From service to commodity: corporization, competition, commodification, and customer culture transforms health care.
Corporate medical practice, a market economy, and a consumer culture are transforming health care. The service relationships of doctors with patients are now commodities. The doctor, directed by disease management protocols (to improve outcomes, reduce costs, and standardize care), is, in effect, providing programmed service commodities. In addition, medical-surgical specialties, now "packaged" for the care of body parts and conditions (as Breast, Stroke, Obesity, Aneurysm Centers), are also made service commodities, marketed by newspaper advertisements, TV, radio, and Internet to patient-customers in search of a healthy body. In sum, the promise of corporate practice in a competitive market economy is greater efficiency and productivity to reduce the costs of care that are a burden on industries and the state. Viewed from office encounters with patients, such transformation of services to commodities changes the doctor-patient relationship and the moral mission of care. (+info
American health care and the law--we need to talk!
The first section of this paper highlights five critical legal developments over the past half-century that, while not reflecting considered policy judgments about how the health care industry should operate, put American health care on some surprising paths. The second part then observes five fundamental policy contradictions discernible in health care law today, each of which reflects severe ambivalence in public attitudes toward health care. Although such confusion in the law is interesting in itself, the main purpose of the paper is to propose, in section three, the creation of a permanent high-level forum, perhaps in the Institute of Medicine, where leaders from the health and legal worlds could meet regularly with a view to helping the legal system resolve some of the policy confusion that exists. (+info
Metaphors, models and organisational ethics in health care.
Crucial to discussions in organisational ethics is an evaluation of the metaphors and models we use to understand the organisations we are discussing. I briefly defend this contention and evaluate three possible models: the current corporate model, an orchestrator model which puts hospitals in the same class as malls and airports, and a community model. I argue that the corporate and orchestrator model push to the background some important organisational ethics issues and bias us inappropriately towards certain solutions. Furthermore, I argue that the community model allows these to be more easily brought up. I also respond to the likely challenge that hospitals really are corporations by arguing that this is not relevant to evaluations of the appropriateness of the corporate model. (+info
A Marxian interpretation of the growth and development of coronary care technology.
Cost containment efforts will fail if they continue to ignore the structural relationships between health care costs and private profit in capitalist society. The recent history of coronary care shows that apparent irrationalities of health policy make sense from the standpoint of capitalist profit structure. Coronary care units (CCUs) gained wide acceptance, despite high costs. Studies of CCU effectiveness, using random controlled trials and epidemiologic techniques, do not show a consistent advantage of CCUs over non-intensive ward care or simple rest at home. From a Marxian perspective, the proliferation of CCUs and similar innovations is a complex historical process that includes initiatives by industrial corporations, cooperation by clinical investigators at academic medical centers, support by private philanthropies linked to corporate interests, intervention by state agencies, and changes in the health care labor force. Cost-effective methodology obscures the profit motive as a basic source of high costs and ineffective practices. Health-policy alternatives curtailing corporate involvement in medicine would reduce costs by restricting profit. (+info
A view from the bodies corporate. 2. OrthoWorld 2000 Ltd.
North London may seem an unlikely venue for a discussion about orthodontics which takes us as far afield as South Africa and the USA, but Edgware is where I find the head office of OrthoWorld. At the time of writing OrthoWorld are the only specialist body corporate in the UK. I am meeting Dr. Morris Fine, Director of Operations, a quietly spoken orthodontist - and still practising - with what turns out to be strong views and clear convictions. OrthoWorld had its beginnings 'four and a half years ago. Three of us started the venture, an orthodontist, an ex-dentist and a business man'. Morris Fine is the orthodontist, and the other two of the triumvirate are Jack and Reuben Shapiro respectively. Morris Fine tells that they 'had headed up a successful media company in South Africa before turning their attention to orthodontics in the UK.' (+info
Profit-seeking, corporate control, and the trustworthiness of health care organizations: assessments of health plan performance by their affiliated physicians.
OBJECTIVE: To compare the relative trustworthiness of nonprofit and for-profit health plans, using physician assessments to measure dimensions of plan performance that are difficult for consumers to evaluate. DATA SOURCE: A nationally representative sample of 1,621 physicians who responded to a special topics module of the 1998 Socioeconomic Monitoring System Survey (SMS), fielded by the American Medical Association. Physicians assessed various aspects of their primary managed care plan, defined as the plan in which they had the largest number of patients. STUDY DESIGN: Plan ownership was measured as the interaction of tax-exempt status (nonprofit versus for-profit) and corporate control (single state versus multistate health plans). Two sets of regression models are estimated. The dependent variables in the regressions are five measures of performance related to plan trustworthiness: two related to deceptive practices and three to dimensions of quality that are largely hidden from enrollees. The first set (baseline) models relate plan ownership to trustworthy practices, controlling for other characteristics of the plan, the marketplace for health insurance, and the physician respondents. The second (interactive) set of models examines how the magnitude of ownership-related differences in trustworthiness varies with the market share of nonprofit plans in each community. DATA COLLECTION: The 1998 SMS was fielded between April and September of 1998 by Westat Inc. The average time required for a completed interview was approximately 30 minutes. The overall response rate was 52.2 percent. PRINCIPAL FINDINGS: Compared with more local nonprofit plans, for-profit plans affiliated with multistate corporations are consistently reported by their affiliated physicians to engage in practices associated with reduced trustworthiness. Nonprofit plans affiliated with multistate corporations have more physician-reported practices associated with trustworthiness than do for-profit corporate plans on four of five outcomes, but appear less trustworthy than locally controlled nonprofits on two of the five measures. The magnitude of these ownership-related differences declines as the market share of nonprofit plans rises: for two of the five measures, ownership-related differences in practices related to trustworthiness are entirely eliminated when the nonprofits enroll more than 30 percent of the local market. CONCLUSIONS: The combination of for-profit ownership and multistate corporate control appears to consistently and substantially reduce physician-reported measures related to the trustworthiness of health plans. Because this is the fastest growing form of managed care, these results raise concerns about further erosion of trust in American health care. Preserving a substantial market niche for nonprofit plans appears to reduce this erosion and should be considered by policymakers as a strategy for restoring trust in the health care system. (+info
Gifts and corporate influence in doctor of pharmacy education.
OBJECTIVES: To explore the nature of corporate gifts directed at PharmD programs and pharmacy student activities and the perceptions of administrators about the potential influences of such gifts. METHODS: A verbally administered survey of administrative officials at 11 US colleges and schools of pharmacy was conducted and responses were analyzed. RESULTS: All respondents indicated accepting corporate gifts or sponsorships for student-related activities in the form of money, grants, scholarships, meals, trinkets, and support for special events, and cited many advantages to corporate partner relationships. Approximately half of the respondents believed that real or potential problems could occur from accepting corporate gifts. Forty-four percent of respondents agreed or strongly agreed that corporate contributions could influence college or school administration. Sixty-one percent agreed or strongly agreed that donations were likely to influence students. CONCLUSIONS: Corporate gifts do influence college and school of administration and students. Policies should be in place to manage this influence appropriately. (+info
Corporate influences on epidemiology.