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.