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2019, Journal of Hospital Ethics
Medical billing has become so intertwined with patient care, that in order to be truly committed to the physician's telos of managing a patient's medical suffering, it is imperative that physician ought to reexamine many of the ethical considerations about billing.
Medical ethics has become an important and recognized component of physician training. There is one area, however, in which medical students receive very little guidance. At most universities, the medical school curriculum contains no discussion of the financial side of medical practice at all. Specifically, students are given no guidance when it comes to thinking about how their professional obligations as doctors should govern their behaviour when charging for their services. My objective in this paper is to initiate a discussion about the moral dimension of physician billing practices. What I would like to suggest is that physicians should expand their conception of professional responsibility, in order to recognize that their moral obligations toward patients include a commitment to honest and forthright billing practices. I will argue that, as individuals, physicians should aspire to a standard of clinical accuracy – not legal adequacy – in describing their activities. More generally, physicians should think of themselves as exercising stewardship over health care resources. As a group, they should strive to promote an integrity-based culture, first and foremost by stigmatizing rather than celebrating creative billing practices, as well as condemning the misguided sense of solidarity that currently makes it taboo for physicians to criticize each other on this score. Beyond this, I will end with a set of modest proposals for institutional reform, all aimed at reinforcing an integrity-based approach to billing.
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 2011
Whether it is ethically acceptable for doctors to require payment of fees before treatment depends on interpretation of the ethical rules of the profession, the circumstances of the doctor-patient relationship, the urgency of the patient's need for treatment, and whether refusal to treat before payment represents abandonment of a patient.
Journal of Medicine and Philosophy, 2005
The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine
This paper proposes that billing gamesmanship occurs when physicians free-ride on the billing practices of other physicians. Gamesmanship is non-universalizable and does not exercise a competitive advantage; consequently, it distorts prices and allocates resources inefficiently. This explains why gamesmanship is wrong. This explanation differs from the recent proposal of Heath (2020. Ethical issues in physician billing under fee-for-service plans. J. Med. Philos. 45(1):86–104) that gamesmanship is wrong because of specific features of health care and of health insurance. These features are aggravating factors but do not explain gamesmanship’s primary wrong-making feature, which is to cause diffuse harm not traceable to any particular patient or insurer. This conclusion has important consequences for how medical schools and professional organizations encourage integrity in billing. To avoid free-riding, physicians should ask themselves, “could all physicians bill this way?” and if no...
The Journal of bone and joint surgery. American volume, 2016
The United States health-care expenditure is rising precipitously. The Congressional Budget Office has estimated that, in 2025, at our current rate of increased spending, 25% of the gross domestic product will be allocated to health care. Our per-capita spending on health care also far exceeds that of any other industrialized country. Health-care costs must be addressed if our country is to remain competitive in the global marketplace and to maintain its financial solvency. If unchecked, the uncontrolled rise in health-care expenditures will not only affect our capacity to provide our patients with high-quality care but also threaten the ability of our nation to compete economically on the global stage. This is not hyperbole but fiscal reality.As physicians, we are becoming increasingly familiar with the economics impacting health-care policy. Thus, we are in a unique position to control the cost of health care. This includes an increased reliance on creating and adhering to evidenc...
The Medical Journal of Australia, 2002
RAPID AND RADICAL CHANGE in almost every facet of society has brought in its wake community anxiety, suspicion and hostility. Current examples in Australia include the impact of globalisation, the introduction of the goods and services tax, and the actions of the banks in phasing out local branches. Even the health industry faces increased levels of public scrutiny and criticism. A recent example has been the agedcare institutions, charged with providing suboptimal facilities and services. 1 Hospitals, too, both in the private and public sector, have received embarrassing media attention -the organ-harvesting scandal in the United Kingdom being but one example. 2 Surprisingly, while such public pressure has resulted in many large companies formulating corporate codes of ethics, few hospitals, with the exception of some with religious affiliations, have adopted such codes. This may be due in part to many hospital staff having their own professional codes of ethical behaviour. However, a hospital is more than the sum of its professional staff, and decision-making at a corporate level raises ethical issues. For example, ethical issues need to be taken into account in the allocation of scarce financial resources and the sometimes fierce interdepartmental battles for funding. The size of many hospital budgets brings them into the ambit of "big business" and, as such, boards must be sensitive to the bottom line of financial accountability. Currently, there is increasing pressure on all businesses, large and small, to establish their activities on a sustainable basis, incorporating "triple-bottom-line" accountability -decision-making must take into account not only financial outcomes but also human rights and the impact on the environment. Only when all these issues are addressed, it is argued, can legitimate and responsible decisions be made. The question might be asked, why bother with a code of ethics when hospitals are governed by highly prescriptive laws and regulations covering just about every aspect of their activities -from occupational health and safety to environmental protection to paternity leave -and where the threat of litigation hangs heavily over the system? The simple answer is that, to maintain and develop a reputation with
DePaul journal of health care law, 2005
DEPAUL JOURNAL OF HEALTH CARE LAW and they collected data that, at least partially, supported this assertion. 9 These critics starkly challenged physicians' ethics, claiming that medical ethics were largely a cynical ploy to profit from monopoly power in the market.' While some of these sociologists, most notably Friedson, subsequently asserted the value of medical professionalism, such as self-regulation and the norms created through codes of ethics, 11 their fundamental criticism remains powerful, widely held, and underlies landmark legal actions against physicians under antitrust statutes. 12 But, the criticism that medical professionals are not civicminded did not arise in a vacuum. As medicine perceived the possibility of government interventions in medical care in 1912, medical ethics increasingly stressed professional autonomy and deemphasized social obligations.1 3 This trend was strengthened by events during World War II, as well-known horrors became strongly associated with physicians acting as agents of the state.' 4 Add to this an underlying American predilection towards individual rights and it is not surprising that, by 1955, the AMA's Code proclaimed that it was ethically imperative that a "physician... be free to choose whom to serve and the environment in which to practice."' 15 Indeed, many medical ethicists urged physicians to completely ignore civic considerations and consider only the welfare of the individual patient before them. In 1984, Norman Levinsky wrote, "...physicians are required to do everything that they believe may benefit each patient, 9 See generally PAUL STARR, THE SOCIAL TRANSFORMATION OF AMERICAN MEDICINE (Basic Books 1982) (documenting this assertion regarding altruism was a broad theme of the book). 'old.
Nursing Research, 2006
2007
The proceedings began with Anant Phadke providing an overview of the various leading issues in medical ethics. He delineated seven broad issues that could be taken up for discussion in the next two days. These included areas such as doctors ethical responsibilities towards patients towards fellow doctors, to the society in general; ethical code to be followed by health researchers; ethical code for drug companies; issues in health education; and health policy making.
Public Health , 2012
Ethics in healthcare practice has become a growing public health concern. Ethics in any discipline are guidelines to prevent abuse or misuse of power wielded by a person or group in the practise of that profession. The code of Medical Ethics provides a suitable framework defining the doctor-patient relationship in professional, social and legal contexts .The Hippocratic oath is taken by doctors being sworn into the profession, signifying responsibility to society as well as constituted authority of the medical profession. Ethical issues in Medicine include patient's autonomy, informed consent, beneficence, non-maleficence, distributive justice, and confidentiality. As professions mature and become established, they begin to create an ethical environment of shared expectations and norms for acceptable and appropriate behaviour in the practise of its duties and obligations.
Case Western Reserve law review
Economic pressures are constantly changing the delivery of and access to health care in America. In examining changes in physician payment mechanisms and effects of business-orientation organization of the health care system, and in evaluating those effects along the ethical dimensions of fidelity, fairness, and access, Professor Capron concludes that the changes and effects must bejustified ethically, not simply as the results of marketplace forces.
The Journal of Bioethics, 1984
The Hippocratic orientation to medicine has been smothered by the weight of endless attacks from a variety of perspectives. In the moral sphere many have argued that on this model the physician becomes the benefactor of health to the beneficiary patient by unjustly violating the patient's rights. Since medical decisions invariably rest on a selection and prioritization of values, the patient should actively participate in the decision process. In place of this priestly model, Robert Veatch defends a contractual model which intends to protect the rights of both patient and physician. I The purpose of this paper is to critically examine the contractual model. Although a significant improvement over earlier models, the contractual model should be dismissed in favor of what I call the counseling-sanctioning model of the patient-physician relationship. A case is summarized immediately below. I critically examine the contractual model in Section I. The alternative model is suggested in Section II followed by a discussion of the case.
Journal of Clinical and Diagnostic Research
Traditional health systems, with patients as passive recipients of care, have proven unsuccessful in stemming the most irresistible and exponential growth of the epidemic we now face. There is considerable healing power in a good Physician-patient relationship. In the field of healthcare, patient empowerment has been acknowledged as an alternative to compliance in order to guide the provider-patient relationship. It will help patients' confusion, fear and doubt slowly transform into clarity, relief and assurance. With the positive role of physicians, patients will definitely be relieved of hopelessness, have higher satisfaction, better adherence and improved health. There is no doubt that this small gesture by physicians will be a precious gift to humanity.
Online Journal of Health Ethics, 2008
The purpose of this analysis is to examine specific segments of healthcare policy and practice, applying various ethical perspectives. We examine the economic and political influences that surround ethical behavior in health services, as well as how practitioners, patients, and families respond and act as a result of such influences. We then delve into the fundamental principles that guide ethical behavior by medical practitioners, including the Hippocratic Oath and vows of medical professionalism. Further, we analyze disparities in healthcare provisions based on gender, race, and ethnicity. Ethical theory is weaved into each of these sections, as the philosophical and ethical writings of prominent scholars illuminate how the conditions of contemporary healthcare administration are affected by the injustices and political influences that pervade the entire health services industry.
Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria
Ethical problems routinely arise in the hospital and outpatient practice settings and times of dilemma do occur such that practitioners and patients are at cross-roads where choice and decision making become difficult in terms of ethics. This paper attempts a synopsis of the basic principles of medical ethics, identifies some ethical dilemmas that doctors often encounter and discusses some strategies to address them as well as emphasizes the need for enhanced ethics education both for physicians and patients particularly in Nigeria. Literature and computer programmes (Medline and PsychoInfo databases) were searched for relevant information. The search showed that the fundamental principles suggested by ethicists to assist doctors to evaluate the ethics of a situation while making a decision include respect for autonomy, beneficence, non-maleficence and justice. Although the above principles do not give answers as to how to handle a particular situation, they serve as a guide to doct...
2nd International Conference Global Ethics - Key of Sustainability (GEKoS), 2021
The aim of the paper is to understand in depth the notion of medical ethics and how it can be applied by medical and auxiliary staff in daily work, whether we are considering a private health unit or a public unit with the same object of activity. The importance of the subject, in the authors' view, although it is always current, comes especially in the context of the need to improve the health of an increasing number of people affected by the SARS Cov2 pandemic, people who use health services.
Bioethics, 2002
Patients have not been entirely ignored in medical ethics. There has been a shift from the general presumption that`doctor knows best' to a heightened respect for patient autonomy. Medical ethics remains one-sided, however. It tends (incorrectly) to interpret patient autonomy as mere participation in decisions, rather than a willingness to take the consequences. In this respect, medical ethics remains largely paternalistic, requiring doctors to protect patients from the consequences of their decisions. This is reflected in a one-sided account of duties in medical ethics. Duties fall mainly on doctors and only exceptionally on patients. Medical ethics may exempt patients from obligations because they are the weaker or more vulnerable party in the doctor-patient relationship. We argue that vulnerability does not exclude obligation. We also look at others ways in which patient responsibilities flow from general ethics: for instance, from responsibilities to others and to the self, from duties of citizens, and from the responsibilities of those who solicit advice. Finally, we argue that certain duties of patients counterbalance an otherwise unfair captivity of doctors as helpers.
Teaching Business Ethics, 1998
The purpose of this paper is to present a teaching tool that can be used in a variety of courses to examine ethical issues that have emerged in the turbulent health services environment of the United States. More specifically, we describe a structured discussion on the collision between traditional medicine and business practice. We examine six ethical dilemmas and frame them according to the major stakeholders in each situation. We describe these dilemmas in the form of double binds, unattainable situations, conflicts of interest, and countervailing incentives existing between the stakeholders. We analyze the roles that various players have in maintaining the integrity and ethical foundations of health care in the United States. Finally, in light of the increasing industrialization of medicine, we use evidence from the business ethics literature to provide an additional perspective on these relevant health care issues.
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