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Are the ethics of healthcare compatable with the ethics of business?

Healthcare providers need to be profitable to serve patients. But, the interests of the patient are primary over the interest of profits. Are the two co-exist?
Is physician entrepreneurship a contradiction in terms?

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    Jan 22 2014: i'm not aware of different ethics for different fields. i think ethics is ethics, let it be business, healthcare, friendship, father and son relationship, whatever.
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      Jan 22 2014: Would be the way to practice some peace in our mad society. We think in the same direction, Kriszian.

      Thank you :)

      However, people still need to agree upon some basic ethics that would be workable….
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        Jan 22 2014: surely in some cases, but we also don't have to in other cases. we need to agree on how to use a river, many people affected. we don't have to agree on what i eat, it is my decision.

        but certainly, it is time for us to discuss what is ethical. and to get to somewhere, i suggest dropping such silly notions that "business ethics vs healthcare ethics". we need to focus on the individual. deciding questions like "what level of inflation is the best" is next to impossible to do. we always have to go down to the individual, and judge actions. if an action, in itself, is ethical, or acceptable, we should not condemn it because it goes against some high level principles. if principles disallow otherwise commonsensically ethical behavior, the principle is defective, and should be discarded. we are bad at judging principles. we are good at judging individual actions. (okay, maybe not good, but better.)

        i kinda like this talk: http://new.ted.com/talks/barry_schwartz_using_our_practical_wisdom
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          Jan 23 2014: You've said it - "we need to focus on the individual."

          It's a very forgotten approach/thinking - in our "robotic" society of industrial games. I just published my long post. Please read it and let me know what you think, if you have a few minutes.
  • Jan 22 2014: Do patients have any ethical responsibility to optimize scarce healthcare resources in any of this? Or, are they just lemmings being led to slaughter by greedy capitalists and physician entrepreneurs who take advantage of unknowing prey?
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      Feb 4 2014: Hi Dr. Meyers,

      Thank you for your insightful, timely, and highly relevant questions. These are the questions I'm asking myself as a patient or consumer of healthcare. Most of the time, I feel just like a lemming as you mentioned.

      What can we do about this?
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      Feb 9 2014: Arlen, We are talking about a salad which is comprised of apples and oranges. First the apples: The Hippocratic Oath binds the doctor to provide care to the best of his ability swearing to medical honesty. The oranges: The cost of doing business. The realities are that medical practice is very expensive ... in terms of education, facilities, equipment, personnel, insurance, and all of the other "costs".

      So as the salad cannot be made with out each of the two ingredients nor can the physician serve his patients without the necessities of "doing business".

      Laws passed that says a hospital must treat all who request services have cost the medical profession dearly. As the federal government has refused to protect our boarders the illegals have found that they can go to emergency rooms and get treatment with no means or cares about payment ... this means that there are approximately 11 million who can get "free" care. The private practice also has dead files that must be absorbed ... insurance companies deny claims or seriously reduce the payment for treatment ... Now there is Obamacare which has the force of law to question and deny medical opinions. Oops, I forgot it is a TAX that can question medical opinion. ACA can also set payment limits which would further reduce the income of the doctor. All of this to obtain a goal that both Hillary and Obama proclaimed ... sole source providers. Socialism in action. Worked so well in all of the other third world countries why not do it here .... As Nancy Polosi stated ... First lets pass it and then examine it .... That happened and in the light of day the problems are glaring and damning.

      I looked up ethics: ethics, also called moral philosophy, the discipline concerned with what is morally good and bad, right and wrong. ... A person is either ethical or not .... by having two professions or ten the answer remains the same ... good or bad .. right or wrong.

      I wish you well.
      • Feb 9 2014: Illegal immigrants represent about 2 % of ER visits
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          Feb 9 2014: I just did a quick search and cannot find anything which substantiates your statement that 2% of ER visits are illegal immigrants Arlen. Could you please provide a link to where you got that information? Thanks
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          Feb 9 2014: Out of the 2000 characters I wrote you only heard about illegal immigrates ....

          Sorry to have wasted your time .... Bob.
      • Feb 9 2014: We should be celebrating physician entrepreneurship. I don't mean price gouging or ripping off patients. I mean adding patient defined value through the deployment of innovation.

        We need to eliminate the unintended barriers and give patients the tools they need to be better patient customers...transparent outcomes and prices, an incentive to spend carefully, better ways to partner and communicate with care teams, etc.

        Medicine is no lonter a doctor taking care of a patient. It's a care team taking care of a patient's team or community.
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          Feb 9 2014: I wholeheartedly agree Arlen, that the practice of medicine can be a "team" endeavor. I consider the medical professionals involved with my health care as a team, and I am the captain of the team.

          In order to be on a team, we each have to do our part. We can "give patients the tools they need....", and if a person does not know how to use those tools, they are the same as they are without the tools. In order to communicate with care teams, a person needs to have information about their own body/mind functions, and that seems like something some folks don't want to explore.
  • Jan 18 2014: We've had the experience of choosing between not-for-profit (which I believe is total BS) and non-profit hospice care for a family member. There is a myth that capitalism improves everything. We saw how the not-for-profit sparingly doled out services. For what? Presumably to preserve the salaries of the providers not to preserve resources for the community. If we can, we'll choose a non-profit hospice every time. To me, there is something immoral about profiting from dying. (PS - I believe the same for funerals so I am glad my family member chose cremation.) To me, the problem lies with sustainability. The high salaries of hospital administrators, health care insurance administrators, equipment manufacturers, etc. cannot be sustained. There is no real competition. Its more like a cartel between providers.
  • Feb 7 2014: Ethics is a wrong concept in healthcare. If we have to spend million dollar to save a baby that will need life time of care? What will be ethical choice? To let baby die?

    We need to set a parameter on what society can afford and what individual can afford. Business is there to bring innovation and efficiency to the table and then have clarity on their operation and charges. If they are unfair they will go our of business. It will be value judgment call on the part of society.

    Society need to be trained so that at some point "NO" is acceptable even if it means death. There are competing choices on efficient spending of resources
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      Feb 7 2014: This has already been addressed by the 4 pillars of ethics: autonomy; beneficence; non-maleficence; and social justice.
      Justice is the pillar that ensures the extent to which resources are utilised are in keeping with the ability of society to sustainably and easily repeat the exercise without burdening the system on the whole. The scenario you describe is only possible in a private healthcare system where individual resources of parents can 'command' the system to unethical depths.
      • Feb 7 2014: Sumesh:

        Thank you.
        My impression is that it happens with Government support at child birth and end of the life in Medicare all the time. I am not sure what will happen in Obama care. Issue is unresolved. 20 % of hospitalization consumes 80 % of resources. Society has not resolved when death is acceptable.May be I am wrong.
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          Feb 7 2014: I'm not sure where you get the 20% 80% relationship from, but I don't agree with it.
          Medicine has resolved when death is acceptable. The details are available if you search for EOL care and protocols (end of life care). Futility is a specific and defined term and specific criteria must be met.
          The field of medicine is quite clear on many issues that society claims it needs clarity on.
          Sadly it is commerce that comes in and creates confusion by inciting greed and inequality.
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    Feb 3 2014: "The etymology of 'business' stems from the state of being busy, and implies commercially viable and profitable work." Wikipedia

    Heathcare is one form of business. In fact, it is one of the most profitable businesses. People who work for clinics and hospitals, i.e. healthcare admininstrators, doctors, nurses, and medical technicians are some of the best compensated workers and their positions are some of the most stable. People get sick and need healthcare all the time. Healthcare business is not seasonal, unlike some other types of businesses.

    Ethics, good business practices, and good customer service are expected regardless of the type of service or business. These are even more critical in the business of healthcare, where some cases are a matter of life and death.

    Good medicine and good business practices are compatible. To succeed in healthcare business, one has to practice good medicine and good customer service, including not gouging your patients just because you can.

    MD and MBA should not be contradiction in terms.
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      Feb 6 2014: And how do you achieve that when the human is a biological creature driven not only by compassion and altruism but also by instinctive physical desires, emotion, lust, anger, greed etc.
      Sadly we will never be rid of these qualities and they will always invade the 'busy' venues we interact in.
      This is alright when life is upheld, but when you could lose your life, or suffer interminably then I refuse to accept your syllogistic simplification of medicine. Medicine was a field DEVELOPED by compassionate and altruistic minds to actively perform the duty of helping our fellow humans without discriminating between economic classes.
      It Transcends all other form of commercial activity to allow itself the stature of being business that is not the slave of commerce.
      It is ok for a trader to refuse you processed food since it is possible for you to grow your own. Therefore payment for staple food may be contentiously regarded as acceptable. But if you are in severe pain, or you have been knocked by a bus and cannot breathe, then to insist on payment first is beyond inhuman.
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      Feb 7 2014: I agree Rodrigo, that health care is a business, and like all businesses, it depends on how it is managed. So I agree that good medicine and good business practices are compatible

      You say...
      "Ethics, good business practices, and good customer service are expected regardless of the type of service or business. These are even more critical in the business of healthcare, where some cases are a matter of life and death."

      If the business part of health care is not managed well, it often contributes to compromising the health of the customer. If the "managers" of health care are simply looking at the bottom line and profit, they may not be aware that the profits may be at the cost of the care they are providing.

      We had a good example of this locally years ago with the big teaching medical facility in the area. It was once on the top ten in the country for good care. The board of directors were apparently looking primarily at the bottom line profit. They decided to redecorate the lobby, at the cost of a couple million dollars, and at the same time, they were decreasing the nursing staff by about 300 nurses. A lot of people, including myself were appalled at this, and it certainly was not the only poor decision the directors made, but it was a very public one.

      I had a relative and friends who were patients in the facility at the time, and it was VERY clear that there was a shortage of nurses, as the construction for the new lobby was happening. As I said, there were a lot of other very poor decisions, and finally, there was so much public outcry, most of the members of the board of directors were terminated. There was a legal matter with the chair of the board as well, regarding money he accepted from contractors.

      On the other side, my doctor and her husband have a small practice in a small town and don't make a lot of money, while providing health care to a small community. I would say that an organization like doctors without borders is in this category as well.
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        Feb 7 2014: Thanks for your insightful testimony, Colleen. We need a peaceful revolution or, at least, constructive evolution in healthcare, education, and public administration.
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    Jan 24 2014: Business and healthcare have compatible ethics only to the extent that there exists a positive correlation between healthy workers and profitable businesses.
  • Feb 17 2014: i disagree with the first sentence: healthcare providers do not need to be profitable to serve patients. They only need to make payroll and cover expenses.
    Medical care should not be a profit focused activity. It is unethical to make a profit off of sick and dying people. People who do this are vultures not doctors.

    It seems to me the biggest problem is that insurance creates huge pools of money which allows healthcare providers to charge extremely high prices. Prices are completely out of control.
    The only solution is to eliminate the huge pool of money, i.e. get rid of insurance plans and go to cash based payments only. That would limit usage and lower prices.

    However under the new ACA more people are required to have it.
    This will cause prices increase since more money will be available.

    I'm in favor of private physician practice and for eliminating the AMA which controls the number of physicians thus keeping salaries extremely high.

    One problem in the U.S. is the wolves are in charge of guarding the sheep.
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    Feb 9 2014: Thanks:

    1. All professional people were on time for you!
    2. sharing your Story.
    3. It is very nice to meet you at the TED conversation”.

    Best Wishes for You, every day that will be peaceful and content. Colleen.
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      Feb 9 2014: Thank you very much Lamb Lamb......I appreciate you and wish you every day peace and contentment:>)
  • Feb 9 2014: Until the medical and health professions (and any parasitic "hangers-on" including politicians and regulators) have a profitable incentive to provide wellness and disease prevention services, they will keep on being motivated to have the patient return for more sales. Where is the incentive to teach "self-responsibility" to keep the patient away from the doctor?

    Business schools teach that an existing customer is more profitable than finding a new one. So in the sickness industry (not health), it is better to have a sick customer remain a sick customer and return for regular checkups and prescriptions. There is no incentive for anyone who makes a living from the diseased and sick to do themselves out of a job. The system that bows to the power of the big players is the reason why the medical system itself is now the largest killer, and the various "wars" (eg "war against cancer") will continue to be a farce. The World Economic Forum in 2011 stated that most western health systems will be bankrupt by 2030. They also stated that most non-communicable diseases are lifestyle related (nutrition, exercise, etc).

    Until there is a change of consciousness and a leveling of the playing field so that we start to focus on lifestyle wellness factors (including funding scientific research into these areas), the problem will continue to grow. You do not need to go back far in history to find examples of how some people kept healthy without pharmaceutical or medical interventions. Our biological systems genetically evolved from hunter-gatherers. They have not had time to adapt to the onslaught of toxins from excess consumption, modern food systems, industrial chemicals and pharmaceutical drugs.

    There are some parts of the world where natural plant medicines and alternative practices exist and are used in parallel with modern medicine (eg plant medicines from the Amazon, dry fasting in Russia, nutrition).
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      Feb 9 2014: Good points John....."self-responsibility"! I agree that there is not much incentive to learn better ways of taking care of ourselves, when drugs are readily available to "fix" our discomfort!

      I agree that a change of consciousness is needed with individuals and health care providers, and the challenge seems to be to encourage folks to be aware of the mind/body connections, how they work, and how we can keep ourselves more healthy. I strongly agree with you that it is good practice to use all available resources, and that requires KNOWING and LEARNING about all available resources and how they work with our body/mind.
  • Feb 6 2014: Doctors are people like you and I. Not saints. The organizations they work with are run by people. Not saints. Their reputations are determined by the experience of the local people not bureaucrats in Washington. With private health care you can choose to tell all of your friends of this organization`s shortcomings and never go there again You can seek legal redress for any wrongs against you through the courts. These options would be lost for you under government health plans..
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    Jan 25 2014: This question asks about ethics and not morals, and while they are both concerned with right vs wrong, ethics relate to formal rules provided by an official body of people, whereas morals refer to an individual's beliefs. In responding to this question, I think we should be clear as to whether we are thinking about morals or ethics.

    When hospitals dump its poor patients onto the streets early to save money (see http://www.alternet.org/news-amp-politics/ca-sues-nv-dumping-mental-patients and also http://www.latimes.com/local/lanow/la-me-ln-patient-dumping-skid-row-20140103,0,7977084.story), that clearly shows the incompatibility between healthcare and business ethics.

    The Hippocratic oath is one of the first and most famous formalizations of healthcare ethics. It says very clearly, "Do no harm." It says that unconditionally. Not "Do no harm if you can help it." If you're dumping patients on the street, you are doing harm.

    Sidetrack: I just read one translation of the original Hippocratic oath - fascinating! Here's the first paragraph - wow, how far is this from reality today?!

    "To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art — if they desire to learn it — without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but to no one else."

    [From "The Hippocratic Oath" by Ludwig Edelstein]
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    Jan 23 2014: At least most businesses know when they are pricing themselves out of the market. Almost everyone is already saying that healthcare is going to bankrupt America, yet, it seems no one from the industry is listening. Health insurance and healthcare costs have been out of control for a long time now. Insurance is intended to make people feel secure in the event of serious or long-term illness but, instead, it has put a lot of us to bankuptcy and misery. These days, it seems ethics and healthcare have become contradiction in terms.

    Hello, is there anyone listening ... someone who truly cares?
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    Jan 23 2014: Our healthcare systems appear as grotesque and ugly as any social circus may ultimately become.
    Presently some goodhearted teachers and doctors cannot change existing systems because they are already insiders, Servants, and must obey their mindless, controversial rules.

    We are missing basic ETHICS in all schools as well, demonstrating unethical methods in teaching. Schools are Taming students to think as conventional units to get them prepared to serve large systems, industries, institutions and dogmatic religious institutions. This popular sort of "education" commonly create natural resistance among some young students, especially most talented. Some of the students might become dangerously desperate, fighting agains the systems later on .

    Unfortunately they have no idea that there are some wiser, more peaceful ways.

    I must say that All Large Systems/industries, and everyone who serves them, as well as many of us, who are involved as victims are already Unethical in every way, even towards our own selves.

    My goal in writing this very post is to suggest how we might change this nightmarish industrial "culture".

    I'd like to engage someone in this thinking.

    Well, perhaps it would be impossible to change or fight against gigantic systems - this might be costly, time-consuming and even bloody. I honestly do not see any need to do so!!

    My main thought - we have to invent and practice new Independent Small Systems which would be purposely designed to serve real individuals with their individual needs. It would be a more natural approach, beneficial economically, educationally and health-wise.

    These small systems can be designed after the idea of a Sustainable innovative community, for instance, we can build them as small enchanting villages, with gardens, a small bakery, restaurant, library and perhaps a club/theater. Can a school or a hospital be built after an enchanting resort, while offering meaningful New jobs and traditions?
  • Jan 23 2014: Hi Vera

    Regarding: "There are no truly thoughtful ethics possible until Both sides are ethical."

    Can't say I agree, as I have always maintained my own ethics, regardless of others determination to sidetrack them.

    As to "Never treat others as you would like to be treated yourself - unless they agree to it first - because what "works" for you may be damaging for others"

    I could not agree more; and as to the Golden rule of ethics, I have always felt that perhaps it should have been stated differently, which now given "your version", would seem to work well together

    "Do for others, that which you would want them to do for you"

    But

    "Never treat others as you would like to be treated yourself - unless they agree to it first - because what "works" for you may be damaging for others"

    However my own feeling has always been; "Do not do unto others, that which you would not have them do unto you".

    And it follows; "If others undeservedly do unto you, that which you have not, and would not do unto them, it is not acceptable behaviour.

    Cheers Carl
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    Jan 22 2014: Hi Vera,
    the ethics of those 2 fields were only compatible in historical China where doctors were assigned certain areas and they got paid for those people that were not (!!!) ill.
    In modern systems a healthy person does not bring any income. Successful practitioners thereby would become at one point bankrupt and that has to be avoided by any means.
    Like a friend of mine in Copenhagen had a business selling herbs (Urte was his surname which actually means 'herb' in Danish). One day we got told that he went on a 'trip' and left while his shop got sold by a lawyer. I have never seen him again. Though this doesn't proof anything, one gets into thoughts about it especially if one hears similar stories from other friends.
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      Jan 23 2014: This is a very ill-some "healthcare" situation in which we are all involved, more or less. Here, in the USA, that "healthcare" system and its pretentious "humane philosophy" appears as grotesque and ugly as any social circus may ultimately become.

      Why do Medical institutions and their doctors honestly Love to keep their patients ALIVE, and its is important for them to look so "helpful and humane" to their patients ? They do this for the wrong, unethical, reason.

      You have answered this painful question boldly - if patients are gone, die too soon, or get really well , it'll be no work, and no income for those healthcare systems.

      Therefore, medications/procedures do Not Help us Get really Well - the main purpose is simple - to Keep us Alive as long as possible, absolutely addicted to pricy medications. While we live in misery and pain, we are not getting much of a clarity - we feed a bunch of systems simply by staying Sick!


      Thank you, Tobias.
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        Jan 23 2014: Hi Vera,
        here in Germany it’s not different. Doctors are helpful. But what they are doing is patchwork and this has to be recognized. They are very good at patching somebody up, but they don't handle the cause of it. This is needed if somebody e.g. has a car accident or something like it so he doesn't die before the cause can be handled. But then they also prevent the cause to be handled.
        I forgot to mention in my earlier post that this friend had managed to cure a case of Aids and couldn't keep his mouth shut. Though he insisted on his 'treatment' not to know what his customer’s problem is. He only recognized on symptoms what the body is missing and sold that to the person. But then this customer came back and told her success, that she through all medicine from the doctors away and only took what he gave her.
        There are few people that still belief after all these years and money spent 'on research' that cancer is not curable, but Aids is still hot business.
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          Jan 23 2014: Tobias, Very grateful for sharing with your your stories.
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    Jan 22 2014: There are no truly thoughtful ethics possible until Both sides are ethical.

    In this respect I'd like to suggest to Replace the Old Golden Rule with this New one

    "Never treat others as you would like to be treated yourself - unless they agree to it first - because what "works" for you may be damaging for others"
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    Jan 20 2014: I don't think so, I am not a doctor, but I have come to know a few. So a doctor to practice medicine as an individual has to have help to provide those services... Clerks, nurses, others, there are offices spaces, equipment and supplies, utility expenses, insurances, school loans, taxes... the list goes on. So, the doctor needs to know what his costs are to provide services and therefore his charges to patients to meet those costs. Then he has to be in some sort of price range with other doctors. This same process is as it is with all business.

    There is no question of ethics.

    If a doctor or any business man fails to give service for value received, he will soon be out of business.
  • Jan 19 2014: Here in Europe health is considered so important that the goverment of most countries are responsible of taking care of all their citizens, not only of those who are wealthy.
    Heath is not a business and never will be. Is a human condition previous to the economy.
    So YES: medical entrepreneurship is a nonsense.
    • Jan 19 2014: That has been my experiance as well. We moved from Holland to Canada and seeing the difference, I call it the medical industry.

      Added:
      In my opinion it is only the government that can set and maintain/enforce the rules.
      Most European governments are socialistic, which means people come first and have to be protected against companies. I don't know about other countries, but in Holland there are hardly any unions and practically never any strikes.
      Well, i'm talking about the situation of 30 years ago..
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    Jan 18 2014: Without the funding from business and tax payers, health care would be hard to have at all, because it is very costly to preform the treatment that is needed, and it require that you have at least some profit. It would be amazing, if money wasn't the thing that runs everything, and it would create less conflict through out the world, but as it is greed is the root of everything in this world, and if money was were not the root of it something else would be.
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    Jan 18 2014: Physician entrepreneurship by itself is not a bad thing. Abuse of it is such as physicians over utilizing their own labs, diagnostics, etc,. If a physician group owns a hospital who cares if they make the profit versus a big company?

    The big companies are really the issue - the boards and investors of these companies make far more than the physicians.

    Here is the financial statement from HCA
    http://phx.corporate-ir.net/phoenix.zhtml?c=63489&p=irol-reports
    I would bet their BOD (all 20 plus) are all millionaires. VERY FEW of the physicians I work with are, even after 20 years of practice.
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    Jan 18 2014: Excellent Topic. I look forward to the thoughts that will out. I suspect we may find our demons are very much alive and well and wish us well as we proceed with the business of evolving.
    What I currently think is that we would like to live in a world where ideals reign supreme, but frontal lobe thinking is so very energy consuming that once we stop 'envisaging' and resume 'living', we suddenly feel these primitive competitive, survival urges taking control of our billing software, management strategies, course attendances, and perk-related medical purchasing patterns.
    Every now and then Professor Frontal Lobe gets a little jolt from a good night's rest and resolves to mend his wicked ways, but watching cognitively challenged bling-decorated unreconstructed homo sapiens drive past you in wickedly expensive sports cars somehow results in an instant frontal lobotomy and .... kerrchinggg!
    Financially, we currently require far less as a profession than we generally earn. I feel it is only natural to see oneself as a human being first and behave as nature intended. To do this unrepentantly requires us to extend the same courtesy to everyone else. This is not a good recipe for the maintenance and growth of a civilised society. The problem is it needs to be addressed in all professions at all levels, and I understand, despite taking exception to, societies vilification of doctors.
    It is imperative we push ahead the humane agenda, insisting on fair and equitable healthcare sans the standard supermarket business model. But we must not just engage in the increasing practice of humane and fair healthcare delivery, but also actively protest at other sectors that fly under the radar yet remain sickeningly unethical due to the focus being on doctors.
    I refer to hospital and managed healthcare business-persons, politicians, pharmaceutical companies, subscription journals, academic researchers, etc.
  • Feb 17 2014: Quite simply cutting to the chase

    Is it wrong or right, to profiteer off the sick and dying, yes or no

    And putting aside all excuses and academic arguments, that is a matter of conscience; which quite clearly as the massive profits of the health Corporations serve to define, they do not possess
  • Feb 17 2014: The ethics of human being always are differs from human to human which means human ethics in health care or in business will be changed from one to another this will lead the concept of "Health Care For Patients" or "Business Of Health Care" are carried by human "Doctors, Nurses, ... and so on" will not be compatible in every and each case, so we are going to something like "Standards" to try to measure "The Ethics" scale between the business and the service.
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    Feb 17 2014: /
    Physician entrepreneurship is a contradiction of ethics orientations, not terms. Fairness or ethics for each has a different center of gravity even though ethics for each is basically the same thing: ethics, seeking to do the good, is about doing no harm and finding a healthy thriving outcome for patients for physicians, and at the same time in business it is doing the prime good of growing your business, profit margin, market share without unfairly disallowing others to be financially successful as well. A good business person does no harm as part of being a good person but that directive does not take center stage as a constant center of focus. If the patient is under my knife I am likely to be acutely aware of every choice in the light of possible harm. If I am removed from the patient, as a pharmaceutical business person, I may see opportunities to do good without seeing possible harm as clearly.

    Profitability may accompany but does not correlate with nor cause quality of care.

    good question
  • Feb 16 2014: Given current industry I don't think that there is an industry wide way to make this happen. Why is it that insurance companies get far different rates for medical services than someone with cash? I have seen multiple examples of people getting the short end of the stick when they are not covered while health insurance companies are getting price breaks all over the place. I understand the business aspect of this model and am intrigued by the cash flow but in an industry where compassion and humanity should be priority number one the profit margins seem to win out.
  • Feb 11 2014: Larry alludes to the difficulty in making the hard decisions needed to reform healthcare, whether private vs. public or corporate vs. entrepreneur. Defining the terms clearly demonstrates the impractically of expecting morality to dominate decisions regarding the allocation of any scarce resource.

    Our system's failure to keep costs competitive with other developed countries is the result of politically savvy 'haves' demanding Cadillac coverage even though it forced the cost of providing treatment for to large group of uninsured to spiral out of control. If we admit resources consumed must be more important than morality of allocation of service, tough rules must be agree upon ......... and enforced.
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    Feb 11 2014: I simply do not favor ethics as defined in an association of healthcare and business. Business sense of what is right and wrong seem to change as a matter of convenience. The goals of healthcare and business do not run parallel but you got to have a business presence in healthcare. I would favor physician entrepreneurship on a sound foundation of integrity clearly defined.

    eth·ic noun ˈe-thik

    : rules of behavior based on ideas about what is morally good and bad
    ethics : an area of study that deals with ideas about what is good and bad behavior : a branch of philosophy dealing with what is morally right or wrong: a belief that something is very important

    Full Definition of ETHIC
    1 plural but sing or plural in constr : the discipline dealing with what is good and bad and with moral duty and obligation
    2a : a set of moral principles : a theory or system of moral values —often used in plural but singular or plural in construction
    b plural but sing or plural in constr : the principles of conduct governing an individual or a group
    c : a guiding philosophy
    d : a consciousness of moral importance
    3 plural : a set of moral issues or aspects (as rightness)

    in·teg·ri·ty noun in-ˈte-grə-tē

    : the quality of being honest and fair
    : the state of being complete or whole

    Full Definition of INTEGRITY
    1: firm adherence to a code of especially moral or artistic values : incorruptibility
    2: an unimpaired condition : soundness
    3: the quality or state of being complete or undivided : completeness
  • Feb 10 2014: Does any healthcare program around the world deny joint replacement based on age or obesity etc.?
  • Feb 10 2014: Does any health care program limit the availability of artificial joints based on age?