Changing Health Care Systems from Ethical, Economic, and Cross Cultural Perspectives

This volume is the result of a conference sponsored by the Medical Alumni Association of the University of California, Davis and held in Sacramento, California, in January, 2000, The purpose of this conference was to examine the impact ofvarious health care structures on the ability of health care professionals to practice in an ethically acceptable manner. One of the ground assumptions made is that ethical practice in medicine and its related fields is difficult in a setting that pays only lip service to ethical principles. The limits of ethical possibility are created by the system within which health care professionals must practice. When, for example, ethical practice necessitates—as it generally does—that health care professionals spend sufficient time to come to know and understand their patients’ goals and values but the system mandates that only a short time be spent with each patient, ethical practice is made virtually impossible. One of our chief frustrations in teaching health care ethics at medical colleges is that we essentially teach students to do something they are most likely to find impossible to do: that is, get to know and appreciate their patients’ goals and values. There are other ways in which systems alter ethical possibilities. In a system in which patients have a different physician outside the hospital than they will inside, ethical problems have a different shape than if the treating physician is the same person. Health Care Systems And Ethics / Erich H. Loewy -- Facing Finitude In Health / Larry R. Churchill -- Health Care As A Right / Eike-henner W. Kluge -- The Oregon Health Care Plan Ten Years Later / Michael J. Garland -- A Mortgage On The House Of God / Perry A. Pugno -- Values In Medicine / Faith T. Fitzgerald -- Generational Conflicts And Their Impact On Thinking About The Healthcare System / Reimer Gronemeyer -- The Uninsured And The Rationing Of Health Care / David Chinitz And Avi Israeli -- Application And Implications Of Deontology, Utilitarianism, And Pragmatism For Medical Practice / Thor Cornelius -- The Old Ethics And The New Economics Of Health Care / Ben Rich -- Playing The Hmo Language Game / Roberta Springer Loewy And Erich H. Loewy -- Rationing Health Care In The United States And Canada / Walter Glannon -- Altering Capitation To Reduce The Incentive To Undertreat Patients Inappropriately / Rory Jaffe -- Cross Cultural Issues In Medicine / Jeanny K. Park -- Competing Interests In Pediatric Managed Care Settings / Susan E. Zinner-kemp. Edited By Erich H. Loewy And Roberta Springer Loewy. This Volume Is The Result Of A Conference Sponsored By The Medical Alumni Association Of The University Of California, Davis And Held In Sacramento, California, In January, 2000.--p. Xiii. Includes Bibliographical References And Index. This volume explores the impact of various health-care structures on the ability of health-care professionals to practice in an ethically acceptable manner. The limits of ethical possibility are created by the system within which health-care workers must practice: a system which mandates `getting to know your patient' but at the same time is restricted by financial concerns of a hospital, hospice, or a health management organization. This juxtaposition of the two conflicting concerns of a health-care worker is discussed in this volume. Among the issues addressed are: Is it possible to appreciate patients' goals and values within a system that mandates that only a short time be spent with each patient? Ethical issues raised in a system where patients are treated by different physicians inside and outside the hospital; Health-care ethics which deal with the concerns of those with access to care but are not concerned with the needs of those who lack access to care. This volume will be of interest to health-care ethicists, as well as health-care professionals Front Matter....Pages i-xvii Health Care Systems and Ethics....Pages 1-14 Facing Finitude in Health....Pages 15-27 Health Care as a Right....Pages 29-48 The Oregon Health Plan Ten Years Later....Pages 49-61 A Mortgage on the House of God....Pages 63-69 Values in Medicine....Pages 71-76 Generational Conflicts and their Impact on Thinking about the Healthcare System....Pages 77-84 The Uninsured and the Rationing of Health Care....Pages 85-99 Application and Implications of Deontology, Utilitarianism, and Pragmatism for Medical Practice....Pages 101-111 The Old Ethics and the New Economics of Health Care....Pages 113-126 Playing the HMO Language Game....Pages 127-141 Rationing Health Care in the United States and Canada....Pages 143-150 Altering Capitation to Reduce the Incentive to Undertreat Patients Inappropriately....Pages 151-161 Cross Cultural Issues in Medicine....Pages 163-171 Competing Interests in Pediatric Managed Care Settings....Pages 173-180 Back Matter....Pages 181-187