Alexander's dilemma: conflict between professionalism and entrepreneurialism in health services administration

Potential philosophical and socioeconomic conflicts between entrepreneurialism and the mandate of community service are raising difficult questions for health care administrators today. As those involved in the quickly evolving health care field examine the knowledge base and future direction of their professional roles, ways must be found to reconcile the increasing economic pressures on the industry with the values traditionally associated with high-quality personal care. This article describes some of the ethical problems inherent in a health care system that is being run increasingly like a purely economic enterprise, and cites historical and sociological sources indicating that entrepreneurialism cannot be the primary motivation in the field of health care. The author suggests that "outsider entrepreneurialism" and self-interest have no place in health care delivery, and that the public trust and the professional identity of the health administration field depend upon a successful blend of personal social responsibility and effective and efficient community service.