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Prospective payment and medical ethics.

C E Begley

    The Journal of Medicine and Philosophy
    |May 1, 1987
    PubMed
    Summary

    Prospective payment may create ethical conflicts for physicians by incentivizing reduced patient care. However, evidence on its impact is uncertain, and ethical issues arise from physicians

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    Area of Science:

    • Medical Ethics
    • Health Economics
    • Healthcare Policy

    Background:

    • Prospective payment systems (PPS) are common in healthcare reimbursement.
    • Concerns exist regarding potential ethical conflicts for healthcare practitioners under PPS.
    • A key concern is the economic incentive for physicians to reduce services provided to patients.

    Purpose of the Study:

    • To analyze the ethical implications of prospective payment for physicians and healthcare practitioners.
    • To critically evaluate the argument that PPS creates ethical conflict by incentivizing reduced patient care.
    • To propose an alternative framework for ethically evaluating PPS.

    Main Methods:

    • Review of available evidence on the effects of different prospective payment schemes.
    • Analysis of the dual role of physicians as agents and service suppliers.
    • Ethical evaluation focusing on the impact of incentives on physician decision-making.

    Main Results:

    • Evidence suggests uncertainty regarding the actual incentives created by PPS and their effect on practice patterns.
    • Ethical conflict is inherent in the dual role of physicians, existing under various payment mechanisms.
    • The incentive to provide less care under PPS may not necessarily lead to adverse effects compared to other systems.

    Conclusions:

    • The ethical evaluation of prospective payment should focus on its potential adverse effects on physician decisions relative to other payment models.
    • Physicians' dual role as agents and suppliers is a primary source of ethical conflict, irrespective of payment system.
    • Further research is needed to clarify the impact of PPS on optimal healthcare practices and patient outcomes.
    Keywords:
    Analytical ApproachHealth Care and Public HealthPhilosophical Approach

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