informed Consent Cases
  - Physician as Agent
- CONCLUSION
- REFERENCES AND NOTES
Biographical Sketches of Contributors
Index