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The Ethical Neutrality of Prospective Payments: Justice Issues

Published online by Cambridge University Press:  29 July 2009

Jean McDowell
Jean McDowell
Affiliation:
RNFNP, has a Master's in Philosophy and is currently writing her dissertation in the Philosophy Department at Loyola University of Chicago. She teaches and consults in the area of healthcare ethics.
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Extract

The U.S. healthcare system has been subject to unprecedented scrutiny over the past three years; one of the results of this scrutiny has been recognition of the serious problems that exist in both healthcare delivery and reimbursement mechanisms. While the verbal debate in Washington has essentially ceased, within the healthcare community a historic shift has taken place in the way healthcare reimbursement is structured: increasingly, traditional fee-for-service reimbursement methods are being replaced with capitation reimbursement methods. While this phenomenon originated on the West Coast, it has spread to all geographic sectors of the United States in varying degrees and can be expected to dominate the funding patterns of healthcare over the next decade.

Type
Articles
Information
Cambridge Quarterly of Healthcare Ethics , Volume 5 , Issue 4 , Fall 1996 , pp. 570 - 578
Copyright
Copyright © Cambridge University Press 1996

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References

Notes

1. See Pellegrino, E. Ethics. Journal of the American Medical Association 1994;271:1868–70.Google ScholarPubMed

2. Pellegrino, E. Competition: New moral dilemmas for physicians, hospitals. Hospital Progress 1983;64:8,10,22–25.Google Scholar

3. Rodwin, MA. Medicine, Money and Morals. New York: Oxford Press, 1993.Google Scholar

4. Miller, R, Luft, H. Managed care performance since 1980. Journal of the American Medical Association 1994;271:1512–9.CrossRefGoogle ScholarPubMed

5. Sadron, D, Tarlov, A, Rogers, W. Primary care performance in fee-for-service and prepaid healthcare systems. Journal of the American Medical Association 1994;271:1579–86.Google Scholar

6. Wolf, S. Health care reform and the future of physician ethics. Hastings Center Report 1994;24(2):28–41;CrossRefGoogle ScholarPubMedDaniels, N. Why saying no to patients in the United States is so hard: Cost containment, justice and provider autonomy. New England Journal of Medicine 1986;314:1380–3.CrossRefGoogle ScholarPubMed

7. Eisenberg, L. Healthcare: For patients or for profits? American Journal of Psychiatry 1986;143:1015–129.Google ScholarPubMed

8. Okun, A. Equality and Efficiency: The Big Trade-Off. Washington, D.C.: The Brookings Institute, 1973:13. Okun argues that by the identification of certain values that promote economic equality (which he differentiates from sameness), even at the cost of market efficiency, “society refuses to turn itself into a giant vending machine that delivers anything and everything in return for the proper number of coins” (13). It is interesting that in the mid-seventies, when Okun wrote this text, there appears to have been a sense of political optimism about both the need and the political justification for some sort of universal healthcare that seems to be absent in the current debate.Google Scholar

9. Daniels, N. Am I My Parent's Keeper? An Essay on Justice Between the Young and the Old. New York: Oxford University Press, 1988:145–6.Google Scholar

10. Pellegrino, E, Thomasma, D. The Physician as gatekeeper. In: Mappes, T, Zembaty, J, Eds. Biomedical Ethics, 3rd ed.New York: McGraw-Hill, 1991:122–8.Google ScholarPubMed

11. See note 10. Pellegrino, , Thomasma, 1991:123.Google Scholar

12. I do not address the issue of physician incentives for ‘efficient care’ since that poses obvious and, seemingly unavoidable, conflict of interest issues. While important to the discussion, that issue is best taken up within the context of the implications of prospective payment funding for the physician-patient relationship.

13. Callahan, D. What Kind of Life. New York: Simon and Schuster, 1990.Google Scholar

14. A hospital administrator echoed this when he commented that “the room rate is meaningless because no one pays the entire rate anyway. It really doesn't matter what we set our rates at, the insurer is only going to pay a set portion of that rate and neither Medicare nor Medicaid is going to pay the whole bill anyway.”

15. Gauthier, D. Morals By Agreement. New York: Oxford University Press, 1988:113. The justice requirement in the cooperative interaction constrains the utility maximizing actions of the members.Google Scholar

16. See note 15. Gauthier, 1988:113.Google Scholar

17. See note 15. Gauthier, 1988:118.Google Scholar