Medicine, Money, and Morals

Medicine, Money, and Morals : Physicians' Conflicts of Interest

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Physicians' conflicts of interest are rampant in the American medical community. Today it is not uncommon for doctors to refer patients to clinics or labs in which they have a financial interest; for hospitals to offer incentives to physicians who refer patients to them; or for drug companies to provide lucrative give-aways to entice doctors to use their "brand name" drugs. In Medicine, Money, and Morals, Marc A. Rodwin examines these conflicts of interest, explains why the profession has failed to cope successfully with them, and shows how they have become worse over the past century. He looks at how - in response to dubious practices of the past such as fee-splitting, physicians' ownership of medical facilities, drug dispensing, and the like - the profession developed ethical guidelines but was unable to enforce them. He shows how current public policies and institutional practices now offer doctors financial incentives to promote various goals at odds with the interest of patients. These policies and practices, Rodwin writes, tie doctors' personal financial well-being to medical care providers - hospitals, medical suppliers, and pharmaceutical firms - and also to insurers and other third party payers. Doctors today are tempted to think of how they will fare financially by making particular clinical decisions. As a result, patients often receive too many or too few medical services, or the wrong kind, sometimes undergoing painful, dangerous, or unnecessary medical procedures. Rodwin shows what can be learned from the way society has coped with conflicts of interest involving other professionals (lawyers, government officials and financial professionals), all of whom are held to higherstandards of accountability than doctors. He explains, too, why simplistic solutions such as public disclosure of conflicts or government ownership of health services won't work. He offers examples of what can be done to help reduce these problems by regulation, tax policy, audi
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Product details

  • Paperback | 430 pages
  • 136.7 x 204 x 24.4mm | 378.21g
  • Oxford, United Kingdom
  • English
  • Reprint
  • halftones, tables
  • 0195096479
  • 9780195096477

Back cover copy

A theoretically sophisticated, empirically detailed account of conflicts of interest and the physician's role...An impressive piece of work- broad in its scope, clear in its objectives, confident of its finding, certain of the policy implications.
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Table of contents

1. The Problem and the Profession's response: Physicians conflicts of interest; The medical profession's response ; 2. Current Problems and Institutional Responses: Incentives to increase services: The range of practices; The dangers of incentives to increase services and the ineffectiveness of current responses; Incentives to decrease services in HMOs and hospitals; The dangers of incentives to decrease services and the ineffectiveness of current responses; ; 3. Inferences for Policy: Fiduciary theory and the professions: Regulation of civil servants, business professionals and lawyers; What needs to be done? ; 4. Appendices
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Review quote

This book should provoke critical reflection on the current reforms in health care. * Malcolm K. Benson, Oxford Radcliffe Hospital, Journal of Medical Ethics * Medicine. Money, and Morals is about the effects of financial incentives on medical practice. It is not the first work to address these questions ... But it is the best ... the book clearly will be of great use to whose who have professional reasons to be interested in, for example, the joint venture safe harbors under Medicare fraud and abuse regulations or the effects of physician risk sharing on the quality of care. It deserves an even broader audience. This book
is an important start to understanding the fundamental implications that financial incentives and decisions about the shape of the financing system hold for the ties that bind doctors and patients. Anyone practicing medicine or studying the health care system would benefit from its description and
its analysis. * Henry T. Greely, Stanford Law School, JAMA, June 1994, Vol. 271, No. 24 * The most important contribution of the book ... is the practical nature of the solutions it offers ... it is a major contribution to the legal, ethical, and health policy literature. One hopes that it will be read carefully by those currently seeking to redesign our health care system. * Timothy Stoltzfus Jost, Ohio State Unievrsity, Journal of Health Politics, Policy and Law, 1994 (Spring) 19(1) * Marc Rodwin's Medicine, Money and Morals provides a thorough, thoughtful, and practical analysis of this important problem. Rodwin - canvassed not only the academic, trade, and popular literature on the subject but also comments on providers on proposed federal rules, investment prospectuses for medical joint ventures, and kickback trial records to come up with the most exhaustive catalogue available of the scope of the conflict-of-interest problem. The analysis and
recommendations that follow make this book a must-read for those seeking to understand the current health care crisis. The strength of Rodwin's book are many. It is well written and easily accessible to persons lacking expertise in fraud and abuse law. This is continued below as it is more than 1000
characters. Rodwin's book is a "must" for anyone concerned with the organisation of the health service, as well as for any academic. The book presents an extraordinarily well-marshalled account of the types of conflict of interest to which physicians in the United States are prone. * Times Higher Supplement * impressively documented and detailed book * Francis H. Miller, Boston University, Indiana Law Review, Volume 27, Number 3, 1993 * Rodwin ... painstakingly scrutinises medical practice in the USA, giving a fascinating insight into the dilemmas facing patients when medical decisions can affect the doctor's economic wellbeing ... the success or otherwise of a practice, or the survival of a hospital ... for those familiar with US practice the detail will be compelling. * Joe Collier, St George's Hospital Medical School, London, The Lancet, Vol. 343, June 1994 * admirably researched and cogently argued book ... His findings and recommendations must be pondered by everyone concerned with quality in health care . * David J. Rothman, Columbia University, Science, Vol. 262, 1993 * excellent book. probably the first systematic examination of financial conflicts of interest in the medical profession.
If health care reform is to achieve the worthy goals of better ensuring the practice of cost-effective medicine and increasing public confidence in the health care system, it will have to come to terms with the persistent and ingrained conflicts of interest so splendidly articulated by Professor Rodwin. * New England Journal of Medicine, Volume 329, September 16, 1993 Number 12 * excellent book. If health care reform is to achieve the worthy goal of better ensuring the practice of cost-effective medicine and increasing public confidence in the health care system, it will have to come to terms with the persistent and ingrained conflicts of interest so splendidly articulated by Professor Rodwin. * New England Journal of Medicine * admirably researched and cogently argued book.
His findings and recommendations must be pondered by everyone concerned with quality in health care. * Science Vol 262,15 October 1993. * A convincing case for resolving financial conflicts of interest that compromise the judgment of doctors and that bias the clinical choices they make. A constructive contribution-featuring a well-presented analysis as well as concrete proposals for reform-to the ongoing discussion of our national health-care crisis. * Kirkus Reviews * a well documented closely argued book ... He makes clear and manageable recommendations for improvement, * Scimed Publicity *
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About Marc A. Rodwin

Marc A. Rodwin, Associate Professor of Law and Public Policy at Indiana University, Bloomington, has an M.A. from Oxford University, a J.D. from the University of Virginia Law School, and a Ph.D. from Brandeis University.
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