The Ethical Financial Dilemma Physicians Face in
Medicine

Devon Updegraff-Day

Health Administration Law & Ethics

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A course assignment presented to
the College of Graduate Health Studies in partial fulfillment of the
requirements for the Doctor of Health Science Degree A.T. Still University

January 27, 2018

The Ethical Financial Dilemma Physicians Face in
Medicine

 

Introduction

 

            Physicians today need to be prepared
to face ethical dilemmas throughout their careers. Unfortunately, ethical
conflicts and dilemmas are not always clear cut or black and white.  As the medical industry continues to evolve
and insurance reimbursement models for medical services change with increasing
regulations, doctors are having to find new ways to stay financially afloat (“5 Trends in Healthcare,” 2017). The financial burden physicians
face can cause ethical conflicts in consequential ethics, patient fairness and medical
honesty when treating both insured and non-insured patient.

Discussion

            Those who choose to practice
medicine, agree at graduation from medical school to meet the standard code of
ethics when treating patients.  The
Hippocratic Oath that most medical providers swear to and hold sacred has been
the moral and ethical model for physicians since the time of Hippocrates (“Definition of Hippocratic Oath,” 2016). Physicians must approach
each patient with consequential ethics and provide beneficial medical care with
beneficial outcomes for the patient (Pozgar, 2016).  Physicians must approach each patient with
fairness and without personal bias, discrimination or judgement (Pozgar, 2016).
Physician must also provide medical care to patients with honorable motives and
maintain an honest and truthful character that patient can rely on (Pozgar,
2016). These ethical expectations can become blurry when experiencing
financially pressure and burdens. Physicians may find themselves unknowingly
breaking their Hippocratic oath in order to stay in business and maintain their
practice. Rising overhead, changes in insurance payment models and the high
cost of upgrading to electronic health records have pressured physicians to
find various ways to increase practice income (Mathews, 2012).  

            Unnecessary medical tests or
excessive medical exams can be used by physician as more of a financial gain rather
than used to benefit the actual patient. Over $200 billion is spent on
unnecessary medical cost in one year and approximately 21% of current medical
care is consider unnecessary (Szabo, 2017).  Physicians who order unnecessary tests on
patients for financial gain are not only contributing to the sky rocketing
costs in medicine but may also be causing harm to their patient resulting in a
conflict in consequential ethics (Szabo, 2017; Pozgar, 2016). Patients may
potentially suffer from needless pain and suffering from meaningless bloodwork
or unwarranted biopsies and may be exposed to avoidable radiation with frequent
x-ray or CT scans (Szabo, 2017).  This exposure
to needless radiation or pain, damages patient trust and weakens the
physician’s honorable and trust worthy moral character (Pozgar, 2016). Physicians
who order excessive tests with the knowledge of their lack of benefit may not
always be pushing ethical boundaries but merely protecting themselves from
frivolous liability (Szabo, 2017).  Many
physicians today fear being sued and are pressured to protect themselves by
ordering additional test that may not be always necessary for diagnosis or
treatment (Szabo, 2017). Physicians need to work to find balance between maintaining
their medical oath, providing appropriate patient care while at the same time protecting
themselves from trivial lawsuits.

            Ordering an excessive number of
tests for financial gain is not the only ethical dilemma physicians face when
practicing medicine.  Providing equal
care for both the insured and non- insured patient can be an ethical challenge
of bias and unfair medicine.  A 2006
study of twenty- five primary care physicians found that 90% admitted to
adjusting their medical care to patients based on insurance status (Jain,
2008).  Some physicians have acknowledged
that they personally spend less time with non-insured patients and admit to
scheduling non-insured patient surgeries at the end of the day so they are the
first to get bumped when the schedule runs late (Jain, 2008).  Non-insured patients have also been found to
receive less preventative care medicine when compared to insured, receiving
less routine bloodwork, cancer screenings and fewer recommended vaccines (Jain,
2008).  Doctors should always take cost
into consideration especially for those paying out of pocket, but an open and
honest discussion with patients directly can help minimize bias or unintentional
discrimination. Additional possible solutions for non-insured patients could be
to offer them reasonable payment plans to help cover cost of routine medical
exams and preventative medicine allowing medical care to become more affordable
(Jain, 2008). 

           

            Direct, open communication is always
crucial to maintaining a trustworthy relationship with patients, but additional
policies and solutions help to reduce medical financial fraud and insufficient
care for the non-insured. Recent insurance policy changes in healthcare have
begun the process of reducing the number of unnecessary tests and move toward a
more equal approach to medicine.  Traditionally, healthcare providers are paid
for their medical services through a fee-for-service model which simply pays
for tests and procedures regardless of necessity (“5 Trends in Healthcare,” 2017). Today more insurance companies are
moving away from the fee-for-service model and moving toward a bundled payment
model (“5
Trends in Healthcare,” 2017). The
bundled payment model pays providers an upfront payment for a single period of
care reducing the expense of unnecessary tests (“5 Trends in Healthcare,” 2017). Currently, the bundled payment
model works well for standard procedures but can become difficult with primary
care physicians caring for complex medical cases (“5 Trends in Healthcare,” 2017). Other possible models that have
proven to reduce unnecessary medical costs is the Choosing Wisely campaign,
currently being used at Cedar Sinai Hospital. Through the Choosing Wisely, doctors
are alerted when a medical test that does not comply with the 18 choose wisely
recommendations; as a result, Cedar Sinai has reduced spending by $6 million in
the first year (Terhune, 2017).  The
ultimate solution may be a combination of everything. Balancing between both fee-for-service
model and the bundled payment model in addition to implementing various
policies that help guide physicians into making wise medical and financially
responsible choices.

Conclusion

 

            Ethical conflicts in medicine will
always occur in some fashion, but the financial ethical dilemma physicians face
today is avoidable.  Most physicians hold
their Hippocratic oath as the highest priority when treating their patients.
But for the few physicians that abuse the fee-for-service model and
intentionally order medical test to make profit can be deterred through changes
in the insurance payment model and incorporating new hospital campaigns that
help guide physician on what is appropriate testing.  Open communication with patients about preventative
medical costs and offering patients affordable payment options can help reduce
discrimination between the insured and non-insured. The healthcare system is
far from perfect but with some moderate adjustments it can be significantly
improved for all.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

References

            5 Trends in Healthcare Reimbursement. (2017,
April 02). Retrieved January 23, 2018, from
http://bhmpc.com/2014/09/5-trends-healthcare-reimbursement/

Definition of Hippocratic Oath. (2016, May 13).
Retrieved January 23, 2018, from http://www.medicinenet.com/script/main/art.asp?articlekey=20909

Jain, M. (2008, October 14). Equal Treatment
for the Uninsured? Don’t Count on It. The Washington Post.
Retrieved January 23, 2018, from http://www.washingtonpost.com/wp-dyn/content/article/2008/10/10/AR2008101002679.html

Mathews, A. W. (2012, March 16).
Why America’s Doctors Are Struggling To Make Ends Meet. The Wall Street Journal. 
Retrieved January 23, 2018, from https://www.wsj.com/articles/SB10001424052970204603004577271340816194320

Pozgar, G. D. (2016). Legal and ethical issues for health professionals (4th ed.). Burlington, MA: Jones &
Bartlett Learning.

            Szabo, L. (2017, October 23). How unnecessary
tests, scans, procedures and surgeries are affecting your patients. Healthcare
Finance. Retrieved January 22, 2017, from http://www.healthcarefinancenews.com/news/how-unnecessary-tests-scans-procedures-and-surgeries-are-affecting-your-patients

Terhune, C. (2017, May 24). The $200 billion
perils of unnecessary medical tests. Retrieved January 22, 2018, from https://www.pbs.org/newshour/health/200-billion-perils-unnecessary-medical-tests