08716nam 2200733Ia 450 991095324210332120251017110102.09786610245857978128024585512802458599780309533836030953383X97805851556780585155674(CKB)111004366655304(OCoLC)70752172(CaPaEBR)ebrary10060488(SSID)ssj0000210386(PQKBManifestationID)11207357(PQKBTitleCode)TC0000210386(PQKBWorkID)10290202(PQKB)11371796(MiAaPQ)EBC3376883(Au-PeEL)EBL3376883(CaPaEBR)ebr10060488(OCoLC)940510202(Perlego)4734856(DNLM)572506(BIP)12806567(EXLCZ)9911100436665530420040924d1983 my 0engurcn|||||||||txtrdacontentcrdamediacrrdacarrierThe new health care for profit doctors and hospitals in a competitive environment /edited by Bradford H. Gray (Institute of Medicine)1st ed.Washington, D.C. National Academy Pressc19831 online resource (viii, 178 pages)Bibliographic Level Mode of Issuance: Monograph9780309078559 0309078555 9780309033770 0309033772 Includes bibliographical references and index.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.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...Health facilities, ProprietaryUnited StatesMedical corporationsUnited StatesHealth facilities, ProprietaryMedical corporations362.1/1/0973Gray Bradford H.1942-1808707Institute of Medicine (U.S.)MiAaPQMiAaPQMiAaPQBOOK9910953242103321The new health care for profit4361914UNINA