The new health care for profit : doctors and hospitals in a competitive environment / edited by Bradford H. Gray (Institute of Medicine).

Format:

Book

Contributor:

Gray, Bradford H., 1942-

Institute of Medicine (U.S.)

Language:

English

Subjects (All):

Health facilities, Proprietary--United States.

Health facilities, Proprietary.

Medical corporations--United States.

Medical corporations.

Physical Description:

1 online resource (viii, 178 pages)

Edition:

1st ed.

Place of Publication:

Washington, D.C. : National Academy Press, c1983.

Language Note:

English

Summary:

This historic book may have numerous typos and missing text. Purchasers can download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1983-04 edition. Excerpt: ...compensated by hospitals are more often found in teaching hospitals than in nonteaching hospitals.20 They also are more common in for-profit hospitals than in voluntary hospitals.21 Systematic longitudinal data are not available, but a general reading of the literature and conversations with hospital administrators and medical staffs suggest that physician involvement in governing board activities, participation in committees, and hospital-based compensation arrangements is growing. For example, over the past five years a number of hospitals have added cost containment committees, medical equipment purchase committees, and strategic long-range planning committees, all with physician participation. Thus, there appears to be a growing trend toward the shared authority model of decision making described earlier or at least deliberate attempts to blur the clear demarcation suggested by the dual authority model. Some of the effects of these changes on the cost and quality of patient care are examined below. Hospital/Physician Decision Making and the Cost and Quality of Care The issue of hospital/physician decision making is important primarily as it affects the delivery of patient care services. The relevant question is whether certain patterns of decision making are associated with improvements in the cost-effectiveness of the care delivered. Present research does not provide a clear-cut answer in terms of cause and effect, but the majority of the existing evidence suggests consistent associations between greater physician involvement in hospital decision making and lower costs. Existing research also suggests consistent associations between greater physician participation and higher quality of care. There is little evidence that costs can be...

Contents:

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

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

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

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

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

Biographical Sketches of Contributors

Index.

Notes:

Bibliographic Level Mode of Issuance: Monograph

Includes bibliographical references and index.

ISBN:

9786610245857

9781280245855

1280245859

9780309533836

030953383X

9780585155678

0585155674

OCLC:

70752172