Nurlan Abdullayev December 2017
English group 2012
How medical professionals are and should be paid?
1. Introduction
Dedicated individuals who require least direction and oversight to perform their duties, they are medical professionals. They are tightly bound to their code of ethics and their fiduciary responsibility to perform well and provide quality services to their clients. It is believed that health care providers are the type of professionals that embody such beliefs and behaviour.Medical professionals are uncommonly found committing intentional mistakes or causing harm to their clients or their environment, but errors do occur
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George Bernard Shaw—a great polemicist of the capitalist enterprise—once complained of the fact that “any sane nation, having observed that you could provide for the supply of bread by giving bakers a monetary interest in baking for you, should go on to give a surgeon a pecuniary interest in cutting off your leg, is enough to make one despair of political humanity." Following Shaw, there have been a long string of harsh critics of the dominant fee-for-service payment model in medicine. Buttressing these critics have been empirical studies showing that physicians, on average, respond to the fee-for-service incentive as expected, by providing more services, including some that may be of marginal value, useless or even harmful. The opposite incentive however—paying physicians more for doing less—has an equally fervent set of critics. When capitated payment models came to the fore in the 1990s, both doctors and patients rose up in protest. Creating an incentive system in which physicians might earn more by withholding useful care was widely seen as a frontal assault on traditional medical professional values. Doctors who might in any way consider promoting the interests of insurers rather than patients have been called “Schmoctors” among many other, mostly unprintable, epithets. In the meantime, US health-care costs are dramatically higher, and rising faster, than costs in other countries. The …show more content…
But these are professional ideals; physicians encounter many challenges in living up to them. Not the least of these challenges is that payment systems, as noted above, can create incentives for unethical behavior by setting the physician’s pecuniary interests in opposition to high-quality care. In fact, given the perverse incentives in physician payments, sometimes “professionalism” has become almost synonymous with acting to protect one’s patients at financial cost to oneself. While altruism is an important virtue, this view of professionalism is disconcerting, first because it is unrealistic to expect physicians to consistently and indefinitely do things for which they are punished. Second, it is an incomplete, and disheartening, view of professionalism that boils down simply to selfsacrifice. Professionalism entails other important values as well, including the existence of a collegial community, selfregulation and commitments to science, teaching and quality improvement.
Pay-for-performance, meanwhile, aims to pay doctors more when they deliver higher-quality care. In theory, therefore, payfor-performance will align both financial and professional incentives towards quality, which should promote professional
Chasing Zero is a documentary which was meant to both educate the viewer on the prevalence of medical harm as well as to enlighten both the public and health care providers on the preventability of these events (Discovery, 2010). The documentary expounded on the fact each year more people die each year from a preventable medical error than die due to breast cancer, motor vehicle accidents or AIDS (Institute of Medicine, 1999). Medical harm can result from adverse drug events, surgical injuries, wrong-site surgery, suicides, restraint-related injuries, falls, burns, pressure ulcers and mistaken patient identities (Institute of Medicine, 1999). Incidences of medical error have been reported in the media for many years. The most startling revelation in the documentary is how common medical errors are and how preventable they are.
113-117. Retrieved April 21st, 2011 from website: http://secure.cihi.ca/cihiweb/products/physicians_payment_aib_2010_f.pdf. D. Squires, The Commonwealth Fund, and others, International Profiles of Health Care Systems, The Commonwealth Fund, June 2010. Retrieved April 20th, 2011 from website: http://www.commonwealthfund.org//media/Files/Publications/Fund%20Report/2010/Jun/1417_Squires_Intl_Profiles_622.pdf. Johns, M. L. & Co. (2010). The 'Standard' of the 'Standard'.
I have been aware of medical errors for some time now. While in nursing school I have heard many stories from classmates and instructors of instances where people they knew, or loved ones had been either harmed or died because of a medical error. I have had experiences with medical errors. When I was in the hospital for the birth of my first child, the nurse that came to change out my IV bag did not check the
In “When Doctors Make Mistakes,” Atul Gawande flatly states that “all doctors make terrible mistakes” (657). In doing so he explains certain failures and errors that doctors commit that led to situations that in danger patients. Gawande first mentions a study that found “…nearly
Providers must act in the best interest of the patient and their basic obligation is to do no harm and work for the public’s wellbeing. A physician shall always keep in mind the obligation of preserving human life. Providers must communicate full, accurate and unbiased information so patients can make informed decisions about their health care. As a result of their recommendations, providers are responsible for generating costs in health care but do not generate the need for those expenses. Every hospital has both an ethical as well as a legal responsibility to provide care, even if the care may be uncompensated.
Just as the economy travels through its cycles, from bear to bull and back again, so does the number of doctors in the country. In the 1960s, the government began an attempt to create more physicians using various methods. One such method was to reward medical schools for training a certain number of doctors (Bernstein 1013). This would give the medical schools an incentive to accept more students and to allow the students to fully graduate and go on to attend residency programs. Another such method was to give a monetary reward to residency programs for providing graduate medical education. This totaled approximately $7 billion, a sum large enough to “pay the tuition and living expenses of every medical student in the United States” with a large portion left over as well (Bernstein 1013). Because of these actions taken by the government, many more physicians were created, causing a physician surplus throughout the 1980s to the late 1990s, although this claim was based on ...
Professionalism is an adherence to a set of values comprising both a formally agreed-upon code of conduct and the informal expectations of colleagues, clients and society. The key values include acting in a patient's interest, responsiveness to the health needs of society, maintaining the highest standards of excellence in the practice of medicine and in the generation and dissemination of knowledge. In addition to medical knowledge and skills, medical professionals should present psychosocial and humanistic qualities such as caring, empathy, humility and compassion, as well as social responsibility and sensitivity to people's culture and beliefs. All these qualities are expected of members of highly trained professions.
Hospital medical errors can involve medicines (e.g., wrong drug, wrong dose, bad combination), an inaccurate or incomplete diagnosis, equipment malfunction, surgical mistakes, or laboratory errors. High medical error rates with serious consequences occurs in intensive care units, operating rooms, and emergency departments; but, serious errors that harmed patients may have prevented or minimized. Understand the nature of the error
In sum, America needs to reevaluate the status quo surrounding medical care. It is becoming increasingly apparent that the current model only benefits a select few and causes insufferable costs for the rest of the world. If there is no reform for these issues, money will continue to be siphoned directly into the pockets of large, for-profit companies that benefit from the strife of
Healthcare professionals: Seek the beneficence and nonmaleficence of the patient by giving them truthful and accurate documented services and charging fair legal rates according to standard industry protocols that are reproducible, verifiable, and truthful for the services
Since patients only need to pay nominal fees in the public sector and the treatment cost might be expensive in the private sector, patients might provide extra money or benefits to avoid being pushed into the private sector by moonlighters. After receiving extra money from patients, some so-called weak moonlighters might increase their quality of care to the recommended care level in the public sectors while so-called strong moonlighters still choose to only provide minimum quality in the public sector and refer their patients to the private sectors. Therefore, based on the definition of moonlighters proposed by Biglaiser and Ma, we can categorize doctors into three groups: dedicated doctors who always provide recommended quality of care without any incentives offered by patients; weak moonlighters who increase their quality of care after being incentivized by patients; and strong moonlighters who only provide minimum quality of care in the public
Keeping patients safe is essential in today’s health care system, but patient safety events that violate that safety are increasing each year. It was only recently, that the focus on patient safety was reinforced by a report prepared by Institute of medicine (IOM) entitled ” To err is human, building a safer health system”(Wakefield & Iliffe,2002).This report found that approx-imately 44,000 to 98,000 deaths occur each year due to medical errors and that the majority was preventable. Deaths due to medical errors exceed deaths due to many other causes such as like HIV infections, breast cancer and even traffic accidents (Wakefield & Iliffe, 2002). After this IOM reports, President Clinton established quality interagency coordination task force with the help of government agencies. These government agencies are responsible for making health pol-icies regarding patient safety to which every HCO must follow (Schulman & Kim, 2000).
It is shocking to know that every year 98000 patients die from medical errors that can be prevented(Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. (Eds.), 2000). Medical errors are not a new issue in our healthcare system; these have been around for a long time. Hospitals have been trying to improve quality care and patients safety by implementing different strategies to prevent and reduce medical errors for past thirty years. Medical errors are the third leading cause of death after heart disease and cancer in America (Allen, 2013). In addition medical errors are costing our healthcare system an estimated $735 billion to $980 billion (Andel, Davidow, Hollander, & Moreno, 2012).
With the explosive growth in the 1990s of managed care that were sold by health insurance companies, physicians were suddenly renamed “providers.” That began the deprofessionalization of medicine, and within a short time patient became “consumers” (The New York Times). The shifts in American medicine are clearly leading to physicians' losing power, which results in deprofessionalization. The subsequent deprofessionalization of physicians should not surprise Americans. Although many people spend time and effort evaluating the present state of medicine, they fail to integrate an important piece of information: physicians and sociologists predicted all of today's events more than ten years ago (Hensel, 1988).
The cost of US health care has been steadily increasing for many years causing many Americans to face difficult choices between health care and other priorities in their lives. Health economists are bringing to light the tradeoffs which must be considered in every healthcare decision (Getzen, 2013, p. 427). Therefore, efforts must be made to incite change which constrains the cost of health care without creating adverse health consequences. As the medical field becomes more business oriented, there will be more of a shift in focus toward the costs and benefits, which will make medicine more like the rest of the economy (Getzen, 2013, p. 439).