Luxury Primary Care, Academic Medical Centers, and the Erosion奢侈初级保健学术医疗中心和侵蚀.ppt

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2018-06-30 发布于浙江
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Luxury Primary Care, Academic Medical Centers, and the Erosion奢侈初级保健学术医疗中心和侵蚀.ppt

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Luxury Primary Care, Academic Medical Centers, and the Erosion奢侈初级保健学术医疗中心和侵蚀

Doctor-Patient Communication re Out-of-Pocket Costs 15-20% of U.S. health care costs paid by patients out-of-pocket Physician-patient communication hindered by discomfort (patients) and perceived lack of time/nihilism (physicians) Relevant/important Ethical Distortions A sizeable minority of physicians admit to “gaming the system” by manipulating reimbursement rules so their patients can receive care the doctors perceive is necessary JAMA 2000;238:1858-65 Arch Int Med 2002;162:1134-9 Ethical Distortions ? of the public sanctions deception; ? of those who believe doctors have inadequate time to appeal coverage decisions Ann Int Med 2003;138:472-5 Am J Bioethics 2004;4(4):1-7 Conclusion:Erosion of Science LPC clinics offer care based on unsound science and non-evidence-based medicine Motives: Marketability Profitability Patient satisfaction/demand Potential for harm Conclusion:Erosion of Ethics The promotion of LPC clinics and the recruitment of wealthy foreigners by academic medical centers erodes fundamental ethical principles of equity and justice and promotes an overt, two-tiered system of health care Solutions Renounce the marketplace as dominant standard or value in medicine Divert intellectual and financial resources to more equitable and just investments in community and global health Solutions Close some academic medical centers Consolidate redundant educational and clinical programs in nearby teaching hospitals Solutions Reduce costs through Quality improvement programs Improved governance and decision-making Augmenting philanthropic contributions Increasing alliances with industry? Risks undue corporate influence on academic institutions’ agendas Solutions Improved training and practice of professionalism in medicine Heal schism between medicine and public health Service-oriented learning, research-based activist courses, volunteerism, political activism Solutions History and literature Role models/mentors Refocus ethics training Solutions Empathic and